Shore Lodge - Care Home Learning Disabilities

We found the following examples of good practice.

• The service had multiple entrances, but only one was in use. There was clear signage at the entrance with personal protective equipment (PPE) and hand gel to support people putting this on and taking it off. Contact details were taken from all visitors who had their temperatures taken and recorded. Visiting was by appointment only and numbers were restricted. Visits took place in the garden area in good weather or in the designated quiet room which was laid out to support social distancing. All visitors were required to wear masks.

• There was a robust infection control policy in place and staff were aware of their responsibilities and the relevant guidance. There was a stable staff team. Staff told us they had received additional training provided by the local Clinical Commissioning Group (CCG) and confirmed that they felt supported in their role. Staff were confident with the measures that had been taken to keep people safe. We saw staff wearing the right PPE for the tasks they were undertaking. People using the service had single rooms with ensuite facilities and had temperatures checked and recorded daily. The manager told us how they barrier nursed two Covid positive people on their discharge from hospital and protected other people by isolating them.

Shore Lodge – Care Home Learning Disabilities is a residential care home providing personal care to nine people with physical and learning disabilities at the time of the inspection. Some people were older, and some had profound needs. The service can support up to 10 people.

The service was registered prior to guidance ‘Registering the Right Support’. However, the service has been developed 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to ten people. Nine people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.

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

People told us and indicated they were happy living at the service and that they felt safe. People continued to be protected from abuse, discrimination and avoidable harm by staff who understood their responsibilities to keep people safe. Risks to people’s health and safety were assessed and measures were in place to reduce risks. Accidents and incidents were recorded, and action was taken to reduce the risks of them happening again. People continued to be supported by enough staff who worked closely as a team to meet people’s needs. People were supported to have their medicines on time.

People were supported by staff who were knowledgeable and knew them well. Staff completed regular training and met with the registered manager regularly to discuss their performance. People told us they enjoyed their meals and staff supported them to cook and shop. People’s health care needs were monitored and regularly reviewed. Changes in people’s needs were recorded and, when needed, people were referred to health care professionals. There was a calm and relaxed atmosphere. The building was easy for people to navigate with good wheelchair access to help support their independence.

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.

The service applied the principles and values consistently of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 become more independent.

People had built trusting relationships with staff. Staff spoke passionately about the people they supported and were kind and caring. People’s privacy and dignity were respected by staff and their independence was promoted. People were empowered to do as much for themselves as possible.

People, their relatives and representatives were involved in the planning and review of their care and support. People were encouraged to remain active and were supported to engage in the local community. People knew how to complain and would speak with staff if there were unhappy. There had not been any complaints since the last inspection.

The registered manager completed regular checks to ensure the quality of the service was good. Staff worked with health care professionals to deliver effective, joined-up care and support to meet people’s needs.

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 Good (published 13 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service had a registered manager in post. 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.

At our last inspection on 14 April 2016, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to the requirements of the Mental Capacity Act 2005 not being met. At this inspection, improvements had been made and the service was compliant with the regulation.

Mental capacity assessments were being carried out and these were decision specific. Staff and the registered manager demonstrated good knowledge of the Mental Capacity Act 2005. However, we found that assessments were recorded in one document and not separated into each individual decision. We have made a recommendation about this in our report.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

Medicines were stored securely and safely administered by staff who had received appropriate training to do so. However, we found that some liquid medicines did not have a date of opening written on them. We have made a recommendation about this in our report.

The registered provider had systems in place to protect people against abuse and harm. There were effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. The environment was clean and appropriate measures had been taken to reduce the risk of infection.

There were sufficient staff to provide care to people throughout the day and night. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

People were being referred to health professionals when needed. People’s records showed that appropriate referrals were being made to GP’s, speech and language therapists, dentists and chiropodists.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed.

People were being supported to have a nutritious diet that met their needs, and were supported to eat by suitably trained staff.

Relatives spoke positively about staff. Staff communicated with people in ways that were understood when providing support. People’s private information was stored securely and discussions about people’s personal needs took place in a private area where it could not be overheard.

People were free to choose how they lived their lives. People could choose what activities they took part in and could decorate their bedrooms according to their own tastes.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Records showed that outcomes of the investigations were communicated to relevant people. People and their relatives were encouraged to give feedback through resident meetings and yearly surveys.

The registered manager was approachable and supportive and took an active role in the day to day running of the service. Staff were able to discuss concerns with them at any time and know they would be addressed appropriately. The registered manager was open, transparent and responded positively to any concerns or suggestions made about the service. The provider carried out surveys to identify shortfalls with the service.

