We inspected all three of Paradise Lodge Care Home Limited services, known as Willow Tree Lodge, Paradise Lodge and Chignal House and, over a period of three days, 07, 08 and 12 March 2018 as these services are all in close proximity. The inspection of Willow Tree Lodge took place on 12 March 2018 and was announced.
Willow Tree 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. Willow Tree Lodge accommodates five people in one adapted building.
Although the provider spent a lot time working across all three services, we found a lack of consistency in outcomes for people. The provider and manager had not always understood their responsibilities concerning regulatory requirements in relation to health and safety, mental capacity and deprivation of liberty. The provider had worked well with health professionals in relation to peoples care needs, however they had not always worked well in partnership with stakeholders, such as the local authority and CQC to share information.
Although, the provider had identified risks to people’s safety, and taken action to address them, they had not always assessed the ongoing risk of harm. The manager and staff had not understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. The lack of governance and poor understanding of the appropriate decision making process and establishing people’s capacity to make decisions had placed people at risk of harm.
The provider and manager told us they kept up to date with current guidelines and best practice in care services through a variety of networks, including CQC web site, Essex Association of Independent Care Providers who do forums, conferences and workshops. However, none of these forums related to most recent guidance and ways of supporting the specific client group using the service.
Although care plans were in place to guide staff on how to support people’s health; welfare and safety, we found one exception where there was no care plan in place in relation to a person’s epilepsy, or how this should be managed in the event of a seizure.
We recommend that the service seek appropriate professional advice regarding the management of epilepsy.
There was a manager in post. Following an interview with CQC they have been approved as the registered manager as of 16 March 2018. 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.
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.” Registering the Right Support CQC policy.
Safeguarding matters and people's finances were well managed. Staff managed the complex needs of the people well and understood the support they needed to keep them safe. Staff understood what people could do for themselves, where they needed help and encouragement and how they communicated. Staff talked passionately about the people they supported and knew their care needs well. Different communication methods had been used to support people to understand information about their care and decide how they spent their day. People were supported to carry on with their usual routines, shopping and accessing places of interest in the community.
A contingency plan was in place with contact details for staff to respond to emergencies and staff knew who to contact should an emergency occur. The service had infection prevention and control systems in place, which ensured people’s health was protected. Staff were trained and understood their roles and responsibilities for maintaining cleanliness and hygiene.
There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service.
People were provided with sufficient to eat and drink to stay healthy and maintain a balanced diet. People had access to health care professionals, when they needed them.
The provider’s mission statement contained a clear vision and strategy to deliver high-quality care and promote a positive culture achieving good outcomes for people. Staff were clear about the vision and values of the service in relation to providing compassionate care, with dignity and respect. Equality and diversity, was understood and promoted across all three services owned by the provider. The provider had taken steps to meet people’s cultural needs.
Staff spoke positively about the provider and the manager. Staff felt supported and said there was good communication between the management and themselves. They described both the provider and manager as approachable, very hands on, supportive and demonstrated good leadership, leading by example.
At the time of our inspection, no one using the service was nearing the end of their life, and therefore we were unable to assess how this aspect of the service was managed. However, we noted that peoples’ care plans did not contain information about people’s preferences regarding future care at the end of their life, where they wished to die or their spiritual and cultural needs.
We recommend that the service seek guidance from a reputable source, about supporting people with learning disabilities to express their views and involve them in decisions about their end of life care arrangements.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.