Elstow Lodge

Elstow Lodge is a care home providing accommodation and personal care to autistic people and people living with a learning disability. People have their own personalised bedrooms and share communal areas such as a lounge, dining room, kitchen and garden. The service can support up to 9 people and 9 people were living at the service at the time of our inspection.

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

People were not supported to pursue their interests or achieve their aspirations and goals. People were not being supported to try new things or to follow social interests and past times on a consistent basis.

Reasonable adjustments were not made so that people could be fully involved in discussions about their support. Staff did not always communicate with people in their identified and preferred methods.

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 always support this practice.

Staff did not always support people safely with their medicines. There were some aspects of people’s support such as risk assessments being detailed and staffing levels that were not always safely supported by staff.

People were supported to live healthy lifestyles and staff members promoted healthy choices in areas such as eating and drinking. Staff kept people’s home environment clean and safe and maintained people’s equipment to help ensure it was always used safely. Staff knew how to support people in a kind and caring way if they experienced distress.

Right Care

Staff were not promoting people to try new things which may have enhanced their wellbeing and enjoyment of life. People’s support plans did not fully reflect their range of needs and promote their wellbeing and enjoyment of life. People who had individual ways of communicating such as using symbols or body language could not always interact comfortably with staff as they did not have all the skills necessary to understand them.

Staff were not being supervised to support people effectively. The registered manager was not checking staff competency to perform their job roles in all areas.

People were not always receiving kind and compassionate care. Staff did not always protect and respect people’s privacy and dignity. Staff knew people well as individuals, however in practice, did not support people in line with their identified likes, dislikes, and preferences.

Staff knew how to recognise, and report abuse to appropriate agencies.

Right culture

The management and staff team did not understand the key principles of guidance such as Right Support, Right Care, Right Culture. Audits completed at the service by management had not picked up on areas that could have been improved to help support a more positive culture. Audits had not been completed in a lot of areas.

People and those important to them, were not fully involved in planning their support. It was unclear how staff evaluated the quality of support provided to people, involving the person, their families, and other professionals as appropriate.

The service had a negative culture that was at risk of becoming a closed culture. Staff were not supporting people to have a good quality of life or achieve good outcomes.

People sometimes received kind and compassionate care from a staff team who had got to know them as individuals. People were happy and relaxed being supported at the service and staff spoke with people in a friendly manner. People and relatives were positive about the support they/ their family member was receiving.

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 26 February 2020) and there was a breach 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, the provider was no longer in breach of this regulation, but was now in breach of other regulations. This service is now rated inadequate. This service has been rated inadequate or requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see all the sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment of people, staffing levels, people being treated with dignity and respect, people receiving personalised care and the way the service is managed at this inspection.

Please see the action we have told the provider to take at the end of this report. 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 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. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice:

The provider had systems in place to support safe visiting at the service. Visitors were required to provide a negative lateral flow COVID-19 test and proof of COVID-19 vaccination prior to entering the service.

There was a dedicated indoor area for visiting, which let in plenty of fresh air and hand sanitiser was available too. During periods of COVID-19 ‘lockdown’ people had been supported to maintain alternative contact with their families and friends through writing letters, window visits, video and telephone calls.

Additional communal space had been created, and new equipment purchased for the garden, enabling people to have a wider choice of indoor / outdoor space. This helped to promote social distancing.

The home was clean, well ventilated and there was a safe process to manage people’s laundry.

There were good stocks of PPE and staff were observed wearing PPE in accordance with current guidance. They had received training in relation to infection control and the safe use of PPE.

Staff and people at the home received regular COVID-19 tests in line with current government guidance. Everyone had received the maximum number of COVID-19 vaccinations offered to date.

Systems were in place to monitor key aspects of infection prevention and control (IPC), to promote people’s safety. The registered manager demonstrated a good awareness of current guidance relating to registered care settings, in terms of preventing a COVID-19 outbreak.

Elstow Lodge is a residential care home providing personal care to eight people at the time of the inspection. The service can support up to ten people. Elstow lodge accommodates eight people in one adapted building, it has ten double bedrooms, communal bathrooms, two communal living areas and a shared garden.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 10 people. 8 people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by 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 provider had not ensured that recruitment procedures were safe. People were put at risk of harm because Disclosure and Barring Scheme (DBS) checks had not always been completed prior to staff starting work. Employment references had not always been obtained and some staff members had gaps in employment history. This meant that the provider had not ensured staff members employed were of suitable character and had the skills to care for people prior to working with people.

The manager completed audits to monitor the quality of the service. These included medication audits, incident audits and health and safety. However, the service’s audit systems were limited to paperwork duties and were not always effective in identifying areas requiring improvement which we found during inspection. This meant there was a lack of continuous improvement within the service.

People were supported with kindness, respect and compassion by a staff team who had gotten to know people as individuals. There was a focus on people making choices about their support and the staff team promoted people to be as independent as possible. People received personalised care and were communicated to in their preferred communication methods.

Despite recruitment checks not being robust the registered manager had systems in place to protect people from potential abuse. People had assessments in place which enabled them to take positive risks. There were enough trained and knowledgeable staff to support people safely and to allow people to do what they wanted throughout the day.

People were supported to take part in a wide array of activities in the community and to take part in daily living skills in the home. Staff members encouraged people to try new things and to be involved in choosing how they spent their time.

People were positive about the way they were supported with food and drink, people were involved in cooking and preparing meals. People were supported to see health care professionals where this support was needed. People had access to a detailed complaints procedure which was available in accessible formats if people needed to make a complaint.

People and their relatives were encouraged to feed back about their care and support and were involved in service delivery at all levels. The registered manager and the staff team worked with other organisations to ensure good outcomes for people using the service. People were positive about the management of the service. The manager was passionate about putting plans in place to continue to improve the way people were supported.

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.

The service applied the principles and 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).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to fit and proper persons employed 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.