This inspection was carried out on 04 March 2016 by one inspector. It was an unannounced inspection. There were 9 people using the service at the time of the inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Following the last inspection in July 2015 the registered provider and registered manager were served with warning notices in respect of breaches the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan addressing the requirements of the notices. At this inspection we found that the required improvements detailed in the warning notices had been made. At the last inspection we also issued a requirement notice in relation to consent. At this inspection we found that, although improvements had been made, the registered manager and staff did not fully understand the requirements of the Mental Capacity Act 2005.

Staff were trained in the principles of the Mental Capacity Act 2005 (MCA), however we found that assumptions had been made in respect of people’s mental capacity to make decisions. It was recorded on people’s care plans that they did not have the capacity to make decisions. The registered manager and staff had not understood that an assessment of a person’s capacity needed to be carried out for each decision to be made, where they believed the person may be unable to make the decision. This placed people at risk of losing their right to make a decision because assumptions were made or because they had not been able to make a previous decision. This was a breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were completed based on the needs of the individual. Staff understood what action they needed to take to keep people safe. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Action had been taken to reduce the risks to people’s safety.

There were sufficient staff to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were suitable to work with people.

Medicines were stored, administered and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The service was clean, well maintained and designed to meet the needs of the people that used it. Risk within the premises and in the use of equipment had been assessed and managed effectively. Staff knew how to minimise the risk of infection spreading in the service.

Staff knew people well and were trained and competent to meet people’s needs. They had the opportunity to receive further training specific to the needs of the people they supported. Staff felt supported and received one to one supervision sessions and an annual appraisal of their performance. Staff were clear about their responsibilities. This ensured they were supported to work to the expected standards.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted where needed and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements.

People were provided with meals that were in sufficient quantity and met their needs and preferences. People enjoyed their meals. Staff knew about and provided for people’s dietary preferences and restrictions.

People were promptly referred to health care professionals when needed. Staff included advice from health professionals in individuals’ care plans and records showed that this advice was followed.

Staff were caring and treated people with kindness and compassion. They knew each person well and understood what was important to them. Staff understood how to communicate with each person. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were involved in their day to day care. People participated in reviewing their care plans as far as they were able and relatives were invited to attend reviews with people’s consent. Personal records included information about people’s life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves, however this was not planned for proactively as part of the care plan. We have made a recommendation about this.

Information about the service, the facilities, and how to complain was provided to people and their relatives. People were asked their views about the service at regular intervals, however the registered manager had not considered alternative ways to seek the views of those who did not use verbal communication or could not complete a questionnaire. We have made a recommendation about this.

People were supported to take part in activities that responded to their individual needs and interests. Work was underway to develop more opportunities for meaningful activities and occupation for people.

Staff told us they felt supported by the registered manager. The team had worked hard to develop the culture of the service to reflect the person centred principles the registered provider committed to deliver. Improvements had been made, but it was too early to see that these had been fully embedded in the culture of the service. We have made a recommendation about this.

The registered manager was open and transparent in their approach and receptive to recommendations for improving the service. The registered provider ensured the registered manager kept up to date with any changes in legislation that might affect the service and they had carried out regular audits to identify how the service could improve. The registered manager had acted on the results of these audits and made necessary changes to improve the quality of the service and care.

We recommend that the registered manager review each person’s support plan to ensure it outlines how staff can promote their independence and help them to achieve their goals and aspirations.

We recommend that the registered manager review how the views of people using the service are sought to ensure it meets individuals’ communication needs.

We recommend that the registered manager continue to closely monitor staff practice and to regularly assess the culture of staff practice to ensure it reflect person centred values.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. There were enough qualified, skilled and experienced staff to meet people's needs. We also found that systems were in place for people and relatives to make a complaint about the service if necessary and that complaints were managed in a timely and satisfactory manner.

People we spoke with indicated that they liked living in the home and the staff. People and relatives we spoke with said there was plenty to do both inside and outside the home. We saw that people who used the service were encouraged to help with the day to day running of the home and were involved with tasks such as menu planning and food shopping.

We arranged to speak with some relatives over the telephone. They told us that they were happy with the care and support provided by the service. Comments included 'My relative loves living in Shore Lodge, everyone is well looked after' 'We are very happy with the home and so pleased our relative is there' and 'We can't praise the service enough'. We found that relatives and people who used the service had been involved in their care. One relative told us, 'We have been involved from the start with our relative's initial assessments and their care plan' Another relative told us 'We are kept involved, I regularly attend my relative's care reviews.'