Lapwing Lodge

Updated 15 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

One inspector carried out this inspection.

Service and service type

Lapwing Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Lapwing Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

We used all this information to plan our inspection.

During the inspection

We spoke with one person. We also observed staff supporting people in their day to day lives at the home. We spoke with one staff member, and the registered manager.

We reviewed two care plans, two medicines records, and documents relating to governance of the service. We requested further records such as staff meeting minutes and supervision records sent to us electronically.

After the inspection we spoke with two staff members, and two relatives. We also received feedback from the local authority quality monitoring officer, and one social worker.

Updated 15 September 2022

About the service

Lapwing Lodge is a residential care home which can accommodate up to three people with learning disabilities or autistic people. 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. The service provides respite care, and there was one person who lived at the home on a permanent basis. At the time of our inspection there were two 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.

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

Lapwing 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.

People were not always supported to have maximum choice and control of their lives and staff did not 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; the service had not always adhered to the Mental Capacity Act 2005 and consent was not always sought. There were gaps in staff's knowledge in terms of promoting people's safety from experiencing potential abuse and harm. We also found shortfalls when a new person came to stay at the home in terms of assessing risks and making plans to support them and others to be safe.

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

Some people were not always safe from harm from the people they lived with. Some people's needs did not fit in with others when using the communal areas of the home. This had led to some people having negative experiences. The registered manager had not been made aware of an incident when a person had been harmed by another. Following the inspection, we made a safeguarding referral in relation to this incident and the on-going risks posed.

Right Care

The service provided care and support to individuals on respite, and to people who lived at Lapwing Lodge on a permanent basis. This did not always provide a predictable environment for people to live in, and incidents had occurred. When new people came to stay at the home, people were not always consulted with in a meaningful way, to see if they were happy about this.

Although we observed staff to be effective in supporting people, we could not be assured that staff had completed all training necessary to ensure they had the skills to deliver people’s care effectively. Records of staff training were not always up to date. People received their prescribed medicines by staff who had received training. However, staff had not been assessed for their competency whilst undertaking a more complex procedure of medicine administration.

We observed caring interactions between staff and people. Staff told us they were very fond of and cared about the people at the home. Staff knew people well and had established positive relationships with them. People enjoyed activities which were personalised to them, and relatives confirmed this. People accessed activities within the community and attended the Iceni day centre.

People's hydration and nutritional needs were met, and people received a varied diet of their choosing.

Right Culture

The management team aimed to provide a service that was person centred and caring. However, the underpinning systems of governance did not always support this. Audits to monitor the quality of the service had not been regularly undertaken. Some audits were not completed robustly which would help the service to identify and address on-going issues. Action plans were not always in place when improvements had been identified. Provider oversight needed to be strengthened so they were able to recognise and act on shortfalls in care provision and quality checks.

The registered manager was responsive to feedback and began addressing the shortfalls and concerns we identified during the inspection.

Rating at last inspection

This service was registered with us on 4 March 2021 and this is the first inspection.

Why we inspected

This was a planned comprehensive 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.

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 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 management of risk, consent procedures, staff training, and governance.

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, which will help inform when we next inspect.

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.