Amethyst Lodge

Amethyst Lodge is a residential care home providing accommodation and personal care for adults with learning disabilities or autistic people. The service is registered to accommodate up to four people and there were four people living at the service at the time of the inspection.

People who used the service had their own bedrooms with a separate communal kitchen and lounge. There was also a shared garden area people had access to.

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:

Amethyst Lodge is based in a residential building. It is close to local facilities and externally, there was nothing to indicate it was a registered care home which helped to promote the concept of community living.

Improvements were required to ensure that the premises were designed and decorated in a way that supports autistic people and people with a learning disability, and we have made a recommendation about this.

Staffing levels had sometimes fallen short. There had been a high use of agency staff to cover some shortfalls, but people told us they preferred staff they knew well. The provider had recently recruited five new staff and hoped the use of agency staff would reduce as a result, meaning people will receive care from a consistent staff team. Recruitment processes needed to be more robust to ensure staff were suitable for their roles. The provider had begun implementing more detailed checks and were reviewing all previous recruitment files.

Care records did not always reflect what people's aspirations or longer-term goals were. Some goals were not person-centred. There was limited evidence that people had been involved in creating their care plans.

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 support this practice. However, documentation in relation to decisions that had been made in people’s best interests required review to ensure that people continue to have maximum choice and control over their lives and that the least restrictive option was always considered.

Right Care:

People were taking part in activities of their choosing, including in the community, and with family or friends. Staffing levels sometimes impacted on how long people could be out for as staff needed to return to attend to other clinical duties.

We observed caring interactions between staff and people. Staff told us they cared about the people at the home. The core staff team knew people well and had established positive relationships with them.

Although we observed staff to be effective in supporting people, some staff were overdue refresher training in several subjects.

People received their prescribed medicines by staff who had completed relevant training. People's hydration and nutritional needs were met, and people received a varied diet of their choosing.

Right Culture:

More robust monitoring and auditing checks were required to ensure all aspects of people's care needs and their quality of life were being measured effectively. Several audits which monitored the quality and safety in the service had not been completed in the timeframes set by the provider.

The previous registered manager had left, and there was a new manager in post. However, they had been covering staffing shortfalls, impacting on their time to complete the usual quality checks. As a result, opportunities to identify shortfalls had been missed, such as infection control procedures. Staff told us they liked the new manager and considered that they would be good for the service going forward.

There was no formal feedback documented around people’s views about the service they received. Improvements were needed to ensure that people were consistently supported to provide feedback and to ensure people were fully involved in shaping their support.

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 17 March 2020). 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 regulations.

At our last inspection we recommended that the provider reviewed people’s care records to ensure they reflected the principles of the Mental Capacity Act 2005. At this inspection we found that the provider had made improvements in this area. However, these were not always being reviewed in line with the provider’s own guidance.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned comprehensive inspection. This inspection was carried out to follow up on action we told the provider to take at the last 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.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service remains requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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 Amethyst Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to infection control procedures, care record documentation, and governance at this inspection.

We have made a recommendation about improving the environment.

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 also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress, and continue to monitor information we receive about the service, which will help inform when we next inspect.

Amethyst Lodge is a residential care home providing accommodation and personal care for adults with learning disabilities, autistic spectrum disorder, and mental health needs. The service is registered to accommodate up to four people and there were four people living at the service at the time of the inspection.

Amethyst lodge comprises one bungalow with four separate bedrooms, each with an en-suite. There is a large communal lounge / dining room, and kitchen facilities. There is also an outside space which people can access.

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.

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

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.

Risks had been assessed and those identified were safely managed; however, for some people these were not always accurate, updated, or in place. Staff showed a good understanding of their roles and responsibilities of keeping people safe from harm. Medicines were managed safely, but some documentation needed improvement, as well as the need to review medicines procedures for people when they are out. The provider had recruitment checks in place to ensure staff were suitable to work in the service. Staffing levels had improved and people were going out more; the provider understood that they would have to continually review staffing levels due to the often unpredictable and complex needs of people living in the service.

