Archived: Lomack Lodge

This inspection took place on 7 February 2018. It was announced, we gave very short notice to make sure there would be a staff member present when we visited.

Lomack Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lomack Lodge accommodates up to seven people in one two storey residential building. At the time of our inspection there were three people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Why the service is rated Good.

There was a registered manager at 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.

Staff knew how to respond to possible harm and how to reduce risks to people. Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made to staff practise or the environment, to reduce further occurrences. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Medicines were stored and administered safely. Regular cleaning made sure that infection control was maintained.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. People received a choice of meals, which they liked, and staff supported them to eat and drink. They were referred to health care professionals as needed and staff followed the advice professionals gave them. Adaptations were made to ensure people were safe and able to move around their home as independently as possible. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and care records provided staff with clear, detailed guidance in how to do this. There were activities for people to do and take part in and people were able to spend time with their peers. A complaints system was in place and there was information in alternative formats so people knew who to speak with if they had concerns. An end of life policy was being developed to support people and staff.

Staff worked well together and felt supported by the management team, which promoted a culture for staff to provide person centred care. The provider’s monitoring process looked at systems throughout the service, identified issues and staff took the appropriate action to resolve these. People’s views were sought and changes made if this was needed.

Further information is in the detailed findings below

Lomack Lodge provides care and support for up to seven people with learning disabilities and complex needs. The service is located in close proximity to Bedford town centre. On the day of our inspection there were three people living in the service.

During our inspection in October 2016, we found that accidents and incidents had not always been reviewed appropriately to determine whether they should be raised as a potential safeguarding. This meant that systems and processes were not operated effectively to ensure that people were protected from potential abuse.

This was a breach of Regulation 13 (1) (2) (3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that risk assessments were not always reflective of people's current needs and the guidance contained within them was not always consistently carried out by staff. This meant that risks to people's health, safety and well-being were not effectively managed.

This was a breach of Regulation 12 (1) (2) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People's care and treatment was not always planned to ensure their preferences and needs were met by the service. People and their family members were not always involved in making decisions about their care.

This was a breach of regulation 9 (1) (a) (b) (c) (3) (a) (b) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found that the registered person had not consistently implemented effective systems or processes to assess, monitor and improve the quality and safety of the services being provided.

This was a breach of Regulation 17 (1) (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had a registered manager who was new in post. 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 and associated Regulations about how the service is run.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make. We undertook this unannounced focused inspection on 01 February 2017 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lomack Lodge on our website at www.cqc.org.uk

We reviewed the safeguarding systems in place and found staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. Accident and Incidents had been investigated by the provider and action had been taken to ensure that people were safe from avoidable harm or abuse.

Improvements had been made to people’s risk management plans to protect and promote their safety. Staff had received training in relation to risk assessments and we found that all risk assessments had been reviewed and updated to reflect peoples assessed needs.

Improvements had been made to the care plans so they provided staff with sufficient guidance to meet people's specific needs and wishes. We observed that people's care was delivered in a person-centred manner and was reflective of their specific needs recorded in the care plans.

Staff were positive about the improvements made at the service and felt supported by the registered manager. Effective quality assurance systems had been implemented which were used to good effect and to improve on the quality of the care provided.

While improvements had been made we have not revised the rating for this key question; to improve the rating to 'Good' would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.

Prior to this inspection we had received concerns in relation to the way in which people were cared for at the service, staffing levels and the general management of the service, including the staff culture. The concerns raised alleged that staff did not always take appropriate action to safeguard people from abuse and neglect and did not always provide them with the required care to meet their needs. Allegations also claimed that individual risk assessments were not always adhered to in order to keep people safe, and that staffing levels were not conducive to allow staff to perform their duties or to support people to undertake their preferred activities throughout the week.

Concerns had been raised in respect of people’s dietary intake; stating that the service had no food or finances available to purchase food items. Alongside this it was also alleged that the general culture and morale amongst staff was poor following the registered manager’s recent absence from the service. Concerns had been raised about the impact that this absence had upon the people that lived at the service.

There was a registered manager in post although they were absent from the service at the time of our inspection. 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. The service was being overseen by a registered manager from one of the providers other services, with support from the quality and compliance manager, office manager and provider.

This inspection took place on 11 and 12 October 2016 and was unannounced.

We found that accidents and incidents had not always been reviewed appropriately to determine whether they should be raised as a potential safeguarding. This meant that not all incidents had been referred to the local authority for further investigation and that appropriate action was not always taken to keep people safe from abuse or neglect. Potential service user on service user safeguarding incidents had not always been reported to the relevant external agencies.

Risk assessments were not always reflective of people’s current needs and the guidance contained within them was not always consistently carried out by staff. This meant that risks to people's health, safety and well-being were not effectively managed.

Care plans did not always provide staff with sufficient guidance to meet people's specific needs and wishes and were often not user-friendly. We found that care plans had not consistently been reviewed and there was no evidence to show that people or their families had been involved in reviewing them. As a result they were not always reflective of people’s current needs and requirements.

Quality monitoring systems and processes had not always been used as effectively as they could be to ensure that action was taken to make improvements when required. Audits checks and satisfaction surveys had been completed but there had been no attempt to analyse or have oversight of the outcome of these in order to drive future improvement. Although the staff we spoke with felt positive in respect of their roles, it was apparent that there had been an adverse impact caused by the absence of the registered manager.

