About the service Neville Lodge is a residential care home providing personal and nursing care to up to 6 people. The service provides support to adults with learning disabilities and autistic people. At the time of our inspection there were 4 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.
Right Support: People's support needs and risks associated with their care were not always appropriately managed to
ensure safe care could be provided. The provider did not have effective systems in place to protect people from avoidable harm. Physical restraint was being carried out without robust processes and procedures being followed. People were at an increased risk of being restrained inappropriately and therefore at risk of harm. People were not consistently 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. We made a recommendation about mental capacity. The home was well maintained, and environmental safety checks were taking place. There were plentiful facilities for people to use and lots of space both inside and outside for people to utilise.
Right Care: Systems and processes were not always effective in ensuring people were protected from the risk of abuse and staffing was not always provided in line with people's needs. People were not always supported by staff who had been trained to do their jobs properly. This meant people were at risk of receiving unsafe care. The provider used effective infection, prevention and control measures to protect people from infection control risks. We were assured that the provider was using PPE effectively and safely. Staff supported people safely with their medicines and worked with health professionals to achieve good health outcomes. People lived in a safe and well-maintained environment which was set up to maximise their independence.
Right Culture: There were several areas falling short of the necessary standards during the inspection. There had been a lack of leadership at the service. Systems were not in place to support effective oversight and governance. This meant that risks to people were not always identified and managed and records were not consistent and accurate. Whilst there were some systems in place to identify shortfalls these systems needed further strengthening and embedding into practice and provider oversight needed to improve. The provider gave a thorough and detailed action plan giving us assurances that action would be taken to address the concerns identified through the inspection.
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 10 August 2022).
Why we inspected
We received concerns in relation to people’s safety, culture, staffing and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Neville Lodge on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to safeguarding, risk monitoring, training and governance at this inspection. We have made a recommendation about following the Mental Capacity Act and associated guidance.
Please see the action we have told the provider to take at the end of this report.
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.
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.