Herons Lodge

The service provides accommodation and personal care to people with a learning disability and or autism and people with mental health needs. The care home can accommodate 10 people in one adapted building. At the time of our inspection, there were 7 people using the service.

People's experience of the 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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Following the last inspection, the provider had made improvements, and this had a positive impact and outcomes for people living at the service. This was confirmed by feedback from partner agencies, relatives, staff and by reviewing internal systems and procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right support: Guidance for staff of how to meet people’s individual care and support needs, including actions to mitigate known risks had been reviewed and updated. Information was detailed and reflective of people’s routines and preferences.

Safeguarding and whistleblowing procedures were regularly discussed with staff to ensure they felt confident to act upon any concerns. An internal investigation had also been completed to ensure people’s individual daily and night routines and preferences were respected and met.

People received their medicines safely. Staff responsible for administering medicines had received additional training and their competency assessed. Fire risks had been reviewed and action taken to mitigate risks. This included increasing the number of night staff available.

Right Care: Staff deployment and recruitment had been reviewed and improved upon. This improved safety and provided greater opportunities for people to lead active and fulfilling lives. Staff were kind, caring and knew people well. Relatives were positive and spoke highly of the staff.

Right Culture: The provider’s systems, processes and oversight of the service that assessed, monitored and reviewed quality and safety had been improved upon. However, further time was required for these to become fully embedded and sustained.

Staff had completed refresher training and received opportunities to discuss their work, development and training needs and further training and support was planned. Internal staff communication systems had been reviewed and improved upon.

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 Requires Improvement (published 22 November 2023).

Why we inspected

We carried out an unannounced focussed inspection of this service on 9 and 10 October 2023. Breaches of legal requirements were found. We issued the provider with 2 Warning Notices and gave a date in which we expected compliance to be met.

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulation 17 Good governance and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) had made the required improvements and to confirm they now met legal requirements. We found the breaches in regulation had been met. This report only covers our findings in relation to the Key Questions Safe, Effective 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 changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow Up

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

The service provides accommodation and personal care to people with a learning disability and or autism and people with mental health needs. The care home can accommodate 10 people in one adapted building. At the time of our inspection, there were 7 people using the service.

People’s experience of the 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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People were not 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.

Right support: Guidance to support staff on how to mitigate known risks were not consistently followed. Incidents were not analysed to identify themes, patterns and learning opportunities. Staff were aware of safeguarding procedures but had not always acted when they had concerns. Medicines best practice guidance was not consistently followed. The environment was clean and hygienic.

Right care: There was not enough staff deployed to meet people’s individual care, support needs and safety. This impacted on people’s opportunities to lead active and fulfilling lives. Overall, observations of staff engagement with people were positive, kind and caring. Relatives spoke highly of the caring approach of staff.

Right Culture: The provider’s systems, processes and oversight to monitor quality and safety were found to be ineffective. Staff had received limited training for working with autistic people and people who have a learning disability. Staff had not completed mental health training. Staff received opportunities to discuss their work but supervision meetings had not been completed at the frequency the provider expected.

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 24 January 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement

We have identified breaches in relation to staffing and governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will work alongside the provider and local authority to monitor progress of the improvements required. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

• The service is in a residential area of Market Harborough, close to the town centre.

• The service provides accommodation and personal care to people with learning disabilities and autism, people with mental health needs and younger people. The care home can accommodate 10 people in one adapted building. At the time of our inspection there were seven people using the service.

• This is one of 10 locations that the provider operates.

People's experience of using this service:

• The service did not comprehensively provide a safe service. It continued to provide, compassionate and well-led care.

• People liked living at the service.

• There was a homely atmosphere and the staff enjoyed caring for people.

• People were largely protected against abuse, neglect and discrimination. However, not all staff were not aware of how to ensure people's safety or how to act when necessary to prevent any harm.

• Staff knew people well. They had developed good relationships with people. People enjoyed the presence and attention from staff.

• People were assisted to have choice and control of their lives. However, the quiet lounge was locked, acting as a barrier to people freely using this room.

• People had a say in how the service was operated and managed.

• People's care was personalised to their individual needs.

• Appropriate governance processes were in place to ensure quality care.

• The service met the characteristics for a rating of "good" in key questions except Safe.

• More information is in the full report.

Rating at last inspection:

• At our last inspection, the service was rated "good". Our last report was published on 16 June 2016.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people received safe, high quality care. Further inspections will be planned for future dates.

Herons Lodge provides care and support for up to ten people who have mental health needs, learning difficulties or autistic spectrum disorders. On the day of our inspection there were seven people living at the service.

The service had a registered manager. 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.

People who were able to talk to us told us they felt safe living at Herons Lodge. Relatives we spoke with agreed that their loved ones were safe. Staff we spoke with understood their responsibilities for keeping people safe and were aware of what to look out for if they suspected that someone was at risk of harm.

The risks associated with people’s care and support had been assessed. Where risks had been identified, these had been where ever possible removed or reduced. This was so that people could be provided with the safest possible care.

The registered manager had carried out an initial assessment of people’s care and support needs prior to them moving into the service. This was so that they could be confident that people’s needs could be met by the staff team working at the service.

Before any new member of staff started working at the service, the necessary checks had been carried out. This was to ensure that as far as possible, only suitable people worked there.

All new members of staff had been provided with a comprehensive induction into the service. This enabled them to get to know the people using the service and learn the day to day requirements of the role of a support worker.

Not all of the staff team had received the training they required. The registered manager and operations manager immediately addressed this. A training plan was drawn up and where a staff member had not completed certain training, this was arranged. All outstanding training was expected to be completed by July 2016.

People received their medicines as prescribed and in a safe way. Medicines were being appropriately stored and the necessary records were being kept. There were thorough systems in place to audit the management of medicines.

People’s nutritional and dietary requirements had been assessed. They had been fully involved in the development of the menus that were in place and these catered for their individual needs.

People had been involved in making day to day decisions about their care and support and capacity assessments had been carried out when necessary. This was to assess people’s ability to make decisions for themselves. Although the registered manager and the staff members we spoke with understood the principles of the Mental Capacity Act 2005, not all of the staff members we spoke with had received training on this subject.

We were told that the staff team were kind and caring to both the people using the service and their relatives and friends. Observations during our visit confirmed this.

Meetings for the people using the service and the staff team were held on a regular basis. Weekly and monthly meetings provided the people using the service with the opportunity to be involved in the service and have a say.

Staff members we spoke with felt supported by the registered manager. They explained that they were given the opportunity to meet with them on a regular basis and felt able to speak with them if they had any concerns or suggestions of any kind.

There were systems in place to monitor the quality and safety of the service being provided. Regular audits on the documentation held had been completed and regular checks on the environment and on the equipment used to maintain people’s safety had been carried out.

Family members of people who lived at the home told us they were happy with the care and support provided.

One relative told us, 'I am very pleased with the quality of care.' Another family member told us, 'The manager is good, and deals with any questions straight away. She picks up the 'phone and makes time for me.'

We saw that rooms in the home were spacious, clean and decorated with personal effects of the people who lived there. We saw the staff approached their work in a caring and supportive manner. When we spoke with the staff they were able to explain their role to us and understood their responsibilities to ensure people were cared for appropriately and their needs were met.

We looked at the record keeping in the home and found that some improvements were required in security and storage of archived material. The Services Manager told us that new security cabinets were on order and an audit had been planned to review the management of information at the home.