Devon Lodge

Devon Lodge is a care home without nursing. It provides care and support for up to 12 adults with autism, learning disabilities and other complex needs. There is a main house which can accommodate 8 people and a self-contained annex that can accommodate up to 4 people. Both areas have their own kitchen, dining area and lounge. At the time of the inspection there were 10 people using the service.

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.

Whilst this inspection found that many improvements had been made, the service was not able to demonstrate how they were meeting all of the principles of Right support, right care, right culture.

Right support: We continued to find that risks relating to people’s medicines were still not always effectively assessed, planned for and mitigated. We were assured that that people were being more appropriately supported to have a fulfilling and meaningful life that included achieving, or working toward, goals and aspirations. The environment was more homely, clean and better maintained. The service continued to plan for when people experienced periods of distress and this enabled staff to respond in a safe and effective manner. Staff continued to provide support in the way each person preferred and decision making followed best practice frameworks.

Right care: People were not always supported to have maximum choice and control of their lives and it was not always evident that staff had considered less restrictive options before limiting people’s choices. Overall, care and support plans reflected a good understanding of people’s needs. Improvements had been made which ensured that there were sufficient numbers of familiar staff available to provide a personalised response to people’s needs. Staff understood how to protect people from abuse.

Right culture: The registered manager had not always effectively operated the systems that were in place to monitor the quality of the service people received. People’s care continued to be enhanced by the involvement of a team of specialists employed by the provider, who worked closely with the support staff to develop a collaborative and problem solving approach to people’s support. However, there continued to sometimes be a disconnect in practice between how staff told us people best communicated and the communication methods and styles documented in their care and support plans. Overall improvements had been made to ensure that staff had been recruited safely. Staff told us the registered manager performed their role effectively. They felt valued and involved in developing the service. Relatives and staff all told us the service had improved and they were happy with the changes.

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 25 March 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We carried out an unannounced focussed inspection of this service on 24, 25 and 26 January 2022. 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: safe care and treatment, the safety of recruitment, staffing, person centred care, the premises and the governance arrangements.

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, Effective and Well-led which contained those requirements.

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.

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 remained 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 Devon Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

We have also made a recommendation that the service explore a broader range of alternative options to support the use of debriefs with people in line with best practice.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

About the service

Devon Lodge is a care home, without nursing, that provides care and support for up to 12 adults with autism and learning disabilities and other multiple needs. There is a main house which accommodates eight people and a self-contained annex that accommodates four people, both have their own kitchen, dining area and lounge. At the time of the inspection there were ten people using the service.

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

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

More needed to be done to ensure that people were consistently supported to have a fulfilling and meaningful everyday life that included achieving aspirations and goals. Improvements were needed to ensure that the environment was homely, clean, and well maintained. Staff enabled people to access health care services in their local community, although some improvements were needed to ensure that peoples medicines were managed in a way that ensured the best possible health outcomes. The service planned for when people experienced periods of distress and this supported staff to respond safely, using a person-centred approach. Staff supported people to make decisions following best practice.

Right Care

Managers had not always ensured that risks faced by people had been assessed and planned for. People received personalised support from staff with whom they seemed engaged, relaxed and comfortable. Staff were committed to providing an individualised response to people's needs, but this was at times difficult as there were not always enough staff. More needed to be done to ensure that all of the staff supporting people understood their individual ways of communicating.

Staff understood how to protect people from poor care or abuse, although not all safeguarding concerns had been escalated in line with the providers policies and procedures.

Right culture

Peoples care was enhanced by the involvement of specialists employed by the provider who worked closely with the support staff to develop a collaborative and problem-solving approach to people’s support. Staff were provided with training which helped to ensure that they understood how people with a learning disability or autistic people saw their environment. However, staff turnover was high and too many agency staff were supporting people which meant they did not always receive consistent care from staff who knew them well. Checks to ensure that staff were suitable to work in the home had not always been completed appropriately. People’s support plans did not always reflect their needs or demonstrate that the person had been involved as a partner. Whilst the provider demonstrated a commitment to create a culture of improvement that provided good quality care to people, the success of this approach had been affected by changes in leadership at the service. The provider was aware of the risks of closed cultures developing within the staff team and of the impact this could have on people's care.

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

Rating at last inspection

This last rating for this service was good. (Published 17 February 2021).

Why we inspected

We undertook this inspection to assess whether the service was applying the principles of Right support right care right culture.

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. This included checking the provider was meeting COVID-19 vaccination requirements

The inspection was prompted in part due to concerns received about safety and staffing. A decision was made for us to inspect and examine those risks.

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.

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.

Enforcement and Recommendations

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 and will take further action if needed.

We have identified five breaches in relation to safety, medicines management, person centred care, the premises and recruitment at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Devon Lodge is a care home which provides care for up to twelve young adults with autism and learning difficulties often accompanied by complex needs, behaviours which might challenge others and self-injurious behaviours. The accommodation is arranged over two self-contained buildings, a main house and a smaller four bedded annex. At the time of our inspection there were ten people living at the home.

