Preceptory Lodge

Preceptory Lodge is a small residential care home providing personal care for up to 8 people with autistic spectrum disorder or learning disabilities. At the time of the inspection there were 6 people living in the service, two in the bungalow and four in the main house.

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

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.

Right Support: Staffing difficulties meant that some people did not always have the correct support available to them. We did not find that any harm had come to the people from this concern, however, the lack of staffing in the service increased the risk of harm. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. However, records did not always reflect best practice guidance. We made a recommendation about this. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Safety checks were taking place on the emergency equipment; however, more work was needed to ensure all fire safety precautions were in place. We made a recommendation about this. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. 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.

Right Care: Staff understood people’s needs however, the service did not always ensure their training was up to date and that their competency in administering medication was reviewed. Staff told us they felt well trained and supported by the senior management team however, the delay in refresher training increased the chances of poor practice. Support plans were in place to help guide staff on how to care for people. These records reflected people’s preferences however, some areas needed updating and expanding to ensure they fully reflected the people’s range of needs. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people's individual needs. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

People and their relatives told us they were happy with the care provided by the service, one relative said, “I feel fortunate [Person] is there, it’s like going to someone’s home, very homely and [Person] seems happy.”

Right Culture: Quality systems had been developed to review and monitor the care in the service however, these failed to highlight some of the concerns raised from the inspection. The management team promoted an open culture, which supported learning lessons from when things went wrong, but records did not always reflect this. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes, needs and rights at the heart of everything they did.

Staff told us they felt well supported in their roles and found the management team approachable. They would not hesitate to raise concerns and discuss ways on how to improve the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 December 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety and governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 remains as requires improvement. 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 Preceptory Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the staffing and the governance of the service at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Preceptory Lodge is a small residential care home providing personal and nursing care for up to eight people with autistic spectrum disorder or learning disabilities.

At the time of the inspection there were six people living at the service, two in the bungalow and four in the main house.

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

The quality assurance and audit systems in the service were not developed or used effectively. Shortfalls in quality and practice were not identified which placed people at risk of harm.

The systems in place to check the equipment and safety of the premises were not always followed or recorded. We have sought reassurances about the systems in place to ensure the safety of the premises.

There were no formalised meetings to reflect provider oversight, team meetings or lessons learnt. We have made a recommendation to the service to improve their communication with others.

The service was clean, homely and personalised where possible to reflect the people’s interests.

Staff were kind and caring in their approach with positive interactions between them and people who use the service. There was enough staff on duty to meet people’s care and support needs.

Relatives spoke positively of the service. One relative said “I am very satisfied with the service and staff do an amazing job."

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 Care Quality Commission to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions safe and well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were able to take positive risks and access activities and the community, promoting their independence. Care was person-centred, promoting people’s dignity, privacy and human rights, with best interest decisions in place and understanding of the mental capacity act. Staff felt well supported from the management team and reported an open culture. People are given the opportunity to voice their opinions and share their views within resident meetings with the time taken to ensure the information is given in an accessible format for maximum understanding.

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 25th April 2018).

Why we inspected

This was a planned inspection of the key questions, safe and well-led only.

We reviewed the information we held about the service. No areas of concerns were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led section 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 Preceptory 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 monitor the service.

We have identified breaches in relation to the safety of the service and governance and oversight of the service.

Follow up

Reassurances of improvement have been sought from the registered manager and 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.

Preceptory Lodge is a residential care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Preceptory Lodge accommodates up to eight people in two adapted buildings for people with autistic spectrum disorder or learning disabilities. The service provides personal care and accommodation in a domestic environment. There were six people living at the service on the day of our inspection.

The care service has 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A registered manager was 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from harm by staff that recognised the signs of abuse and were confident to raise concerns.

Personalised care plans and risk assessments were in place and there was enough staff to safely provide care and support. People were supported to make choices in relation to their food and drink and to maintain good health.

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 the service supported this practice. Staff understood the principles of the mental capacity act.

There were safe recruitment processes to prevent unsuitable staff working with vulnerable people. We recommended that the registered manager evidenced more clearly what new staff had learnt during their induction and reflected this in their supervisions.

People's medicines were stored and administered safely. Staff were aware of the infection control measures in place to reduce the risk of the spread of infection.

The care and support people received was person centred. Staff were kind and treated people with dignity and respect and their independence was promoted. They were sensitive to people's needs regarding equality, diversity and their human rights, as their choices and preferences were respected.

The provider had a system in place for responding to people's concerns and complaints. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided.

The registered manager led a good service. Staff said the registered manager was approachable and supportive and there were good working relationships with health and social care professionals.

Further information is in the detailed findings below.

People told us that they liked the staff who cared for them. They said there were enough staff to care for them. Comments included "The staff are excellent. I know them all well" and "Staff are all alright. There are plenty of them."

We saw that staffing levels were maintained so that people's assessed needs could be met.

People told us that they were well cared for and liked living at Preceptory Lodge. Comments included "I like it here and I like all the staff. I have a lovely room."

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 told us that the current staffing arrangements were impacting on the care and social opportunities for people living at the home. We were also told that staffing levels placed people at risk as there were not always sufficient staff on duty to meet people's assessed needs.

The home had quality monitoring systems in place to seek the views and opinions of those using the service and other stakeholders. People told us that they could speak to staff and that they had meetings where they could raise issues.

People said they were well cared for and said that they liked living at the home. People had support plans and risk assessments in place which helped staff to understand and meet people's needs. We observed staff helping people to maintain their independence and make choices for themselves.

The home had policies and procedures which helped to protect people. People told us that they felt safe and that their concerns would be listened to.

Although people told us that they liked the staff who cared for them, we also found that the majority of staff had not received sufficient training to enable them to meet the needs of people living at the home.

People's views were being sought about the quality of the service provided. We saw that the management team acted upon any issues to make sure that people remained happy with the service they received.