About the service
Swanage Lodge is a care home for up to six adults with mental health needs. At the time of the inspection, six people were living at the service. The registered manager also managed another registered care home and supported living services. The staff worked across all of the services.
People’s experience of using this service and what we found
People were not cared for in a safe way. There were risks within their environment which had not been monitored or mitigated which included failures to follow systems to manage infection prevention.
People's money was not safely managed. Records of financial expenditure were incomplete. In some instances, receipts were not available to account for how money was spent. One person was not being supported to manage their savings account in a safe manner as poor record keeping meant we could not confirm what savings they had and how their money had been used. We raised a safeguarding alert about this with the local authority.
The provider had not identified serious failings at the service or risks to people, despite recording that they had completed audits on different aspects of the service, such as health and safety, infection control and people's money. There had been a lack of oversight which led to poor practice and poor record keeping. Incidents were not recorded in a manner which allowed for provider oversight and lessons were not always learnt following incidents.
People's needs were not always met. One person who had complex needs was not being supported to manage their behaviours in a way which addressed their dual diagnosis of mental health and learning disability.
Medicines were generally managed in a safe manner with a few aspects which could be improved. We have recommended the provider reviews the guidance in relation to the management of medicines in care homes.
Three of the people who lived at the service told us they were happy at the service. Care workers spoke positively about management support and told us they thought there were enough staff and enjoyed working as a team.
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 supported this practice.
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.
This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The care provided by staff maximised people’s choice, control and independence. Care plans were mostly person-centred, and we made a recommendation the provider should review their systems and processes to achieve best practice when working with people who have learning disabilities and autism. Staff promoted people’s dignity, privacy and human rights. The ethos, values, attitudes and behaviours of the managers and care staff ensured people using services led confident, inclusive and empowered lives.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The rating at the last inspection was good (published 7 May 2020).
Why we inspected
The inspection was prompted due to concerns received about this location and the other provider’s location. In particular, we were alerted to concerns about how people's money was being managed and staffing arrangements. A decision was made to inspect both of the provider's registered services on the same day to assess whether people were being safely cared for. We focused our inspection on the key questions of Safe, Responsive and Well-led because the concerns we had received related to these.
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 have found evidence that the provider needed to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.
The key questions of Effective and Caring were not looked at on this occasion.
The overall rating for the service has changed from good to inadequate. 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 Swanage Lodge on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment and good governance 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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.