Shrub End Lodge

Updated 5 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 1 inspector.

Service and service type

Shrub End Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Shrub End Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 6 July 2023 and ended on 7 August 2023. We visited the service on 11 and 26 July 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We received feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) since the last inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who use the service about their experience of the care provided and 2 relatives. We spoke with 4 members of staff including the manager. We observed staff interactions with people and observed care and support in communal areas. We reviewed a range of records, including 3 people's care records, multiple medicine records and risk assessments. A variety of records relating to the management of the service were reviewed.

Updated 5 September 2023

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.

About the service

Shrub End Lodge is a residential care home providing accommodation and personal care for up to 6 people. At the time of the inspection, 5 people were living in the service. The premises is a residential property in keeping with the other houses in the area.

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

Right Culture

Quality assurance systems were not always robust, and improvements were needed in relation to management of environmental risks, MCA processes, recruitment, and training. The provider was not present at the inspection, and we were not assured the manager overseeing the service had sufficient knowledge in relation to regulatory and legislative requirements and current best practice guidance.

People told us they liked living at the service and were happy with staff support. A person told us, “It is lovely here, staff are magnificent to me. They are excellent.”

People were supported by staff and management who knew people very well. People and those important to them were involved in planning their care.

Right Support:

Not all environmental risks had been mitigated and whilst the manager did respond to our concerns and sent us information following the inspection, the management of Legionnaires had been a recommendation in a previous inspection which had not been met. Staff had training on how to recognise and report abuse and they knew how to apply it. Medicines were managed safely

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

Staff enabled people to access specialist health and social care support in the community. People were able to personalise their rooms.

Right Care:

Staff respected the people they supported and provided care that was kind and caring. Staff supported people to take part in activities and pursue their interests in their local area, however, we received some feedback people would like to go out more. Staff responded to people’s individual needs.

Staff had received training in some mandatory areas including fire, infection control, first aid and dementia awareness. However, there remained gaps in staff training.

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 on 12 December 2018).

Why we inspected

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.

We received concerns in relation to governance processes, safeguarding and MCA processes. As a result, we undertook a focused inspection to review the key questions of safe, effective, 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 requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective, and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to staff training and governance arrangement at this inspection.

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

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.