Background to this inspection
Updated
22 January 2021
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 Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes.
Inspection team
The inspection was carried out by two inspectors. Two inspectors visited the home on the 04 September 2020, one inspector undertook telephone calls to staff and relatives on 07 September 2020.
Service and service type
The Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We saw all seven people that lived in the service, however people living in the service were unable to effectively communicate with us on their safety or the effectiveness of leadership in the home. We spoke with three relatives about their experience of the care provided to their family members. We spoke with four members of staff, the manager, and two heads of operations. We also spoke with one healthcare professional.
We reviewed a range of records. This included three people’s care records, restraint records and medication records. We looked at one staff file in relation to recruitment. We also looked at records that related to the management and quality assurance of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
22 January 2021
About the service
The Lodge is a residential care home providing personal care for seven younger adults with learning disabilities and/or autism spectrum disorder. The service can support up to eight people.
The service has been designed taking into account best practice guidance and the principles and values underpinning Registering the Right Support (RRS) in respect of the environment. The building design fitted into the residential area as it was domestic in style in keeping with other homes in the street. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
People’s behaviour was not always safely managed, and restraint was not always implemented for the shortest possible time.
There were not always enough staff to safely support people and meet their identified needs.
Staff were not always following current government guidance in relation to COVID19 and the use of personal protective equipment.
People received their medicines when needed and staff where trained to administer people’s medicines safely.
A lack of oversight meant potential risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service were not always effective and had not identified the areas for improvement found at this inspection.
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 Good. (Published 30 January 2020).
Why we inspected
The inspection was prompted in part due to concerns received about safeguarding, use of restraint and the care being provided. Additional concerns were shared with us by the Clinical Commissioning team and Sandwell Local Authority. A decision was made for us to inspect and examine those risks.
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 coronavirus and other infection outbreaks effectively.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to person centred care, safeguarding, recruitment practices and governance.
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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.