Kacee Lodge

Kacee Lodge is a domestic style single storey detached house in keeping with the other houses in the area.

We found the following examples of good practice.

The service was following correct infection prevention and control guidance and policy to protect people from infection and prevent the spread of infection.

Management were making sure infection outbreaks can be effectively managed. The service has a new manager. They attended daily video meetings with senior managers to discuss impact and management of Covid-19 pandemic across the providers services and to learn from each other. There were also additional meetings at regional level twice a week.

The manager was following the government's guidance on whole home testing for people and staff. This included weekly testing and rapid testing for staff and essential visitors.

All people using the service have received their first Covid-19 vaccination and staff were in the process of receiving theirs.

There was clear signage and guidance in the service to help prompt and remind staff on how to work safely and minimise the risk of spreading infection. Staff had received training in infection control, Covid-19 and personal protective equipment (PPE). They were using PPE properly and there was a good supply of PPE and hand sanitiser. Cleaning schedules had increased with regular hard surface and high touch cleaning carried out throughout the day.

Alternative forms of maintaining social contact were used for relatives. For example, using video calls, weekly newsletters to family members, using a phone to communicate with and garden visits socially distanced in warmer weather.

Kacee Lodge is a residential care home registered to provide accommodation with personal care for up to seven people with learning disabilities, and who may also have an autistic spectrum disorder. The service does not provide nursing care. At the time of the inspection six people were living at the service.

Kacee Lodge is a domestic style single storey detached house within a residential area of Colchester. Each person has their own bedroom and access to additional communal facilities, including a purpose built sensory room. The design of the building fits into the residential area and is like other 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.

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

At our last inspection we recommended the provider reviewed their arrangements relating to their quality assurance processes, to ensure they meet best practice guidance and relevant legislation, and ensure staff were properly trained, had regular supervision and an annual appraisal of their overall performance. The provider had made these improvements.

However, further improvements were needed to ensure the governance systems used by the registered manager at local level were effective. These had not identified the issues we found during this inspection in relation to safe recruitment, cleanliness of the laundry and failed to recognise and address people’s protected characteristics.

Although the majority of staff had worked at Kacee Lodge for a long time, a review of recruitment files found, references from previous employers had not always been obtained to confirm their fitness to work at the service. Additionally, where previous convictions had been disclosed on a staff’s disclosure and barring service check, the registered manager had not explored these issues to ensure they were not a risk to the vulnerable people in their care.

We have made a recommendation about the safe recruitment of staff.

Further work was needed to promote people’s protected characteristics, such as age, disability, race, religion or belief, and sexual orientation. People had not been involved in deciding who provided their care, including their preference for male or female staff.

We have made a recommendation about people’s protected characteristics.

The premises need modernising. The provider had a plan in place for refurbishment of the service over the next 12 months, and some progress had already been made in relation to fire safety and replacement flooring throughout the premises. The registered manager took immediate action during the inspection to refer issues about the laundry flooring to the estates team, and ensure it was cleaned to prevent the risk of spreading infection.

Staff had good understanding safeguarding procedures and how to report concerns. Medicines management and risks to people were assessed and managed well. The service had worked well liaising with other professionals and services to ensure people received the support they need to stay safe. Staff understood how to support people’s anxieties and behaviours in a positive way.

Staffing levels were sufficient to meet people's complex needs. Staff and records confirmed they had received a range of training to give them the skills and experience to carry out their roles.

Where things have gone wrong, systems were in place to learn from such incidents and improvements made. Improvements had been made since our previous inspection to ensure people's personal monies were accounted for.

Staff were aware of people’s specific health needs. Changes in people’s care and support needs were identified and responded to promptly. People were being supported to live a healthy lifestyle and had access to food and drink of their choice. Work was in progress to develop end of life care plans to ensure people’s wishes are considered at such time, and ensure they experience a pain free and comfortable death.

The requirements of the MCA and DoLS were understood and managed in line with relevant guidance and legislation. 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 values 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. People were supported to access colleges and activities, such as ‘bounceability’ to improve their fitness, however we found little evidence to reflect people had access to community-based activities on a regular basis that were socially and culturally relevant to them.

People using the service were well cared for, by staff that knew them well. People were involved in making decisions about their care and how their home was decorated. People had good access to advocacy support where needed to support them when making important decisions. The service was meeting the requirements of the Accessible Information Standards (AIS) which ensured people were provided with information in a way they can understand.

