Archived: Donylands Lodge

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.

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

Feedback from relatives, review of care records and analysis of information shared with CQC reflected further work was needed to ensure risks were properly assessed and managed to promote people’s and staff’s safety. This specifically related to people using the service whose needs, and anxieties may put themselves or others at risk of harm.

There was no registered manager in post and the service was being managed by a senior operations lead. Donylands Lodge provided personal care in ten supported living services within the local area. There has not been a stable management team in place. This has led to a poor staff culture, lack of leadership and oversight of the service. This resulted in risks to people's and staff’s safety not being identified and managed effectively. The provider was taking steps to improve this, and a new manager had been recruited and started on 01 September 2021

Quality assurance arrangements and serious incident reviews had not always been learned from or reduced reoccurrence of incidents. There continued to be repeated medicines errors as well as times where people’s anxieties had resulted in some incidents of violence and aggression. The providers governance framework to assess the quality and safety of the service, had not been fully embedded in the service to drive the required improvements.

High turnover of staff and use of temporary agency staff at Donylands Lodge and some of the other supported living services had impacted on the provider’s ability to consistently meet people’s complex needs. The provider was working on strategies for the recruitment of new staff. Recruitment systems needed to improve to ensure staff are of good character and suitable to work with people using the service. Staff training was not up to date to ensure they had the skills and experience to carry out their roles effectively.

Relatives raised concerns that people’s complex healthcare needs were not always being met resulting in poor diet, poor health and poor hygiene. There was a focus for improvement to support people to make healthier choices. People were supported to access their GP or other healthcare services.

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.

Right support:

The provider had recognised the current layout and design of some its supported living services did not maximise people’s choice, control and independence. Plans were in place to redesign some services. People were involved in decisions about the redesign of their living accommodation and what they would like to do with their space.

Right care:

The providers website states the service has a focus on helping people become more independent, by maximising opportunities, minimising the amount of intervention required and teaching coping strategies to help with situations which trigger anxieties. Although there were improvement plans in place for this, relatives shared experiences was that the service did not yet provide the right care and specialist support, particularly in relation to their loved one’s complex behaviours and health.

Right culture:

The nominated individual, senior operations lead, area manager and manager have worked with commissioners of care, safeguarding and other professionals in an open and transparent way. They have recognised and acknowledged the improvements needed. They have provided plans to ensure people using the service are supported to lead confident, inclusive and empowered lives. Relatives and staff told us the service was improving under the new leadership team.

Complaints had been managed inconsistently across the services. Where they had been investigated these had been responded to in a timely way and the outcomes used to improve the service people received.

Further work was needed to ensure people's views about end of life care, including their individual religious and cultural values and beliefs, were known, respected and acted on.

We have made a recommendation about end of life care arrangements

The provider acknowledged the difficulties during COVID-19 for people to take part in routine hobbies and access community activities. They had created outdoor activities to prevent isolation, including an Olympics event and a garden and flower project competition.

Rating at last inspection

This service changed their legal entity on 23 July 2020, and this is the first inspection. The previous provider TLC Care Homes Limited transferred their existing locations to TLC Care Homes Colchester Supported Living Ltd. The last rating for the service under the previous provider was Good published on 05 October 2019.

Why we inspected

The inspection was prompted in part due to concerns about repeated medicines errors, staffing numbers, high number of safeguarding concerns and whistle blowing’s about the quality and safety of the service and the impact on people. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the key question safe. 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. We were assured the provider had systems in place to manage the control and prevention of infection well.

We have found evidence that the provider needs to make improvements. We found no evidence during this inspection that people using the service had been harmed, but staff were not always safe because risk management strategies needed to be improved. Please see the safe, effective, caring, responsive and well led sections of this full report. The provider had taken action to mitigate the risks to people. They had recognised that the service cannot meet the needs of some people they care for. They were working with professionals, people and their families where this was needed.

We have identified breaches in relation to safe care and treatment, management of medicines, recruitment practices and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Donylands Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.