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

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service model of care and setting maximised people’s choice, control and independence. Care was person-centred and the ethos, values and behaviours of the leaders and care staff ensured people lead confident, inclusive and empowered lives.

Risks to people were mostly recorded in their care plans. However, some did not always contain sufficient detail. The risks of this was mitigated by how well staff knew people. The culture in the home was not risk adverse. People were supported to take positive risks and the provider was passionate about promoting people’s independence.

The manager and staff understood their responsibilities to safeguard people from abuse. Relatives told us people were safe and staff were confident any concerns raised would be acted on. Incidents and accidents had been investigated, analysed and remedial action taken. Incidents were managed safely by staff, and staff consistently supported people using proactive approaches, redirection and de-escalation techniques.

Medicines were administered in line with people's preferences by staff who knew people well. However, whilst PRN protocols contained sufficient detail to support people safely, care plans for regularly prescribed medicines did not always have sufficient detail to support people safely. The risks were mitigated by how well staff knew people and the robust medicines training and competency programme in place.

Staffing levels were sufficient and although there was a reliance on agency staff the provider had prioritised recruitment and ensured consistent agency staff were used. Safe recruitment processes were in place. Staff demonstrated a good understanding of infection control procedures. Staff had received training in infection control and COVID-19.

A manager was in post, but they were not registered with the Care Quality Commission. However, the manager was in the process of applying. Relatives and staff spoke positively about the new manager. The service worked in partnership with professionals to achieve positive outcomes for people. There was an ‘open-door’ policy in place and staff felt they were supported and listened to. The provider had robust quality assurance procedures to help drive ongoing improvements within 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

The last rating for this service was Good (published 29 January 2018).

Why we inspected

We received concerns in relation to staffing levels, use of physical interventions and a closed culture. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern 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.

The overall rating for the service has not changed from Good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

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.

This was the first comprehensive inspection of this service under the provider CAS Care Services Limited. We have rated the service as overall Good. This was because, although we found some areas where the service could improve upon, people overall experienced good care and support.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

Some aspects of medicines had not always been managed safely. Overall staff had a good understanding of the risks associated with people’s care; however, records showed that in some instances, risk management protocols were not being effectively implemented.

Planned staffing levels were not always been achieved. At such times, people’s planned activities were adjusted to ensure safety. Recruitment remained a priority for the registered manager and the provider was undertaking an urgent review with the commissioners of people’s care to reassess the staffing requirements within the service.

Overall the home was clean although one person’s room had a strong odour of urine which the staff had not yet managed to control. Policies and procedures were in place to protect people through effectively preventing and controlling the risk of infections.

The provider had appropriate policies and procedures for reporting abuse. This ensured staff had clear guidance about what they must do if they suspected abuse was taking place.

Accidents and incidents were investigated to make sure that any causes were identified and action was taken to minimise any risk of reoccurrence. Lessons learnt were communicated effectively with the staff team and throughout the organisation through a lessons learnt group.

People's rights were protected because the registered manager ensured that the requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) were embedded within the service.

People’s dietary needs were met and they were supported to make meal choices.

There were systems in place to support effective joint working with other professionals and agencies and to ensure that people’s healthcare needs were met.

In general the environment was suited to people’s needs, but we have made a recommendation that the provider continue to review the design and layout of the home and the number of people accommodated to further support the delivery of person centred care.

Staff had built strong relationships with people and knew how best to support them. They knew what was important to people and what they should be mindful of when providing their support. Staff interacted with people in a caring, good humoured and when needed, in a tender manner.

People's individuality and choices were respected and where necessary advocates were involved to ensure the person’s views were represented and their rights protected throughout a decision making process.

Staff supported people in a way that maintained their independence and they spoke with, and about, people in a respectful manner.

People received care and support that was personalised to their individual needs and wishes. This helped to ensure that people lived in an inclusive environment where they were encouraged to express their views and choices.

People’s relatives were involved in planning their care where appropriate. The support provided was, in most cases, achieving positive outcomes for people.

Staff effectively monitored aspects of the care and support people received to ensure it remained relevant and purposeful.

People were able and encouraged to take part in a range of leisure activities and follow their own interests. They were supported to maintain relationships with people that mattered to them.

Staff had taken innovative steps to provide information to people in a way in which they could understand allowing them to be as involved as possible in decisions about how their care was provided.

The registered manager used complaints or concerns to understand how they could improve or where they were doing well.

The registered manager demonstrated a thorough knowledge of each person living at the home and of the staff team. They fostered a positive and person centred culture within the home and helped staff provide care which was in keeping with people’s needs and wishes.

There were systems in place to assess and monitor the quality and safety of the service and these were an integral part of the way in which the registered manager and provider identified shortfalls, learning and innovation to drive improvements in the service.

The registered manager had a clear vision for the service which was underpinned by key values which included inclusion, choice, independence and the reduction wherever possible of any restrictive practices.