Ormsby Lodge

Ormsby Lodge is a care home. It is registered to provide accommodation and personal care for up to 10 people. It predominantly supports people living with a learning disability, autism or mental health needs. At the time of the inspection there were 8 people living at the service. The service is a large house in the heart of Southsea, close to local amenities. It has been adapted to suit the needs of the people living there.

People’s experience of using this service and what we found

People and their relatives told us they felt staff provided safe care and support. We found improvements had been made, which meant people received safe care from a staff team that knew them well.

Medicines were managed safely by trained staff. Medication administration records (MARs) were completed and regularly audited to identify any areas for development and improvement. Staff had access to medicines policies and procedures as well as best practice guidelines. Although the registered manager regularly observed staff administering medicines, formal records to check staff were competent were not being made. We have made a recommendation about this.

The provider and registered manager had systems and processes to monitor quality within the home. They were working to further improve the effectiveness of the monitoring systems to ensure they were robust in identifying where action was required.

Staff had received training in safeguarding and understood their responsibilities. People were protected from abuse and there was an open culture, where staff supported people to have regular conversations where they could express any concerns.

Recruitment processes were safe to ensure only suitable staff were employed. Where agency staff were used, these were regular and knew people well. There were enough staff to meet people’s needs and support them with activities of their choice.

Infection, prevention and control processes and up to date policies were in place and people’s friends and relatives could visit them when they wished to.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The size of the service had not been designed in line with the principles and values that underpin Right support, right care, right culture, as the number of people living at the home exceeded the recommended number of six. However, people were supported to live as full a life as possible and achieve the best possible outcomes. The outcomes for people using the service promoted choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to be involved in decisions about their own lives and gain new skills.

Right Support: People were supported to make choices about how they lived their life and had the right support to achieve this. People had lived in the service for many years and were a close group of people who knew each other well and were happy living together.

Right Care: Staff clearly knew people well. Although recruitment was ongoing, where agency staff were used, they were supported to get to understand people’s needs and how to meet them. This meant people received person-centred support from staff who knew them well and respected their privacy and dignity.

Right Culture: The values of the registered manager and provider were embedded in the staff team. This meant the values, attitudes and behaviours of care staff supported people to be confident and empowered in living in the community.

The registered manager understood their regulatory responsibilities and shared information with stakeholders in a timely way. There was a complaints procedure and people were supported to express their views.

The staff team were positive about their roles and felt supported by the registered manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 December 2019). We found breaches in regulations in relation to safe care and treatment, duty of candour and governance. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 31 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance. We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last full comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ormsby Lodge on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about following best practice to assess staff competency to safely administer medicines.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ormsby Lodge is a care home. It is registered to provide accommodation and personal care for up to 10 and predominantly supports people living with a learning disability, autism or mental health needs. At the time of the inspection there were 10 people living at the service. The service was a large house in the heart of Portsmouth, close to local amenities. It had been adapted to suit the needs of the people living there.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance as the number of people living at the home exceeded the recommended number of six. However, people were supported to live as full a life as possible and achieve the best possible outcomes. The service met the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service and what we found

People’s safety was compromised as best practice guidance was not always followed in respect of the control of infection and the management of people’s medicines.

Risks to people’s health and safety were not always assessed and managed appropriately.

The provider was not aware of, and had not followed, procedures to ensure they were open and transparent when people came to harm.

Information about the health of staff was not sought to consider whether they had any conditions that might affect their suitability for employment. However, the registered manager addressed this during the inspection.

The provider had not displayed their previous performance rating on their website, but they addressed this immediately.

People’s end of life wishes and preferences had not been discussed with them or those close to them. However, the registered manager had plans to address this.

Quality assurance procedures were not adequate and had not identified any of the concerns we found during the inspection. There was little evidence of a culture of continuous learning.

However, people were protected from the risk of abuse. Their rights and freedom were also protected.

Staff were skilled and knowledgeable. They supported people to be as independent as possible and to achieve positive outcomes.

People’s privacy was protected and staff treated them in a kind and caring way, according to their diverse needs.

Staff used appropriate tools and techniques to communicate with people.

People’s nutritional needs were met and they were supported to access healthcare services when needed.

Care plans were developed with people and their families and were reviewed regularly.

There was an accessible complaints procedure in place and people felt able to raise concerns.

People and their families spoke positively about the management and felt engaged in the way the service was run.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 8 November 2018).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ormsby Lodge on our website at www.cqc.org.uk.

Enforcement

At this inspection, we identified breaches of regulations in relation to safe care and treatment, duty of candour and quality assurance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan and meet with the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 25 and 26 September 2018. This was the first inspection of Ormsby Lodge since a change of ownership and registration.

Ormsby Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ormsby Lodge offers accommodation and support for up to ten people with a learning disability. At the time of our inspection there were no vacancies.

The care service has been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not always administered safely. Risk assessments did not always promote positive risk taking and did not always result in the least restrictive course of action. Some risks had been identified but there was not a risk assessment in place. People were not always protected from the risk of infection because the water system had not been checked for Legionella.

The service was not working within the principles of the Mental Capacity Act 2005. People’s privacy and dignity was not always respected. There was not a system of annual appraisal and regular supervision in place for staff. The governance and leadership did not support the delivery of a high-quality service. The auditing system was not robust and did not identify the concerns we found during the inspection.

The provider had policies and procedures in place designed to protect people from abuse. People’s needs were met by suitable numbers of staff. Accidents and incidents were recorded appropriately and kept under review by the registered manager.

People were supported by staff who had access to relevant training. People were involved in menu planning at the weekly meeting. The staff team and registered manager worked in partnership with other services and organisations. People had access to healthcare professionals and staff supported people to attend appointments.

People were treated with kindness and respect and during the inspection we observed staff interacting positively with people. Staff communicated with people using communication methods they understood, such as Makaton, where people used this. People were encouraged and supported to join local self-advocacy groups.

People had individual support plans in place which gave staff detailed guidance around personal care, communication needs People were involved in creating their support plans and accessed them when they wished to. People were supported to maintain relationships which were important to them, such as family members. People enjoyed a range of activities and interests within the home, at the day centre and in the local community the provider had a complaints procedure in an easy read format.

The registered manager promoted a culture which was open and inclusive.

We identified breaches of Regulations 10, 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.