Devon Lodge

Updated 2 March 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

The inspection was carried out by 1 inspector, an assistant inspector, a pharmacist from our medicines team, a specialist professional advisor with experience of working with people with autism and a learning disability, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Devon 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. Devon 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.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us 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 spent time observing the quality of care and support people received. This helped us to understand the experiences of people who we were unable to communicate with. We spoke with the registered manager, deputy manager, regional manager, 5 day support staff and 2 night support staff. We also spoke with the regional maintenance manager, a speech and language therapist, an occupational therapist, psychologist and assistant psychologist. We reviewed a range of records. This included 5 people’s support plans and 10 people’s medicines records. We looked at 4 staff recruitment files and 3 agency profiles. We also viewed a range of records relating to the management of the service.

After the inspection

We received feedback from a further 2 support workers and from 1 social care professional. We continued to seek clarification from the provider to validate evidence found.

Updated 2 March 2023

About the service

Devon Lodge is a care home without nursing. It provides care and support for up to 12 adults with autism, learning disabilities and other complex needs. There is a main house which can accommodate 8 people and a self-contained annex that can accommodate up to 4 people. Both areas have their own kitchen, dining area and lounge. At the time of the inspection there were 10 people using the service.

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.

Whilst this inspection found that many improvements had been made, the service was not able to demonstrate how they were meeting all of the principles of Right support, right care, right culture.

Right support: We continued to find that risks relating to people’s medicines were still not always effectively assessed, planned for and mitigated. We were assured that that people were being more appropriately supported to have a fulfilling and meaningful life that included achieving, or working toward, goals and aspirations. The environment was more homely, clean and better maintained. The service continued to plan for when people experienced periods of distress and this enabled staff to respond in a safe and effective manner. Staff continued to provide support in the way each person preferred and decision making followed best practice frameworks.

Right care: People were not always supported to have maximum choice and control of their lives and it was not always evident that staff had considered less restrictive options before limiting people’s choices. Overall, care and support plans reflected a good understanding of people’s needs. Improvements had been made which ensured that there were sufficient numbers of familiar staff available to provide a personalised response to people’s needs. Staff understood how to protect people from abuse.

Right culture: The registered manager had not always effectively operated the systems that were in place to monitor the quality of the service people received. People’s care continued to be enhanced by the involvement of a team of specialists employed by the provider, who worked closely with the support staff to develop a collaborative and problem solving approach to people’s support. However, there continued to sometimes be a disconnect in practice between how staff told us people best communicated and the communication methods and styles documented in their care and support plans. Overall improvements had been made to ensure that staff had been recruited safely. Staff told us the registered manager performed their role effectively. They felt valued and involved in developing the service. Relatives and staff all told us the service had improved and they were happy with the changes.

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 25 March 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out an unannounced focussed inspection of this service on 24, 25 and 26 January 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve: safe care and treatment, the safety of recruitment, staffing, person centred care, the premises and the governance arrangements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective and Well-led which contained those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

We have also made a recommendation that the service explore a broader range of alternative options to support the use of debriefs with people in line with best practice.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.