There was sufficient staff on duty, with the correct skill mix, to support people with their needs. Staff were able to meet people's basic care needs, however; there deployment within the service could have been improved so as to provide people with increased levels of support at mealtimes.

People were not able to comment on whether they felt safe but their demeanour was generally relaxed in the presence of staff. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in their knowledge of how to report them.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day. We found that people were supported to access a variety of health professional when required, including opticians and doctors, to make sure they received appropriate healthcare to meet their needs.

We identified that the provider was not meeting regulatory requirements and was in breach 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We found that people were protected and kept safe because the service had effective systems in place to ensure allegations of abuse were reported and responded to and that the systems in place were monitored on a regular basis. Staff we spoke with had received training in a variety of subject areas and were clear about their responsibilities. People who used the service benefited from being provided with information in an appropriate format.

There was a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards which meant that people's human and legal rights would be upheld. Records showed that the service had carried out mental capacity assessments for some people when required. These assessments documented a clear rationale about what the decision to be taken was and why it was in the persons' best interests.

Staff responded to behaviour that challenged in a proactive manner that respected the individual. Any risks to people as a result of their behaviour, environment or health had been assessed and monitored by the service.

Is the service effective?

Care plans were individualised to people and contained information in relation to their personal preferences, needs, wishes and routines. We found that people's care was delivered in a way that reflected this information. Care plans in relation to behaviours that challenged had been developed and provided staff with guidance in how to communicate effectively. This ensured that the staff had valuable knowledge and expertise about people to utilise.

We found that people's representatives were involved in the delivery of their care and support when appropriate and that staff knew how to access to advocacy services when necessary.

People were supported to maintain good health by on-going monitoring and referral to appropriate health professionals when necessary.

Staff had a good understanding of the needs of people who used the service and had received relevant and appropriate training and support to ensure they delivered effective and person centred care.

Is the service caring?

Our observations showed that staff interacted with people in a positive way and treated them with respect and kindness. Staff showed consideration for people's individual needs and provided care and support in a way that respected their diverse wishes and preferences.

Staff spoke positively about their role and the support they provided. We observed that staff reacted in a timely manner to people's requests and that the friendly, approachable manner that they adopted with people, ensured it enhanced people's experience of the care and support the received.

Is the service responsive?

We found that proper consideration had been given to supporting people to engage in meaningful activities and the service promoted people's independence and community involvement. On the day of our inspection, one person was attending a day centre and another was going to college. One person told us that they had been on holiday and said, 'We had a really good time.'

Care plans and records demonstrated people's involvement in the delivery of their care and support and in the running of the service. Staff gathered people's views in a number of ways including questionnaires, residents meetings and through key worker engagement. We saw that the service responded to people's changing needs and wishes.

People's consent was sought in relation to the provision of care and staff understood the procedures they should follow if people did not have capacity to make a decision at the time it needed to be made. This meant that staff were able to respond in a way that ensured people's legal and human rights.

The service had an appropriate complaints policy and responded to concerns and complaints effectively. We were provided with information to evidence that two versions of the complaints policy were available. One is in large print using pictures, and the other using symbols so that people can understand the content. We also found that the provider enabled people to raise concerns during the weekly service user meetings. This demonstrated that people were given opportunities to discuss any issues or concerns that they had in a supportive environment.

Is the service well- led?

The service had been organised to meet the needs of the people who used it. There was a positive culture which promoted people's rights and independence. Staff were clear about their roles and responsibilities and demonstrated this in their values and behaviours.

Staff felt that the service was well-managed and had confidence in the registered manager. One member of staff said, 'The manager has an open door policy and the whole team discuss issues on an ongoing basis.' There was a consistent staff team that had been supported to receive training and development that would enable them to meet people's complex needs. The manager had ensured there were enough staff on duty at all times to provide effective and appropriate care.

There was a robust quality assurance system in place that monitored the risks to people and others and ensured the service was learning and continually improving.

We looked at people's care records and found that people were involved in planning their care and making decisions about their support. Some people were out shopping or at the day centre, and others were given the choice of how they wished to be involved in carrying out tasks to support their personal development. One person confirmed the different activities they participated in.

During our inspection, we reviewed the premises and found some building work was taking place. This had been planned so that it did not impact upon the people living in the home. One person told us, 'My room will be finished soon and I am looking forward to it.'

We looked at staff rotas and saw evidence there was sufficient staff to meet the needs of the people at Lomack Lodge.

We reviewed the quality assurance processes in place within the home and found that these ensured that the service monitored the care that was being delivered to the people who used the service.

We spoke with two people using the service. One person told us, "I'm happy here, I like it." Another said, "It's good here." The people we observed during our visit were happy and relaxed in the company of staff providing care and support for them. Music was playing in the lounge and we observed that three residents were engaged in an activity of their choice. The atmosphere in the home was homely and relaxed and people walked about freely. This meant that people were at ease in their environment and with the staff who supported them.

Staff interacted with people appropriately, using their preferred method of communication and encouraged them to make decisions about all aspects of their lives, this included how they spent their time and what they had to eat. One resident was supported to leave the house to go out as this was part of their preferred routine and something that they enjoyed. Other people accompanied staff to do the weekly food shopping as this was something they liked.

We saw that people's care records contained detailed information to show how they were to be supported and cared for. People told us they were looked after by staff who look after them well.