Archived: Coneyhurst Lodge

Coneyhurst Lodge is registered to provide accommodation and personal care for 10 people who have a learning disability. There were six people living in the service at the time of our inspection visit. All of the people had complex needs for care and most of them used sign-assisted language to express themselves.

The service was run by a company who was the registered provider. There was a registered manager 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 2008 and associated regulations about how the service is run. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 1 February 2017 the service was rated, ‘Requires Improvement’. Although there were no breaches of the regulations, we found that improvements needed to be made to ensure that the service consistently provided people with safe care and treatment. In particular, the arrangements used to protect people’s health and safety when they became distressed needed to be more robust. Changes also needed to be made to ensure that sufficient care staff were always deployed in the service. We also found that improvements were needed to the systems and processes used to manage the service. This was because the shortfalls we have already described had not been quickly resolved. Furthermore, there had been instances when care staff had not promptly liaised with people’s relatives about developments in their family member’s care and some care staff told us that there was low morale in the staff team.

At the present inspection we found that all of these problems had been addressed.

The service had 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. This helped to ensure that people with learning disabilities and autism using the service could live as ordinary a life as any citizen.

Our other findings were as follows: People were safeguarded from situations in which they may experience abuse including financial mistreatment. Medicines were managed safely. People had been helped to avoid preventable accidents while their freedom was respected. There were enough staff on duty and background checks had been completed before new care staff had been appointed. Suitable arrangements were in place to prevent and control infection and lessons had been learned when things had gone wrong.

Care was delivered in a way that promoted positive outcomes for people and care staff had the knowledge and skills they needed to provide support in line with legislation and guidance. This included respecting people’s citizenship rights under the Equality Act 2010. People received the individual assistance they needed to enjoy their meals and they were helped to eat and drink enough to maintain a balanced diet. Suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. The accommodation was designed, adapted and decorated to meet people’s needs and expectations.

People were supported to have maximum choice and control of their lives. In addition, the registered persons had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible.

People were treated with kindness, respect and compassion and they had been given emotional support when needed. Also, they had been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Furthermore, confidential information was kept private.

People received personalised care that was responsive to their needs. This included them having access to information that was presented to them in an accessible way. Also, people had been offered opportunities to pursue their hobbies and interests. Furthermore, the registered manager recognised the importance of promoting equality and diversity. This included appropriately supporting people if they chose gay, lesbian, bisexual and transgender life-course identities. There were arrangements to ensure that people’s complaints were listened and responded to in order to improve the quality of care. In addition, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

The registered manager had promoted a person-centred culture in the service and had made the arrangements necessary to ensure that regulatory requirements were met. People who lived in the service and members of staff were actively engaged in developing the service. There were systems and procedures to enable the service to learn, improve and assure its sustainability. The registered persons were also actively working in partnership with other agencies to support the development of joined-up care.

The service had a registered manager who had been recently registered in December 2016. 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.

At the last inspection on the 12 and 13 April 2016 we identified one breach of Regulations associated with personalised care. A recommendation was also made in relation to staff using consistent caring and compassionate approaches. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this visit, we found that the actions had been completed and the provider had now met the legal requirement.

At the last inspection, we identified people’s care and treatment did not consistently reflect their needs or preferences and care records were not regularly reviewed. This was in breach of Regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection, we found improvements had been made. Care plans had been developed and reviewed within the past month, they considered each person’s preferences and the support they required from the staff team to meet their needs. Care plans included how to support people positively to reduce their anxieties and manage behaviours which may challenge others; therefore this regulation was now met.

At the last inspection, we observed a lack of support provided by staff on duty for one person who seemed agitated. At this inspection, we found staff used a kind and compassionate approach involving people in choices about all aspects of their care including how they wanted to spend their day.

Prior to this inspection, the local authority shared their concerns with the Commission about the care and support being provided to people, particularly around managing behaviours which challenged. This included numerous safeguarding concerns regarding physical assaults by people who no longer lived at the home and how this was managed. The provider had notified us about incidents involving physical aggression between people and other notifiable events. Relatives and staff told us the home had not been a safe place for people to live. At this inspection systems had been put in place to consider the safety of those living in the home. However, further time and work was needed to ensure the systems were embedded in practice and sustained so that the safety of people is consistently protected in the future.

The provider had recently sent out satisfaction surveys to relatives to gain their views on the care provided. Most relatives told us about the difficulties they had experienced regarding poor communication with the home and had lost confidence with the provider and the support provided to their family members. We shared this feedback with the provider as this area required further improvement. The provider told us the action they would take which included inviting relatives to meet with them to discuss past experiences and recent changes in the home.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk from harm. People were treated with dignity and respect. Staff knocked on people’s doors before entering to promote privacy. Staff attended training provided and understood their role and responsibilities.

Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks. There were sufficient knowledgeable staff on duty to meet the needs of people and medicines were managed safely.

We found the home clean and tidy and people’s bedrooms were personalised with their own belongings such as photographs of family members or items of interest. The home had undergone a decoration programme which included new carpets. There was a maintenance plan in place which highlighted the areas of the home which remained in need of decorating which included the lounge.

People were offered enough food and drink and were given a choice of what and where they ate their meals. Staff responded to changes in people's health needs and their support was reviewed when required. If people required input from other health and social care professionals, this was arranged.

People were offered activities to attend in and outside of the home. Complaints were treated seriously and were overseen by the registered manager and the locality manager. People were provided opportunities to give their views about the care they received from the service, this included activity and menu planning meetings.

There was a range of audit processes to measure the overall quality of the service provided to people and to make improvements.

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 did not always receive the care or support they required. During our inspection we saw one person who appeared to be agitated and staff did not take action to engage with them to ensure their needs had been met.

People's support plans were not always reviewed and updated as needed and information available to staff did not always reflect their current needs. We saw that people's positive behaviour support plans had not been reviewed for a considerable period of time. A communication aid, identified in one person’s care plan, was not being used by staff to support them. However their care plan had not been updated to reflect the support the person currently received to meet this need. There were not enough meaningful activities for people to take part in and activity records showed that people were not taking part in activities as planned.

People were protected by staff who knew how to recognise and report the signs of abuse. Staff had received regular safeguarding training.

Safe recruitment practices were followed. Disclosure and Barring Service checks (DBS) had been requested and were present in all checked records. There were sufficient numbers of staff on duty to keep people safe and meet their needs.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

Staff received all essential training had monthly supervision meetings and annual appraisals. People had access to healthcare professionals and all their appointments were recorded in a diary.

People’s rights were upheld as the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards had been adhered to. The registered manager had made applications for all the people living at the home. We were told that these had been carried out with support from the community psychiatric nurse to ensure they accurately reflected people’s current level of need.

Staff encouraged people to remain as independent as possible. We saw that the guidance in people’s care plans reminded staff to encourage people to be as independent as possible.