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 22 November 2018).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kacee Lodge on our website at www.cqc.org.uk.

Why we inspected

This was a planned inspection based on the previous rating. The inspection was also prompted in part by notification of a specific incident, following which a person using the service sustained a serious injury. The information CQC received about the incident indicated concerns about the management of scalding. This inspection examined those risks. The provider had taken immediate action to mitigate the risks of a similar incident happening again, and we found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full 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.

Kacee Lodge accommodates up to seven adults who have a learning disability and who may also have an autistic spectrum disorder. Kacee Lodge is a large single storey detached house within a residential area of Colchester. The premises enables each person using the service to have their own individual bedroom and adequate communal facilities are available for people to make use of within the service.

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.

This inspection was completed on 19 October 2018 and there were seven people living at Kacee Lodge.

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service. Although, the current arrangements had identified some of the issues we found during our inspection, improvements were required to ensure where these were highlighted, compliance was monitored, and appropriate actions taken in a timely manner to rectify these.

This related specifically to staff training, induction, supervision and appraisal. Some staff had not attained up-to-date training relating to manual handling and medication or training relating to learning disabilities or autism spectrum, despite having no previous care experience. Staff had not always received a robust induction even though they had been employed at the service for several months. Formal supervision and appraisal arrangements for staff required strengthening to ensure these were undertaken. The registered manager wrote to us following the inspection advising of the actions taken and put in place to address these areas.

Suitable arrangements were in place to keep people safe. Risks to people were identified and managed to prevent people from receiving unsafe care and support. The service was appropriately staffed to meet the needs of the people using the service. People received their medication as prescribed and in a safe way. Recruitment procedures were followed to ensure the right staff were employed. People were protected by the providers arrangements for the prevention and control of infection. Arrangements were in place for learning and making improvements when things go wrong.

Despite the above, staff carried out their role and responsibilities effectively to meet people’s needs. People’s nutritional and hydration needs were met, and they were provided with drinks and snacks throughout the day. Minor improvements were required to consider the timings of meals, particularly where people were due to attend college, as breakfast and lunch could be too close together. People received appropriate healthcare support as and when needed from a variety of professional services.

The service worked together with other organisations to ensure people received coordinated care and support. 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 support this practice.

People were treated with care, kindness, dignity and respect. People received a good level of care and support that met their needs and preferences. Staff had a good knowledge and understanding of people’s specific care and support needs and how they wished to be cared for and supported, including where people had complex communication needs.

Support plans were in place to reflect how people would like to receive their care and support and covered all aspects of a person's individual circumstances. Social activities were available for people to enjoy and experience both ‘in house’ and within the local community. Information about how to make a complaint was available and staff, relatives and advocates were available to support a person using the service if they were unhappy. The service sought people’s and others views about the quality of the service provided.

We have made a recommendation about the registered provider’s training, induction, supervision, appraisal and quality assurance arrangements.

Further information is in the detailed findings below.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People’s safety was promoted through individualised risk assessments. Risks had been identified, and plans were in place to manage these effectively. Staff understood the risks to people’s health and welfare, and followed guidance to safely manage them. People were safe because staff understood their responsibilities in managing risk and identifying abuse. People received safe care that met their assessed needs. There were sufficient staff to provide people with the support they needed to live as full a life as possible. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred. The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely. Medicines were administered safely in a way people preferred, by trained staff who had their competency assessed by the registered manager.

People were cared for by staff who had undergone the required pre-employment checks to ensure their suitability and had received an induction. The induction took into account the specific needs of the people cared for by the service, including autism and epilepsy. Staff had the required training updated in accordance with the provider’s policy. The provider supported staff to meet people’s needs with an effective programme of induction, supervision and appraisal. Staff were encouraged to undertake additional relevant qualifications to enable them to provide people’s care effectively and were supported with their career development.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

People were supported by staff who supported them to make day to day decisions. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People at the service were subject to the Deprivation of Liberty Safeguards (DoLS). Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People where able, were actively involved in making decisions about their care and were asked for their consent before being supported. Relationships between staff and people were relaxed and positive. Staff engaged with people to identify their individual needs and what they wanted to achieve in the future. Staff showed flexibility and creativity in supporting people to be as independent as safely as possible.

