Archived: Donylands Lodge

Updated 3 October 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 2 inspectors 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

This service provides care and support to people living in 6 ‘supported living’ settings so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

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 were 3 registered managers in post. The service had been split into 3 areas, Donylands Lodge, Colchester and Clacton supported living services, each with its own registered manager.

Notice of inspection

The inspection of Donylands Lodge, the registered location for this service was unannounced. We gave a short period of notice to inspect the smaller supported living services because some of the people needed support to manage anxieties about inspectors visiting the service.

Inspection activity started on 14 June 2023 and ended on 18 July 2023. We visited the location’s office on 14 June 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals 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 spoke with 4 people who used the service. We observed the interactions between people using the services and staff. We spoke with 6 relatives about their experience of the care provided.

We spoke with the area manager who is responsible for supervising the management of the service on behalf of the provider. We also spoke with the registered managers, deputy manager and 8 care staff. We looked at 5 staff files in relation to recruitment and records in relation to the quality and safety of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at 3 people's care records, training data, and a variety of records relating to the management of the service, including policies and procedures.

Updated 3 October 2023

About the service

Donylands Lodge is a supported living service which provides personal care to people as part of the support they need to live in their own homes. The personal care is provided under separate contractual arrangements to those for the person's housing. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of the inspection the service was supporting people living in single self-contained flats or in shared accommodation at Donylands Lodge or in 7 separate supported living services, (referred to as satellite services) within the Colchester / Clacton area. The regulated activity of Personal Care was only being delivered to 11 people in 6 of the 8 supported living properties.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people and providers must have regard to it.

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

Right Support:

The satellite supported living services are houses, or flats in buildings of a similar size to other properties based in the local community. Donylands Lodge site is in a rural location. This is a larger service comprising of a series of older buildings which we found were not fit and safe for people to live in. Issues about the safety of the premises were identified by the area manager in an environmental audit in February 2023. The findings were reported to the housing provider, who holds responsibility for the upkeep and maintenance of the premises.

Senior managers informed us they had repeatedly tried to engage with the housing provider to make the required improvements. However, we found the same issues on inspection which placed people at risk of harm. As CQC does not regulate the premises used for supported living, we shared our findings with the local authority who fund people’s care, and Essex County Fire and Rescue service. The nominated individual (responsible for supervising the management of the service on behalf of the provider) advised they had, and continued to raise concerns with the housing provider relating to the risks to people’s safety and to ensure fire safety standards were addressed. Despite extensive chasing nothing has been forthcoming from the housing provider, other than some contractor visits and minor remedial actions taken.

Since the last inspection, the registered provider, has been incorporated into Ivolve Group Limited, an existing adult social care provider with established governance arrangements in place to assess, monitor and improve the quality of the service. However, these systems have not yet been fully embedded in the service to ensure delivery of high-quality care and drive the required improvements. These failed to identify people’s flats at Donylands Lodge were dirty, and unhygienic, which were not only unsanitary, but increased the risks of people acquiring or spreading infection.

People using the service were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

Right Care:

High use of agency staff had previously impacted on the provider’s ability to consistently meet people’s complex needs. The provider had successfully recruited staff to fill vacancies across the services reducing the need to use temporary agency staff. Relatives and staff confirmed staffing numbers had improved. However, where agency staff were still used, relatives remained concerned about the impact this had on their family members, and their ability to build a trusting relationship. Recruitment practices had improved to ensure the right staff were recruited.

People's care records contained robust communication plans. However, staff had not always received training to ensure they were able to effectively communicate with people, using their specific method of communication, such as Makaton. Systems were in place to ensure people received their prescribed medicines. Staff worked well with the learning disability team, GP, positive behaviour support (PBS) team and families to review medicines to ensure people's behaviour was not controlled by excessive and inappropriate use of medicines.

The service had safeguarding systems, policies and procedures and managed safeguarding concerns promptly. Managers and staff knew people well, understood how to protect them from abuse and worked well with other agencies to do so.

Right Culture:

Our previous inspection found there had been an unstable management team, which had led to a poor staff culture, lack of leadership and oversight of the service. A new management team was in place, consisting of an area manager and 3 registered managers, split across Donylands Lodge and the satellite supported living services. Staff confirmed the new management team were providing more support, and better leadership.

Systems were in place to respond to complaints in a timely way and used to improve practice. However, 3 out of 5 relatives told us engagement between them, and the service could improve, including obtaining and responding to feedback and ensuring their concerns were listened to. A plan to improve engagement with families had been developed, including regular family events. This had included an afternoon tea for relatives to meet and build relationships with the new management team.

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 29 October 2021). We carried out an unannounced comprehensive inspection of this service in September 2021, where breaches of legal requirements were found. The provider completed an action plan after the inspection to show what they would do and by when to improve safe care and treatment and their governance arrangements. At this inspection we found enough improvements had been made and the provider was no longer in breach of regulations.

This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. 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 remined requires improvement. This is based on the findings at this inspection.

Why we inspected

This was a focused inspection to check the provider had made improvements in relation to the key questions safe and well-led and prompted by a review of the information we held about this service to assure ourselves people were receiving safe, good quality care.

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

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.