Griffin Lodge

Griffin Lodge is a residential care home providing accommodation and personal care for people with learning disabilities and sensory impairment. The service can support up to 12 people. At the time of the inspection there were 12 people using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by how the service was organised and how people were supported. People using the service received planned and co-ordinated person-centred support appropriate and inclusive for them.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles (PBS).

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

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and be part of the wider community.

Staff were trained in and understood PBS. People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The home was visibly clean and there were no unpleasant odours. Detailed risk assessments were in place, risks were well managed and detailed records were kept of care and support provided. Medicines were managed safely. Safe systems of recruitment were in place. Staff had received training in safeguarding people from abuse.

There were sufficient staff to meet people’s needs and staff received the induction, training and support they needed to carry out their roles. Peoples nutritional needs were met. The service worked closely with healthcare professionals to ensure people’s health needs were met.

Staff and the registered manager knew people well. Staff were patient, kind and caring and interactions were warm and friendly.

Care records, including PBS plans, were detailed and person centred. Activities were based on people's individual interests, hobbies and wishes. Peoples individual communication styles and methods were identified and respected.

There were now good systems of daily, weekly and monthly quality assurance checks and audits. People were positive about the registered manager and the changes since they had started at the service.

Rating at last inspection

The last rating for this service was requires improvement (published August 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when, to improve.

Why we inspected

This was a planned inspection based on the previous rating. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. We found the evidence supported the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Griffin 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.

Griffin Lodge provides accommodation and personal care support to adults with a range of complex and challenging needs arising from their learning disabilities, sensory impairments and physical and mental health needs. The accommodation is purpose built and made up of two connected bungalows, which provide 12 en-suite bedrooms and a range of communal and activity areas. The home has a large outdoor area at the rear for leisure and activities. The service is located in the Heald Green area of Stockport. Griffin Lodge is part of a large organisation; Community Integrated Care. The care service has been developed and designed 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.

At the time of our inspection there were 12 people living at Griffin Lodge.

This inspection was carried out over three days between 23 and 25 April 2018. Our initial visit on 23 April was unannounced.

We last inspected Griffin Lodge in March 2016. At that inspection we rated the service as good in the safe and responsive domains, and requires improvement in effective, caring and well-led. The overall rating for the service was requires improvement. At that inspection we found one regulatory breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This previous breach related to consent to care in line with the Mental Capacity Act 2005 as best interests decisions were not always in place. As a result of this breach we issued a requirement notice to the registered provider and they supplied us with an action plan.

The service did not have a registered manager in place. The registered manager had left the service three weeks previously and the deputy manager was currently holding the position until the new home manager started in their post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At this inspection we identified breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were around a lack of training and induction, infection control concerns and management oversight. You can see what action we told the provider to take at the back of the full version of the report. We also made two recommendations in the report regarding the recording of aspirational outcomes for people and using appropriate language during support

We found Griffin Lodge had a high level of staff vacancies and used a significant percentage of agency staff. Staff and visitors told us they had concerns around the number of agency staff used and the current staffing levels.

Training for staff was not up to date. We found staff had recently been recruited and were supporting people before completing their mandatory training or induction programme.

We identified concerns regarding infection control practice within the home and a recent infection control audit had identified the home required a deep clean. The home did not employ a cleaner and staff were required to undertake cleaning tasks.

Care files we looked at showed plans and risk assessments documenting people’s specific care and support needs. These were plans outlining how people needed to be cared for in an effective and safe way. However, these did not always include information around people’s family or history.

There were systems and checks in place to monitor the quality of the service to ensure people received safe and effective care. However, these checks had failed to address the concerns we found during our inspection. In addition, we found that previously reported actions regarding fire safety had not always been followed up.

Family and professional visitors to the service spoke highly of Griffin Lodge. One family member told us, “Staff are caring; they take a genuine interest in people – it’s more than just a job.”

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been completed by management to satisfy themselves that suitable staff had been employed to care for vulnerable people.

Care records at the home showed us that people received input from health care professionals, such as psychiatry and social care workers. People were supported to visit the dentist and general practitioner.

We looked at the safe management and administration of medicines and found medication was managed and administered safely.

People’s current care needs were effectively communicated through a system of team meetings, handover meetings and communication books. Information was communicated in different formats to enable people to understand. Staff were required to learn British Sign Language to ensure people and staff could communicate effectively together.

Responsive action was promptly taken to address changes in people’s specific care needs.

The home has good links with partnership agencies and the community. People accessed the community on a daily basis and had a comprehensive programme of personalised activities in place.

The service had completed statutory notifications to CQC of any accidents, Deprivation of Liberty Safeguards DoLS, serious incidents, and safeguarding allegations as they are required to do.

There was a complaints policy in place and we saw information displayed on how to make a complaint.

Staff told us they felt supported in their role and were complimentary regarding the acting home manager.

Information was provided for people in a range of formats to cater for individual care and communication needs.

