The inspection was unannounced and took place on 15 August 2016. May Lodge is a care home which provides care and support for up to 6 people with learning disabilities or autistic spectrum disorder with additional physical disability needs. The service is located in bungalow accommodation and fully accessible for people in wheelchairs. The service is set within residential housing but is set back from a busy road and off street parking is available. At our previous inspection of this service in February 2016 we found the service was not meeting the required standards of quality, safety and personalisation of care and support to the person living there at that time and there were significant shortfalls, the service was placed into special measures. We took enforcement action against the provider and asked them to tell us what they were going to do to put the shortfalls right. Since that time the provider has kept us informed regularly of progress they have made towards meeting the required standards. This inspection was to assess whether the improvements they had told us about had been embedded and were now everyday practice.
At the time of our inspection a second person had been admitted within the past week and a third had been assessed and was commencing transition to move to the service. People were unable to tell us about their experience of care but when we met them they were relaxed in the company of staff and in good moods. A relative spoke positively about the quality and delivery of care provided by staff to their family member.
A registered manager had not been in post since December 2015, although there was an on-going recruitment for this. A registered manager is a person who is 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.
Our inspection highlighted that whilst there had been significant progress made there were still shortfalls that needed further work to evidence they fully met the requirements of some regulations. The use of medicines in the service had been minimal with an occasional ‘as required’ medicine used, however with the admission of more people there was now a need for staff to administer prescribed medicines and we noted some shortfalls within the current system that needed to be attended to. A framework was in place for the assessment of both individual and environmental risks to ensure people were kept safe but there were some risks that had still to be assessed and this could place people at risk of harm.
People referred to the service were assessed prior to admission and a programme of transition implemented to enable them to familiarise themselves with the new service; some key information however, had still not been sufficiently detailed about people’s needs and this left staff still asking questions in relation to needs and support around this. Staff said access to training had improved but some important relevant courses were still outstanding for some staff.
Quality audits were in place but not always carried out robustly or evidenced clearly that actions had been taken to provide assurance that the service was meeting standards.
Staff had an understanding and awareness of the Mental Capacity Act, capacity assessments were being undertaken but staff did not recognise that some of their practice could be considered as restrictive and should be discussed within a best interest discussion. Staff respected people’s choices but there was a risk their privacy could be compromised without appropriate equipment to alert them to the presence of others. A lack of skilled communication by staff could lead to isolation for some people. People were consulted about their menu choices but there was some repetition in the meals provided to them on some weeks.
Incidents of behaviour which challenged were assessed and trends and patterns informed the development of guidance and strategies for staff, however these were overdue and staff still lacked confidence in managing incidents that were very challenging at times.
There were enough staff to keep people safe and the number of staff would increase as new people were admitted. Recruitment procedures ensured that appropriate checks were made of prospective staff in accordance with requirements of the legislation. Staff said that the improved interim management arrangements made them feel better supported and more confident when issues arose that they wanted or needed guidance and support with. They had regular opportunities through staff meetings and individual supervisions to express their views and receive support around their training and development. New staff received induction and were registered for the care certificate but still to commence this. Staff had not been in post long enough to have their performance appraised but new staff experienced a probationary period when they met with a member of the interim management team to discuss their progress.
There had been no complaints and relatives told us they felt confident of making a complaint should they need to do so. The complaints procedure was clearly displayed within the service and an easy read version available, the provider recognised this needed further revision to meet the needs of people in this service.
A comprehensive care plan had been developed to inform staff how to provide support to people in accordance with their needs and wishes. Improvements had been made to range of activities provided to people and transport was available to enable them to go out into the community; each person was provided with an individualised activity schedule that reflected their interests.
The premises were well maintained a maintenance team provided appropriate support for repairs and servicing checks and tests of equipment were completed within timescales. Fire procedures and evacuation plans were understood by staff and they understood how to protect people from harm and keep them safe, but we have recommended discussion around personal evacuation plans with the fire service. Peoples general health needs were supported and appropriate referrals made to health professionals for support and advice.
Peoples relatives were made welcome and people were supported to maintain contact with important people in their lives. Relatives felt informed.
Updated policies and procedures were in place and staff had been asked to read and sign that they had read those relevant to their role and support of people. The management staff understood their responsibilities to alert the Care Quality Commission to events in the service but had not had to do so to date.
People were supported and enabled to develop independence skills. They were supported to personalise their own space. Key workers spent time with people to try and engage with them and listen to what they had to say or sign to them.
As this service is no longer rated as inadequate, it will be taken out of special measures. Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of Regulations. We will continue to monitor May Lodge to check that improvements continue and are sustained.
We have made three recommendations:
We recommend that the provider seek advice from the fire service on the appropriateness of personal evacuation plans in respect of people being left behind fire doors in the event of a refusal to leave.
We recommend that the provider seek advice from a competent source regarding appropriate doorbell systems for hearing impaired people.
We recommend that the provider seek guidance from a competent source on the development of a suitable, appropriate and accessible complaints format for people with complex needs and very limited verbal skills.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.