People were supported by staff who had completed the relevant training to give them the skills and knowledge they needed to meet their needs. People were supported to have sufficient amounts to eat and drink and were protected against the risk of poor nutrition. However, improvements are needed to ensure fluid intake is recorded accurately where this needs to be monitored. Staff supported people to maintain their health and well-being. 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. However, assessment documentation needed to be revised to ensure the principles of the Mental Capacity Act 2005 were being followed, and we have made a recommendation about this.

People’s care records were not always accurate or updated. It was not always evident that people had been consulted about their support plans and involved in creating them, often people had not signed to show their involvement. People were supported to express their wishes and preferences regarding their care and staff provided personalised care. People and relatives were confident to raise concerns and complaints.

Staff treated people in a kind and caring way. People and relatives valued the service and the support the staff provided. Staff treated people with respect and helped them to maintain their independence and dignity.

There were governance systems in place, however, they had not identified all of the issues we found and therefore need to be strengthened in some areas. The manager and operations manager were committed to making improvements in the service. The provider will need to ensure the manager has sufficient support to enable the service to meet regulations and improve their rating to Good.

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 Requires Improvement (published 27 February 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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 Amethyst Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to care records and 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 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.

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.

Amethyst Lodge is a ‘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. This service is registered for four people, on the day of our inspection two people were living in Amethyst Lodge.

At the time of the inspection the registered manager had not worked at the service since September 2018. There was no manager in place and no one had been asked to act up while a new manager was being appointed. 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.

This care service supports people living with a learning disability and should be 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. Meaning, people with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen. However, it was not always evident that the provider understood these principals, there was not always enough staff on duty to promote independence and choice.

We had not planned to inspect this location on this occasion. This inspection was prompted after we discovered breaches in another service owned by the same provider, which is in close proximity to Amethyst Lodge, and a third service also owned by them. All three services are managed and staffed by the same team. Having identified breaches of regulation in relation to staffing and quality assurance in Swanrise we decided to inspect the other two services.

We did not meet the people living in the service on this occasion, but we did observe how the staff who worked with them interacted with people who lived in the other services owned by the provider, that they also worked with.

Although both people who lived in the service had 1-1 care staff support, we found that there were not sufficient staff on duty to keep people safe. The 1-1 care staff worked long hours and there were no staff members available to stand in for the 1-1 care staff to have a break or to step in to offer assistance if it was needed in emergency situations. On the second day of the inspection, a decision had been taken to permanently add a floating staff member to the rota, however this person was to move between the three services within the same grounds and was not effective.

We saw that people did not always receive care that was personalised to their needs. People’s daily activities were sometimes restricted because of staff not being available to support them. Staff had not always been given update training to ensure their knowledge and skills were refreshed and kept up to date. Training and supervisions had fallen behind.

Risks in people’s environment were assessed and steps have been put in place to safeguard people from harm without restricting their independence unnecessary. Risks to individual people had been identified and action had been taken to protect people from harm. However, because staffing levels were not sufficient, people were not always protected from risk.

The service had not been well led; failings in place prior the registered manager leaving had not been identified by either the provider or the previous general manager, who had also recently left. However, we acknowledge that these have now been identified and the provider was taking action to make improvements. An acting manager had not been put in place while a new manager was being recruited, which meant that those shortfalls were not being properly addressed in a timely manner.

People’s needs were assessed and they received care in line with current legislation. The service was in the process of changing the care plans to a new format, they detailed and gave staff sufficient information to allow to get to know people and to meet their needs.

The staff had been safely recruited. People where protected from bullying, harassment, avoidable harm and abuse by staff that were trained to recognise abusive situations and how to report any incidents they witness or suspected.

Medicines were managed in a way that ensured that people received them safely and at the right time. Staff understood their roles and responsibilities.

People were asked for their consent by staff before supporting them in line with legislation and guidance. We saw examples of positive interaction between the staff and people supported by the service. People could express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity. The service listened to people’s experiences, concerns and complaints, which they took steps to investigate.