Talbot Woods Lodge

Updated 3 January 2024

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 undertaken by 3 inspectors, 2 of whom visited the home, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Talbot Woods Lodge is a ‘care home’ without nursing care. 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. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We met most of the people living at Talbot Woods Lodge. We spoke with 5 of them and observed staff supporting people in communal areas. We also spoke on the telephone with 4 relatives about their experience of the support provided. We spoke with 7 members of staff including the registered manager, manager and deputy manager, and received further written feedback from 11 staff.

We reviewed a range of records. These included 2 people's care records and elements of a further 11 people’s care records, 15 people's medication records, and 3 staff files in relation to recruitment, training and supervision. We also reviewed a variety of records relating to the management of the service, including policies and procedures and quality assurance records.

Following the inspection

We received feedback from a healthcare professional.

Updated 3 January 2024

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

Talbot Woods Lodge is a care home accommodating 15 adults with a learning disability at the time of the inspection. The service can support up to 15 people.

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

Right Support:

People were not always supported to have maximum choice and control of their lives and staff did not always 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. This is because, whilst people were supported to make choices in many aspects of their lives, there were shortfalls in relation to physical restraint, certain aspects of medication and the Deprivation of Liberty Safeguards (DoLS).

Best interests decisions had not been completed in relation to the use of physical restraint and were not fully completed in relation to medicines that could be concealed in a person’s food and drink (known as covert administration of medicines) without their knowledge. This presented the risk that physical restraint and covert administration of medicines could be unlawful.

In other respects, mental capacity assessments and best interests decisions had been undertaken and recorded where appropriate, in line with the Mental Capacity Act 2005 (MCA). We have made a recommendation regarding the provider’s policy and procedures in relation to the DoLS.

Accommodating up to 15 people, the service was larger than many care homes that would nowadays be registered following the Right support, right care, right culture guidance. However, the appearance of the building was of a large domestic property, like the large houses that surrounded it. People living there, most of whom had lived there for many years, viewed it as home. They were often out and about, using local facilities.

People had free access to their bedrooms, communal areas such as lounges and the enclosed garden, which was in regular use. In their rooms, people’s independence was promoted through access to voice-activated smart televisions and music, and automated blinds.

Right Care:

People had their medicines as prescribed. During the inspection, staff consulted a pharmacist to ensure medicines mixed in a person’s food and drink were being administered safely. We have made a recommendation regarding medicines prescribed as required.

Some people had care plans that allowed for physical restraint in certain circumstances; staff were trained in this area. However, this practice was not always supported by risk assessments and plans from those people’s health and social care professionals. We have made a recommendation about care planning in relation to restraint.

People’s care and support needs and preferences were assessed and were regularly reviewed. Their dietary needs and preferences were met. Staff knew people well; they had a good understanding of people’s wishes and the support they needed.

People were relaxed and at ease with staff. Enough staff were on duty to provide the care and support people needed in the way they preferred. Staff were supported through regular training and were competent to support people safely and effectively.

The premises were clean, comfortable and well maintained.

Right Culture:

Governance and quality assurance systems were not robust. Although there were regular audits and reviews of various aspects of the service, these had not identified the breaches in regulation and areas for improvement that we found. The provider had not fully acted on a recommendation from the last inspection report published in April 2020. The registered manager had not ensured staff always informed CQC of legally notifiable incidents relating to people's health, safety, and welfare.

Talbot Woods Lodge had a friendly and relaxed feel. People and staff knew each other well and respected each other. People were happy and told us they enjoyed life there. Relatives were positive about the way staff supported their loved ones.

With support from staff, people routinely accessed medical, dental, and primary healthcare services as they needed. The service worked well with other organisations to help ensure people had good health outcomes.

People and relatives knew and felt able to approach the members of the senior management team. Staff also told us they felt able to raise any concerns with the management team. We have made a recommendation about communication with relatives.

Staff told us they felt well supported through training and supervision. The provider had arranged for staff to have mandatory training on autism and learning disability, in line with national guidance and expectations.

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 10 April 2020).

At our last inspection we recommended the provider considered current guidance on the MCA in practice. At this inspection we found they had made some improvements to mental capacity assessments and best interests decision making. However, we identified breaches in regulation relating to assessing mental capacity and making best interests decisions in relation to restrictive practice. We also found shortfalls in relation to working in line with conditions attached to DoLS authorisations, which the service was meeting by the end of the inspection.

Why we inspected

We received concerns in relation to safeguarding adults. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

We have found evidence that 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.

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

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.

Enforcement and recommendations

We have identified breaches at this inspection in relation to consent, specifically assessing mental capacity and making best interests decisions, to good governance and to ensuring CQC was notified of all notifiable incidents.

We have made recommendations in relation to care planning for restraint, working in line with DoLS, and communication with relatives.

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.