Park Lodge provides care and support for up to eight people who have autistic spectrum conditions. At the time of the inspection there were six people living at Park Lodge all of whom had been placed there from out of area due to the specialist care that could be provided.
Due to the complex needs of people living at the home not everyone was able to share their views about the service with us but we did spend time with people in communal areas observing the care and support they received.
An established registered manager was in post and had been registered since October 2010. They had recently returned to work following a period of absence during which time an acting manager was overseeing the day to day running of the service. 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.
We carried out a scheduled inspection of this service on 10, 16 and 17 September 2014. Breaches of legal requirements were found.
The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. Care and treatment was not always planned and delivered in a way that was intended to ensure peoples safety and welfare. Staff had not received all the training they needed or professional development, supervision and appraisal.
The provider submitted a report detailing the actions they planned to take to meet the legal requirements.
We completed a fully comprehensive inspection of the service on the 29 June 2015. This day was unannounced which meant the provider did not know we would be visiting. A second day of inspection took place on 30 June 2015 and was announced.
We found improvements in relation to staff receiving training in autism, appraisals had been completed and relative surveys had been completed.
We found risk assessments had been completed but they did not always contain sufficient control measures to keep people and their staff safe. Some people diagnosed with epilepsy enjoyed going swimming but we saw no evidence of risk assessments in relation to this activity.
People had a care record titled ‘My Plan’ which included area’s of the person’s life where they needed care and support. We found that this did not always detail specific strategies for staff to follow in relation to specialised equipment and it had not been kept up to date with people’s communication needs or medicine administration.
The review and evaluation of documents had been completed on a monthly basis but the comments stated ‘no change’ or ‘reviewed’ therefore it was unclear whether the plan was still effective and appropriate.
Staff were supporting some people to take medicine in food as it had been recognised that they could not tolerate the taste or texture of specific medicines. Best practice would be for a doctor to authorise this as a best interest decision and for the process to be recorded in a care plan and risk assessment. We saw no evidence that this had been completed.
Health and safety checks were being completed by maintenance staff but they were out of date due to the person’s absence from work. The registered manager thought they were being completed by another person from the maintenance team but had not checked so the fire log book and scheduled maintenance checklists were not up to date.
Deprivation of Liberty Safeguards (DoLS) had been authorised although some had now expired and we saw no evidence that further applications had been made although the registered manager confirmed they had done so. Care staff knew DoLS were in place but weren’t able to explain what it meant for people’s care.
Some best interest decisions were in place but they had not been reviewed. Although staff were seen to act in people’s best interest the process for decision making had not always been followed in line with MCA code of practice.
Staff training was not up to date in relation to the provider’s refresher time periods. This related to mental capacity and deprivation of liberty safeguards. Non-abusive psychological and physical intervention (NAPPI) training was not current. We also saw that staff training in relation to medicine administration was out of date and we saw no evidence of competency based assessments. Makaton training, which some of the people use to communicate, had been mentioned in the provider action plan following the September 2014 inspection but not all staff had received this training.
The provider was not meeting its own aim in relation to supervision as they were not on track to complete six supervisions a year with each staff member. This meant there was no formal process, by way of training and supervision to assess staff competency in relation to meeting the specific needs of the people they supported.
People’s ‘my plan’ was not always kept up to date with changes in people’s care needs. One person’s care manager explained that the person was able to understand verbal communication and they confirmed that staff understood them even though their ‘my plan’ stated their preferred communication method was to use makaton and PECS.
Staff interaction with people was, at times, limited to functional task driven communication. Staff were observed to be having conversations amongst themselves over lunch rather than engaging with the people they were supporting. We also observed staff speaking about people rather than to them.
We saw audit tools were in place but these had not been completed. The registered manager told us they had not had a chance to complete any audits yet. This meant there was no effective and robust system in place to monitor and assess the quality of the service provision.
Safeguarding policies and procedures were in place and staff understood what their responsibility was in relation to reporting concerns. Accidents and incidents were recorded manually and electronically and one person had a behaviour chart which was being used to analyse the impact of a medicine change.
A range of health and safety risk assessments were in place and a fire risk assessment and emergency evacuation plan had recently been updated. Each person had a personal emergency evacuation plan and people were involved in fire drills so they knew what the fire alarm meant.
There were enough staff to meet people’s needs and the registered manager said staffing levels were calculated based on people’s activities. No dependency tool was used and they said there were no contracts in place specifying commissioned hours. One care manager told us one person was funded for five hours of two to one support each day if needed for community activities.
Recruitment was effective with the appropriate level of pre-employment checks in place. The registered manager explained they included people in the recruitment process as prospective staff would come to the service for a meet and greet opportunity and to go out on an activity with people so staff could assess their level of engagement and interaction. This information was then used in the staff selection process.
The staff team were long standing and had a good understanding of behaviour which may challenge. Documentation was in place which described potential triggers for behaviour; a description of the behaviour and how the staff should respond.
Medicines were stored safely and records were completed with double signatures and a senior administration check was completed for each administration. Records were kept when medicine was taken away from the service when people went home for a day or an overnight stay.
Freshly prepared food was on the menu every day and people were supported to have a well-balanced diet.
Health records were in place and seizure monitoring was used to inform meetings with one person’s neurologist.
Activities plans were in place and staff completed a daily record of activities people had engaged in, although we did not see evidence of any analysis of people’s enjoyment of these activities.
A complaints policy and procedure was in place. We could not see an audit trail of how one recent complaint had been managed in relation to the acknowledgement of how the complaint would be addressed and who by.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
You can see what action we told the provider to take at the back of the full version of the report.