Franklyn Lodge The Bungalow

Franklyn Lodge – The Bungalow is a care home providing residential care to 4 people with learning disabilities.

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 the Care Quality Commission (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 and family members told us the service was safe. Staff understood their responsibilities about safeguarding and keeping people safe from harm as much as possible. Medicines were managed safely. Risks of harm to people were assessed and reduced as much as possible. Staff were recruited safely. Systems were in place to prevent the spread of infection. 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.

Right Care:

People received kind and compassionate care. Staff respected people's privacy and dignity. They understood people's individual needs and responded to these. People were supported by a staff team who knew them well and were aware of their communication needs. Care plans reflected people's needs, likes and preferences. It was not always evident that people were supported to engage in activities that enabled them to develop their skills.

Right Culture:

The service had made improvements to their quality assurance system since the previous inspection. There was a positive culture, where people felt safe. They had good relationships with staff and each other. We found gaps in staff training so it was not always evident what training staff had completed. Staff turnover was low, which supported people to receive consistent care from staff.

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 28 October 2019).

Why we inspected

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

Enforcement and recommendations

We have made 2 recommendations in relation to training and activities.

Follow up

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

Franklyn Lodge – The Bungalow provides accommodation and personal care for a maximum of four adults who have learning disabilities. The home is a detached bungalow set back from the main road. It is close to shops and transport links. At the time of our visit, there were three people living in the home. A fourth resident had been admitted to hospital.

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 aimed to provide people using the service with planned and co-ordinated person-centred support that were appropriate and inclusive for them.

People’s experience of using this service

People were unable to provide us with verbal feedback because they had complex needs. Two of them however, nodded and smiled when we asked them if they were happy in the home. A relative and three care professionals informed us that staff treated people with respect and dignity and people were safe in the home. We observed that staff interacted well with people and were attentive towards them. Staff made effort to ensure that people's individual needs and preferences were responded to.

Most risks to people’s health and wellbeing had been assessed and documented. There was guidance for staff on how to minimise risks to people. We noted that there was no risk assessment for a person with a catheter. This was needed to ensure that potential risks could be minimised. The completed risk assessment was sent to us soon after the inspection.

Personal emergency evacuation plans (PEEPs) were in place for two people. The acting manager stated that the remaining two PEEPs would soon be brought over to the home by senior staff. This was unsatisfactory as PEEPs needed to be in the home at all times so that staff are aware of action to take in an emergency. The PEEPs were later e-mailed to us.

Staff had received training on how to safeguard people and were aware of the procedure to follow if they suspected that people were subjected to abuse.

Staff had received training in the administration of medicines. We however, noted that there had been several gaps in the medicines administration records (MAR) of a person for the month of August 2019. The acting manager explained that this person was in hospital.

There was a record of accidents and incidents. We noted that an incident in which a person had damaged property did not have guidance to prevent re-occurrence. This was provided soon after the inspection.

Staff had been carefully recruited and essential pre-employment checks had been carried out. However, the criminal record disclosures of three staff had not been updated recently. The human resources manager stated that they would be updating them promptly. The home had adequate staffing levels and staff were able to attend to people’s needs.

The premises were clean and tidy. There was a record of essential maintenance carried out. Fire safety arrangements were in place.

Staff supported people to have a healthy and nutritious diet that was in line with their individual dietary needs and preferences.

The dietary needs and healthcare needs of people had been assessed and attended to. People could access the services of healthcare professionals when needed.

Staff had received training and had knowledge and skills to support people. They had been provided with regular supervision and a yearly appraisal of their performance.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People’s care needs had been assessed prior to them coming to the home and staff were knowledgeable regarding these needs. The service provided people with person-centred care and support that met their individual needs and choices.

The service had a policy on ensuring equality and valuing diversity. People’s diverse needs had been assessed and action taken to meet those needs.

The service was committed to encouraging people to be as independent as possible. Staff supported people to participate in various activities within the home and in the community. Feedback we received from people’s representatives indicated that staff had assisted people to settle down and make progress in their social skills.

There was a complaints procedure and relatives knew how to complain. Only one complaint had been recorded. This had been promptly responded to.

Management monitored the quality of the services via regular audits and checks. We however, noted that some aspects of the service were not well managed. A number of deficiencies were noted by us and we have made a requirement in respect of this deficiency.

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 16 November 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected:

This was a planned inspection based on the previous rating.

