Archived: Cawston Lodge

Cawston Lodge is a residential care home providing personal care and accommodation for up to 36 people. At the time of the inspection the home had been open six months and was supporting 17 people.

The home was a purpose-built bungalow. Not all of the home was open for use and sections of it could not be accessed for safety reasons. There were two communal lounges, a large dining room and conservatory for people to use.

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

There were not enough competent trained staff to meet people’s needs and staff had not been safely or equitably recruited. Risks to people’s health and well being had not been appropriately assessed and mitigated and staff were not competent to administer and record how people needed to take their medicines. There was little knowledge of safeguarding and how to report concerns and as a consequence safeguarding alerts were made over the course of the inspection to keep people safe. People were unlawfully restricted for the benefit of the staff. The provider had been informed of concerns but had not taken appropriate steps to manage this and did not learn from previous mistakes. The home was clean except the kitchen which was the most used room. There were no systems in place to manage the cleanliness of the home.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Consent was not formally acquired from people when staff provided support. Staff had not received appropriate training, an induction or supervision to support them in undertaking their role. Referrals to professional teams were not made in a timely way to best support people, and advice given by professionals was not followed. There was a choice of food but how it was prepared and stored was not safe.

Staff were open and honest with both professionals and each other about the lack of training they had received, they were mostly caring and sensitive individuals who were upset they had not been supported. People told us, staff were caring but we found staff did not know how to deliver a caring service in line with the regulations and standards of care. People were given limited choices due to staff shortages but where choices were available staff happily provided them. People were not involved in how they received care and their feedback had not been sought.

The provider had an electronic care planning system which none of the staff had been trained to use. Care plan information was limited and was not updated when people’s needs changed. Details around the equipment people needed was limited and information staff had on how to support people was not followed or not recorded as followed. A complaints procedure was in place but it had not been used effectively. Staff and the management had no knowledge of end of life care and relied on professional input in this area which was not always available.

Limited systems for audit had been introduced less than a month before the inspection. Support provided had not been audited as it was not known how to access reports from the electronic system and paper records had not been used in the interim. More support staff had recently been recruited but the allocation of staff remained poor and staff simply did not know what needed to be done. Meaningful handovers were not completed and systems to meet regulations had not been introduced or understood. Due to the nature of concerns the provider was issued with an urgent notice of decision to take immediate action. Information requested by the commission was not received and the provider chose to close the home.

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

Rating at last inspection

This service was registered with us on 9/05/2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staff culture, levels and competence of staff and the care provided, including the administration of medicines and meeting people’s dietary requirements. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to all of the regulations inspected. We found breaches in relation to staffing and their recruitment, the safe management of risk and handling medicines, identifying and responding to safeguarding concerns including when people were at risk of neglect and unlawful restrictions. There was a lack of knowledge around people’s dietary requirements and supporting people at risk of malnutrition and dehydration, a lack of person-centred care, people’s dignity was not upheld and the building had not been decorated or designed to meet the needs of people living there. We found the complaints procedure had not been initiated when complaints had been received and a lack of governance and oversight meant the same concerns reoccurred.

Follow up

During the inspection the Local Authority cancelled the commissioning contract with the provider and the Care Quality Commission served an urgent notice of decision restricting the further admission of new people to the home. Continued failure to address concerns led to the provider taking the decision to close the home and people were placed in the care of a different provider

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.