People were provided with nutritious food and drink, which met their dietary preferences and requirements. People were supported to eat a healthy diet of their choice.

There was a friendly and relaxed atmosphere within the service, where people were encouraged by staff to express their feelings, whilst respecting others. Whenever

people had raised concerns or issues prompt action had been taken by the registered manager to address them.

People’s dignity and privacy was respected and supported by staff, who were skilled in using individual’s specific communication methods. Staff were aware of changes in people’s needs, which were reported to relevant healthcare services promptly where required.

Sufficient staff were deployed to provide activities for people. This ensured people were supported to pursue social activities which protected them from social isolation. People were supported to maintain relationships with friends and family.

There was an open culture and staff were supported to provide care that was centred on the individual. The manager was open and approachable and enabled people who used the service to express their views. The manager encouraged people to raise concerns. When complaints were made they were investigated and action was taken by the provider to make improvements where required.

The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service the team leader greeted us and noted our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Appropriate measures were in place to ensure security of the property and people had access to garden areas that were well maintained. We saw a range of equipment for people needing support including an assisted bath with an overhead hoist, a walk in shower, hand rails and hoists. People had an electrically operated profiling bed with integral side rails and rail padding for safety and variable height for ease of access and lifting and handling.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes. At our last inspection on 19 October 2013 we found that best interest decisions had not been taken through appropriate channels with multi-disciplinary team involvement. At this inspection we saw signed and dated documentation that showed all best interest decisions taken on behalf of people who did not have capacity had been taken in accordance with legal requirements.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met. From our observations and time spent at Kacee Lodge we saw that the people living there were receiving the care and support they needed in an individual way and wherever possible staff tried to facilitate choice.

Is the service caring?

We found the service provided a very happy, inclusive and homely environment that enabled people to live a normal lifestyle. We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. We found that staff were understanding of people's individual needs and this was supported by the personalised care plans that related specifically to people's support in relation to their communication needs and physical disability.

People's relatives and other professionals were asked for their views of the service through satisfaction surveys. The most recent were completed in February 2014. Comments from healthcare professionals included: 'I think the quality of care afforded to people at Kacee Lodge is of an exceptional standard,' and, 'The staff at Kacee Lodge are very professional and deliver a good service,' and, 'The home is clean, staff are efficient, friendly and professional; people who live there are happy.'

Is the service responsive?

We found that the service was responsive to people's individual needs. We saw that Kacee Lodge was attractively furnished with plenty of space in all areas. The design and layout of the service was suitable for the needs of people who lived there. People had individual bedrooms that were personalised with their own belongings. All beds had pressure relieving mattresses to help to prevent pressure ulcers.

Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. They also showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to regularly review care plans. This included seeking support and guidance from relevant health care professionals.

People using the service were provided with the opportunity to access the community and participate in activities which suited their individual needs. This included regular trips out each week on the minibus, attending social clubs and therapeutic activities such as hydrotherapy.

Is the service well-led?

The service worked well with other agencies and services such as health and social care professionals to make sure people received their care in a joined up way. The service had not received any complaints in the last 12 months. There were quality assurance systems, audits and records seen by us that showed identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

We found that the provider had systems in place to maintain the safety and welfare of service users. The service provided staff with specialised training to ensure the safety of people with specific medical needs.

The provider had good arrangements to promote effective performance of the service. We found that there were systems in place to review care plans and incidents to support people's care needs. We found that there was enough staff on the rota and on duty to meet people's needs.

We saw that the registered manager showed clear leadership and that all staff were expected to provide a high quality of care to people. The provider ensured that people's care was regularly reviewed and that additional provisions to support their care were provided where required.

All staff had received the appropriate training to meet the needs of people who used the service, we saw this had been regularly updated. The manager told us that they carry out direct observations of staff providing care and support. All staff had received safeguarding training and policies and procedures were in place for this.

Staff told us that they felt well supported by the management and that they received regular training and supervision. The quality of the service was monitored at the local and provider level through spot checks and inspections by the regional manager.

We saw that the people who used the service were supported to communicate with others by using methods of communication such as pictures and symbols. The manager told us that they are exploring different ways of enhancing peoples communication such as communication dictionaries that describes an individuals unique communication method, for example what a gesture they make means.

One relative of a person who used the service wrote to the home and said "Many thanks to you all for the love, care and attention they received in the last years of their life"