We have identified breaches in relation to good governance. Please see the action we have told the provider to take at the end of this report

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.

Franklyn Lodge – The Bungalow is a care home which is registered to provide personal care and accommodation for a maximum of four people. People living in the home have learning disabilities. At the time of our visit, there were three people living in the home.

There was a registered manager in place 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.

Following our last comprehensive inspection of Franklyn Lodge – The Bungalow in August 2017 we rated the home as ‘Requires Improvement.’ We identified that risks to people's health and safety were not safely managed. Personal emergency and evacuation plans (PEEPS) of people were not kept on site, which meant they were not accessible in emergency situations. There was a lack of scrutiny and effective quality monitoring, which placed people at risk of harm or of not receiving appropriate care.

At this inspection we found that the service had started to make improvements. Action had been taken to deal with some concerns that we had raised in our previous inspection. However, further improvements were required in quality monitoring processes. Most of the audits and quality checks were at an early stage of completion, which meant we were not able to fully assess the usefulness of these. Whilst we were reassured that action was underway, we were concerned about the length of time taken to improve the usefulness of the quality monitoring processes.

Improvements were required in the management of medicines. Although there were arrangements for recording medicines that were prescribed to be taken ‘when required’ (PRN), we found this not to be comprehensive. The service did not provide clear and precise instructions to staff to ensure PRN medicines were administered as intended. Also, whilst we generally observed suitable arrangements for the recording, storage, administration and disposal of regular medicines, further improvements were required. People did not have a person-centred medication profile. This was important for medicines that needed to be specifically monitored due to special requirements.

There were effective systems and processes in place to minimise risks to people. Safeguarding and whistleblowing policies were in place. Staff had been recruited safely. They underwent appropriate recruitment checks before they could commence working at the service to ensure they were suitable to provide people's care. There were effective systems and processes in place to minimise risks to people. Care plans contained risk assessments which identified the risks to the person and how these should be managed.

Relatives gave us positive feedback about how the service was meeting people’s needs. People were supported to have sufficient amounts to eat and drink. Their needs had been assessed by the service prior to using the service. Care plans included guidance about meeting these needs. The service also involved a range of health and social care professionals. People's capacity to make choices had been considered in line with the Mental Capacity Act 2005 (MCA). Staff had received regular training and support.

People were treated with respect and their dignity maintained. Their individual preferences were respected. Care plans were detailed so that staff could understand their preferences. Care workers had a good understanding of protecting and respecting people's human rights.

People received person centred care. They were involved in the development of their care plans. People's diversity and human rights were highlighted in their care plans. Relatives confirmed that they could complain if needed to. There was a complaints procedure which they were aware of. People’s communication needs were considered.

At our previous inspection on 7 October 2015, we rated the service as “Good” and there were no breaches of regulation. At this inspection we rated the service as “Requires Improvement”.

People who used the service indicated to us that they were satisfied with the care and services provided. They had been treated with respect and dignity in the home. This was confirmed by relatives and a social care professional we spoke with. Care workers showed an understanding of how to recognise and report allegations of abuse. Risks to people who used the service were assessed and risk management plans were in place. Medicines were managed safely. The premises were clean and tidy and infection control arrangements were in place. We however, noted that the COSHH (Care of substances hazardous to health) cupboard where cleaning detergents were stored had not been locked. This was locked soon after we raised it with the new manager. The PEEPs (personal emergency and evacuation plans) were not kept in the home. However, they were brought to the home by senior staff of the organisation on the afternoon of the inspection. Failure to ensure these safety measures were in place is a breach of regulations and we have made a requirement in respect of this.

Care workers were carefully recruited. They had been provided with essential training. There were regular staff supervisions. Appraisals had been carried out in the past twelve months. The staffing support for one person was not in accordance with that recommended by health and social care professionals. This had been brought to the attention of the funding authority so that additional support could be provided.

Care workers understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Restrictions placed on people had been authorised. People’s healthcare and nutritional needs had been attended to.

Care workers treated people with respect and ensured their dignity and privacy were maintained. There were arrangements for ensuring that the care provided was centred on the person who used the service. The care of people had been subject to regular reviews by health and social care professionals. People could participate in activities they liked. The service had a complaints procedure. Two complaints made had been promptly responded to.

