Elstow Lodge

Updated 11 November 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was completed by 1 inspector and an inspector from the CQC medicines team.

Service and service type

Elstow Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Elstow Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. We visited the service on 20, 23 and 25 July 2023 and we spoke with people’s relatives over the telephone on 28 July 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to fill in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and 5 relatives about their experience of the care provided. Some people using the service could not give us feedback, so we spent lots of time observing how staff supported people and how people spent their time at the service. We spoke with 10 members of staff including support workers, senior support workers, the registered manager, and the director.

We reviewed a range of records. This included 4 people’s care records and numerous medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, training data and quality assurance records were reviewed.

Updated 11 November 2023

About the service

Elstow Lodge is a care home providing accommodation and personal care to autistic people and people living with a learning disability. People have their own personalised bedrooms and share communal areas such as a lounge, dining room, kitchen and garden. The service can support up to 9 people and 9 people were living at the service at the time of our inspection.

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

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.

Right Support

People were not supported to pursue their interests or achieve their aspirations and goals. People were not being supported to try new things or to follow social interests and past times on a consistent basis.

Reasonable adjustments were not made so that people could be fully involved in discussions about their support. Staff did not always communicate with people in their identified and preferred methods.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Staff did not always support people safely with their medicines. There were some aspects of people’s support such as risk assessments being detailed and staffing levels that were not always safely supported by staff.

People were supported to live healthy lifestyles and staff members promoted healthy choices in areas such as eating and drinking. Staff kept people’s home environment clean and safe and maintained people’s equipment to help ensure it was always used safely. Staff knew how to support people in a kind and caring way if they experienced distress.

Right Care

Staff were not promoting people to try new things which may have enhanced their wellbeing and enjoyment of life. People’s support plans did not fully reflect their range of needs and promote their wellbeing and enjoyment of life. People who had individual ways of communicating such as using symbols or body language could not always interact comfortably with staff as they did not have all the skills necessary to understand them.

Staff were not being supervised to support people effectively. The registered manager was not checking staff competency to perform their job roles in all areas.

People were not always receiving kind and compassionate care. Staff did not always protect and respect people’s privacy and dignity. Staff knew people well as individuals, however in practice, did not support people in line with their identified likes, dislikes, and preferences.

Staff knew how to recognise, and report abuse to appropriate agencies.

Right culture

The management and staff team did not understand the key principles of guidance such as Right Support, Right Care, Right Culture. Audits completed at the service by management had not picked up on areas that could have been improved to help support a more positive culture. Audits had not been completed in a lot of areas.

People and those important to them, were not fully involved in planning their support. It was unclear how staff evaluated the quality of support provided to people, involving the person, their families, and other professionals as appropriate.

The service had a negative culture that was at risk of becoming a closed culture. Staff were not supporting people to have a good quality of life or achieve good outcomes.

People sometimes received kind and compassionate care from a staff team who had got to know them as individuals. People were happy and relaxed being supported at the service and staff spoke with people in a friendly manner. People and relatives were positive about the support they/ their family member was receiving.

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 26 February 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, the provider was no longer in breach of this regulation, but was now in breach of other regulations. This service is now rated inadequate. This service has been rated inadequate or requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see all the 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 and Recommendations

We have identified breaches in relation to safe care and treatment of people, staffing levels, people being treated with dignity and respect, people receiving personalised care and the way the service is managed at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.