Talbot Woods Lodge

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.

Talbot Woods Lodge is registered to accommodate up to 15 people and provides care and support for people with learning disabilities. The service is split over three floors which were accessible by stairs. There were 14 people using the service at time of inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was registered to provide support to up to 15 people and there were 14 people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

The service met the requirements of the Mental Capacity Act (MCA). MCA assessments had been carried out for people in relation to their care needs. However, the paperwork was not clear about the specific decision being made.

We have made a recommendation about the MCA in practice.

People told us they were happy and felt safe. Relatives said staff had a good understanding of people’s needs and preferences. Risks had been identified and measures put in place to keep people safe from harm. Medicines were managed safely and administered by trained staff.

Staff listened to what people wanted and acted quickly to support them to achieve their goals and outcomes. Staff offered people solutions to aid their independence and develop their skills.

Staff were well trained and skilled. The emphasis of support was towards inclusion and enabling people to learn essential life skills. Equality, diversity and human rights were promoted and understood by staff.

People and relatives described the staff as caring, kind and friendly and the atmosphere of the home as relaxed and engaging. People were supported to have maximum choice and control of their lives.

People received pre-admission assessments and effective person-centred support. The service was responsive to people’s current and changing needs. Regular reviews took place which ensured people were at the centre of their support.

People, relatives and staff spoke highly about the management and staff had a clear understanding of their roles and responsibilities. The team worked together in a positive way to support people to achieve their own goals and to be safe.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve the service was noted and the registered manager was keen to make changes that would impact positively on people's lives.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 11 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Talbot Woods Lodge is a care home for people with learning disabilities. The home is registered to provide personal care for 15 people. At the time of the inspection there were 14 people living at Talbot Woods Lodge. One of the bedrooms was used for short stays.

At the last inspection in February 2015, the service was rated Good. At this inspection we found the service remained Good. There were improvements in how safe the service was and the ‘Is the service safe’ question is now rated Good.

Is the service Safe?

People’s medicines were managed safely and there was an improvement in how people’s PRN ‘As needed’ medicines were managed. Any risks to people were identified and managed in order to keep people safe.

There was a stable staff team who knew people well. Staff were recruited safely and agency staff were not used at the home.

Is the service Effective?

Staff received an induction, core training and specialist training so they had the skills and knowledge to meet people’s needs. Staff felt very well supported by managers.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in place supported this practice.

Is the service Caring?

People and staff had good relationships. Care was provided with kindness and compassion by staff who treated people with respect and dignity.

Is the service Responsive?

People received care and support in a personalised way that was responsive to their changing needs. Staff knew people well and understood their needs and the way they communicated. We found that people received the health, personal and social care support they needed.

There was an accessible complaints procedure in place and people knew who to talk to if they were worried or concerned. There had been no complaints received since the last inspection.

Is the service Well-led

The culture within the home was personalised and open. People and staff benefitted from the family atmosphere. There was a clear management structure and staff and people felt comfortable talking to the managers about any issues and were sure that any concerns would be addressed. There were systems in place to monitor the safety and quality of the service provided.

Further information is in the detailed findings below

People who use the service were not consistently protected against the risk of unlawful control or restraint because the provider had not made suitable arrangements. Records did not contain evidence of mental capacity assessments or best interest decisions where physical interventions were used.

There were enough qualified, skilled and experienced staff to meet people's needs.

People living at the home had complex needs which meant they were not always able to tell us their experiences. Therefore, in addition to speaking with three individuals we observed the support people received, reviewed records and spoke with the manager and five staff. The people we spoke with told us they liked the home.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people were unable to give valid consent, the provider acted in accordance with legal requirements.

People experienced care, treatment and support that met their needs and protected their rights. We observed that staff supported people in an attentive and dignified way.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. We saw that the home was clean and neatly decorated.

People were cared for by suitably qualified, skilled and experienced staff. Staff we spoke with said they enjoyed their work and received regular training. They confirmed that new staff worked under supervision.

The provider had an effective system in place to monitor the quality of the service and to manage risks to people's health, safety and welfare.

People's diversity, values and human rights were respected. We noted throughout the inspection that care workers were polite, respectful, patient and sensitive. The relatives we spoke with told us that care workers were also polite and respectful. A care worker we spoke to told us Talbot Woods Lodge was a 'very homely home'.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. A care worker we spoke with told us 'the clients come first'.

We found people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

People who use the service, their representatives and staff were asked for their views about their care and they were acted on.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

An individual told us 'it's a nice place to live'.