Care workers worked well together. Appropriate policies and procedures were in place. Care records were up to date. The service had arrangements for quality assurance checks and audits. However these checks and audits were not sufficiently effective as they did not identify deficiencies noted by us such as incidents which were not adequately completed and another incident which was not notified to the CQC. This lack of effective checks and audits may put people at risk of receiving unsafe care. We found a breach of regulation in respect of this.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

We used a number of different methods to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We observed the care provided and the interaction between staff and people who used the service. We also spoke with three care staff, and the registered manager. We also read feedback from relatives.

Below is a summary of what we found. The summary describes what staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service had support plans and risk assessments which helped to ensure their safety and welfare.

We found the home had safeguarding, whistle blowing and Deprivation of Liberty Safeguards (DOLs) policies and guidance in place. Training records showed staff had received training in safeguarding adults and DoLS. When speaking to them, they were able to provide examples of what constituted abuse and how they could identify abuse. They were aware of action to take and how to report allegations or incidents of abuse to the relevant authorities.

CQC monitors the operation of the DoLS which applies to care homes. While no applications have been submitted, appropriate policies and procedures were in place. When speaking with staff we found they had an understanding of the Mental Capacity Act (MCA) 2005 and the DoLS and how it applied to the people they were providing care and support to on a daily basis.

We found the home ensured people were cared for, or supported by, suitably qualified, skilled and experienced staff. We saw there were recruitment and selection procedures in place and found that the appropriate checks had been undertaken before staff began work. Staff were trained in areas of relevance to their job roles and demonstrated knowledge of people's individual needs and requirements.

Is the service effective?

We found the home had taken steps to ensure that people were included and involved as much as possible in their care and support. We found they used various methods of communication to engage and involve people who used the service as much as possible such as pictures, facial expressions, sign language, key objects and words.

We looked at four care plans and saw that people's needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. We found people's care plans were person-centred, very detailed and specific to each person and their needs. Risk assessments had been carried out.

Is the service caring?

We found good feedback had been received about the home. Feedback from one relative read 'thank you for taking good care of [relative]' and 'we are pleased with [relative's] progress, the carers are fantastic.'

We saw people being treated with respect and dignity. Staff communicated well with people and explained what they were doing and why. We observed people were supported to make choices by staff and asked what they wanted to do. During the inspection, we observed people who used the service were relaxed and happy.

Is the service responsive?

We saw the home had a complaints policy and procedure, which was easily accessible to staff and people who used the service. We found staff were aware of how to make a complaint and felt comfortable approaching the manager with any concerns they had.

We also found regular reviews were being held between people who used the service, their family or representatives and the registered manager, where all aspects of their care were discussed and any changes actioned if required.

People's health and medical needs were assessed and we viewed records demonstrating that people had access to health and medical services when necessary.

Is the service well-led?

We found the home had a system in place to obtain feedback through surveys which showed good feedback had been received from relatives of people who used the service.

There were regular consultations and resident meetings with the people who used the service which gave them the opportunity to discuss any issues or concerns they had and to raise any complaints they had.

We also found regular monthly staff meetings took place which ensured staff had the opportunity to communicate their views about the service and to discuss the care and support needs of people who used the service.

We found the home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Checks had also being conducted on all electrical equipment and maintenance checks and service records were up to date.

The bedrooms and the communal areas had been kept clean and tidy. Bedrooms had been personalised by people with their pictures and ornaments. We observed that people who used the service were dressed appropriately and appeared well cared for. Staff were constantly supervising and interacting with people who used the service in a friendly manner. Plans of care had been prepared for people following consultation with people and their representatives. There were appropriate arrangements in place to manage medicines.

Staff were knowledgeable regarding their roles and responsibilities. One person and three relatives indicated to us that staff were able to meet the needs of people.

Arrangements were in place to monitor the quality of care provided. These included satisfaction surveys and monthly checks and audits done by senior staff of the company.

Two relatives who spoke with us stated that people had been treated with dignity and respect and they were well cared. Their views can be summarised by the following comment,' I regularly visit the home and am satisfied with the care provided. I find my relative well dressed and happy.'

Relatives described staff as kind and professional. They said staff kept them informed of the progress of people. Staff informed us that they worked well as a team and felt supported by their managers. Staff were aware of the safeguarding policy and procedure aimed at protecting people from abuse.

Relatives said the home was clean and tidy when they visited. Staff were aware of the infection control policy and procedure and could describe action they took to reduce infection. The home was well maintained and the required safety inspections had been carried out.