Griffin Lodge is part of the Community Integrated Care (the “registered provider”) group of services. The home accommodates 12 younger adults in single rooms arranged in two bungalows. The home is situated in a quiet cul-de-sac in a rural part of Greater Manchester and has car parking on site.

There is a registered manager at the home. 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.

We found that the care provided at Griffin Lodge was safe and that the registered manager and her staff were keen to provide people with a standard of care that was personalised to their individual needs. Staff were well trained both in providing general care but also in providing the specific care that the people who lived in the home required.

Griffin Lodge is a modern building which is suitable for people with mobility difficulties. During our inspection we found that the home was clean and was being redecorated and refurbished. There was a range of facilities in the home including gym and sensory equipment. People who lived in Griffin Lodge were able to take part in activities both within the home and in the local community.

The people who lived in the home were able to enjoy a higher degree of personal care because the staffing levels were sufficient to support this. We found that people who lived in the home were encouraged to develop and maintain their independence. The relatives of people who lived in the home felt able to complain on their behalf about anything they were unhappy about. The registered manager had access to systems which allowed her to monitor the quality of care provided to the people who lived in the home.

We found that arrangements for making decisions for people who could not do so for themselves were not adequate. You can see what action we told the provider to take at the back of the full version of the report.

We have recommended that the provider reviews its care planning documentation to make sure it is easy to use and that quality assurance systems are extended to cover more areas of activity within the home.

We considered the evidence collected under the outcomes and addressed the following questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service safe?

We saw that people were treated with warmth, dignity and respect by staff. We spoke with one person who lived at Griffin Lodge, who told us they were 'Happy' living there. We also spoke with the relative of a person who lived there, who told us they had no concerns about the care their relative received.

The people living at Griffin Lodge have complex needs and staff have to physically intervene when a person's behaviour that challenges, poses a risk to themselves or others. We saw that staff received training in physical interventions with people, which they felt confident using. This indicated that staff were appropriately skilled and experienced to support people in this way and that this support was provided proportionately, with the dignity, comfort and safety of the person being maintained.

We saw that there was an effective system in place to manage safeguarding risks and incidents. Staff had a clear understanding of the signs and risks around safeguarding and told us they felt confident in taking action if they had concerns, including reporting poor practice of colleagues. We saw that staff were trained in this area and that staff at Griffin Lodge felt they had good links with the local authority safeguarding team. One member of staff, who we spoke with, told us that the service had a strong emphasis on safeguarding training due to the vulnerability of the people using the service.

Is the service effective?

Due to the complex needs of the people who lived at Griffin Lodge, they needed support to make decisions about their lives, including the care they received. We saw that staff supported people to make decisions and choices and the management team had a clear understanding of the requirements under Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We spoke with the relative of a person who lived at Griffin Lodge, who told us their relative was supported to make choices and decisions about their care. They told us 'They [staff] give a different outlook for [their relative], it's his perspective, his point of view'.

People's care needs were thoroughly assessed and people, and where appropriate, their families and other professionals were involved in this process. People's care plans were person centred and provided clear guidance for staff in how to deliver people's care. Staff told us they were able to access appropriate information to guide them in supporting people and they demonstrated a good understanding of the needs of the people they worked with.

The people we spoke with made positive comments about the staff and the care they or their relative, who lived at Griffin Lodge, received. We spoke with a relative who told us Griffin Lodge was 'The perfect place' for their relative, 'It's his home'. They also told us 'I can't fault the staff' and 'They [staff] have a rapport with [their relative] that is second only to mine'.

We saw that there were effective systems in place to support staff and that staff received regular training to develop them in their roles. One member of staff told us 'You are trained in what you need to do the job, but also what interests you and is of benefit' and 'The training is very good', 'Support for staff is good'. Another member of staff commented that they were provided with regular training that was 'Tailored to provide people with support'.

Is the service caring?

We saw that staff treated people with respect and warmth and the care we observed was provided in a sensitive, personal way. The people we spoke with made positive comments about the care they or their relative received.

Is the service responsive?

We saw that reviews of people's care were carried out and people's preferences and preferred routines considered. The people who lived at Griffin Lodge and the people supporting them were involved in reviewing and developing the way support was delivered, which demonstrated that people's changing needs were responded to and met.

There was a complaints procedure in place, with accessible information available for the people who lived at Griffin Lodge. We found that the relative we spoke with felt confident in raising concerns and expressing their views. The staff we spoke with told us the management team was 'approachable'.

Is the service well led?

Staff felt supported by the management team, and there were clear lines of accountability in place. Staff were provided with support through face to face supervision sessions, regular meetings and an accessible management team. Training was provided to equip staff in their role and they showed a clear understanding of the protocols in place which guided their work.

We saw that there were systems in place to regularly audit (check) and monitor the service provided, which was the responsibility of senior staff. This meant that the service was able to identify and respond to any shortfalls in the service, as well as recognising the strengths of the service people received.