Neville Lodge

Neville Lodge is a residential care home providing personal and nursing care to up to 6 people. The service provides support to adults with learning disabilities and autistic people. At the time of our inspection there were 4 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.

Right Support: People's support needs and risks associated with their care were not always appropriately managed to

ensure safe care could be provided. The provider did not have effective systems in place to protect people from avoidable harm. Physical restraint was being carried out without robust processes and procedures being followed. People were at an increased risk of being restrained inappropriately and therefore at risk of harm. People were not consistently supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We made a recommendation about mental capacity. The home was well maintained, and environmental safety checks were taking place. There were plentiful facilities for people to use and lots of space both inside and outside for people to utilise.

Right Care: Systems and processes were not always effective in ensuring people were protected from the risk of abuse and staffing was not always provided in line with people's needs. People were not always supported by staff who had been trained to do their jobs properly. This meant people were at risk of receiving unsafe care. The provider used effective infection, prevention and control measures to protect people from infection control risks. We were assured that the provider was using PPE effectively and safely. Staff supported people safely with their medicines and worked with health professionals to achieve good health outcomes. People lived in a safe and well-maintained environment which was set up to maximise their independence.

Right Culture: There were several areas falling short of the necessary standards during the inspection. There had been a lack of leadership at the service. Systems were not in place to support effective oversight and governance. This meant that risks to people were not always identified and managed and records were not consistent and accurate. Whilst there were some systems in place to identify shortfalls these systems needed further strengthening and embedding into practice and provider oversight needed to improve. The provider gave a thorough and detailed action plan giving us assurances that action would be taken to address the concerns identified through the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 10 August 2022).

Why we inspected

We received concerns in relation to people’s safety, culture, staffing and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

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

Enforcement and Recommendations

We have identified breaches in relation to safeguarding, risk monitoring, training and governance at this inspection. We have made a recommendation about following the Mental Capacity Act and associated guidance.

Please see the action we have told the provider to take at the end of this report.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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.

About the service

Neville Lodge is a residential care home providing personal care and support to people with learning disabilities and/or autistic people. There were two people living there at the time of the inspection. The service can support up to six people.

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

Right support

People were supported in a safe environment. Staff supported people in a safe way. Staff followed safe practice to reduce the risk of COVID-19 spreading within the service. Staff encouraged people to live full lives and meet their goals which included learning new skills. The provider, management and staff team developed the service in way that ensured they had the resources and knowledge to support people when they experienced periods of distress. Restrictions were minimised and people had the freedom and choice in how to live their lives.

Staff received the right training for their role, and this included training for specific complex needs people had. People were supported to communicate their needs, views and choices. Communication plans and tools were personalised to enable this. People were supported to personalise their rooms.

People were supported to access the community and to join in with activities and days out in their local area. People were supported by staff to live healthy lifestyles and access health and social care support. This helped improve people's wellbeing. Medicines were managed safely and were regularly reviewed.

Right care

People received support and care that was kind, compassionate and reflected people's own culture and preferences. Staff promoted people's equality and diversity, supporting and responding to their individual needs. People's care plans were an accurate reflection of the support they needed and what people could do independently. They included strategies and plans to help people reach their aspirations and goals.

Staff had received training on safeguarding people from the risk of harm and abuse. Staff knew how to recognise and report abuse. There were enough appropriately skilled staff to meet people's needs and keep them safe.

People were supported by staff who had a good understanding of people's needs, how people communicated and what their preferences were. Staff listened to people. People received care which supported their needs and aspirations, was focused on their quality of life, and followed best practice.

Right culture

The provider, registered manager and staff monitored the quality of service provided to people. People, their relatives, staff and professionals were involved in the process. People were supported by staff who had a good understanding of best practice and how to implement this into their roles. Staff put people's wishes, needs and rights at the heart of everything they did.

People and their relatives were involved in planning their care. This helped to ensure people had a service that was tailored and personal to them. Staff respected people and their views. People had been put at the forefront of all they did. The risk of a closed culture was minimised as people received care and support in line with their wishes, and staff were open and inclusive.

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

This service was registered with us on 23 March 2021 and this is the first inspection.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.