Buttercup Lodge

Updated 9 March 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4 and 7 January 2019 and was unannounced. The inspection team consisted of one adult social care inspector.

Prior to the inspection we reviewed information we held about the service. This included the previous inspection report and statutory notifications sent to us by the service. Statutory notifications are information services such as EAM Lodge are required to send us about significant events such as safeguarding incidents. We used information the provider sent us in their Provider Information Return. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make.

We considered concerns raised in a regulation 28 report to prevent future deaths issued by the coroner in the process of planning this inspection. This report was issued by the coroner in April 2018 following an inquest into the death of a child living at the neighbouring service EAM House. It has been published online at www.judiciary.uk. Although EAM House is a separate service, parts of the prevention of future deaths report were relevant to consider at this inspection due to a shared staff and management team between EAM House and EAM Lodge. We considered the concerns raised by the coroner in relation to the lack of a 'serious untoward incident protocol', the ability of staff to recognise and act on signs of deterioration, escalating concerns for medical review, carrying out physiological observations and appropriate use of care records.

We sought feedback about the service from the local authority quality and contracts team, Healthwatch Trafford, commissioners of the service and health and social care professionals who the provider told us had recent experience working with people living at the home. We used the feedback we received to help plan the areas we would focus on during our inspection.

During the inspection we were able to speak with one person who lived at the home with the support of the registered manager. We spoke with the relative of one person living at the home during the inspection, and a further three relatives by phone shortly after the site visit. We spoke with six staff members. This included two care staff, the registered manager, the nominated individual for the provider, the physiotherapist and the registered manager for the neighbouring service, EAM House. We carried out observations of the care and support people received in communal areas of the home.

We looked at records relating to the care people were receiving, including; three care files, daily records of care and medication administration records. We also reviewed records relating to the running of a service such as a care home. This included; three staff personnel files, records of servicing and maintenance of the premises and equipment, audits and training and supervision records.

Updated 9 March 2019

This inspection took place on 4 and 7 January 2019 and was unannounced.

We last inspected EAM Lodge on 18 and 19 October 2017. At that time, we rated the service requires improvement overall and identified breaches of regulations in relation to safe care and treatment and staff training. We also made two recommendations in relation to assessing people’s needs in relation to the use of assistive technologies, and assessing the safety of the premises and equipment.

At this inspection we found the provider had taken action and had made improvements in relation to all the previous breaches and recommendations. The provider was found to be meeting the requirements of all regulations.

EAM 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.

EAM Lodge accommodates up to five people in one adapted building. The service provides care, including nursing care to young adults who have a learning disability and/or complex heath care needs. The home provides support to people staying at the home for short breaks (respite), as well people who live at the home on a longer-term basis. At the time of our inspection there were three people living at the home on a permanent basis, and two rooms were available to people staying for short breaks. There was one person staying at the service for a short break on the first day of our inspection.

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.

There was a registered manager who was registered to manage the service in September 2016. The registered manager intended to step down from this position in the future, but told us they would continue in the role until the provider could find a suitable replacement. The day to day management of the home had also been supported by the registered manager working at the neighbouring service, EAM House.

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.

There were sufficient staff on duty to enable staff to meet people’s needs. We saw staffing levels were varied dependent on the needs of people using the service. The registered manager also considered the skill-mix of the staff team when deploying staff.

We saw any accidents and incidents were thoroughly investigated, and steps were taken to help prevent a repeat incident and to make the service safer. There was an open and honest culture, and the provider encouraged staff to reflect on how they could have done things differently when they went wrong. Lessons were learned from any incidents and this resulted in improvements being made within the service.

The registered manager and staff team demonstrated a commitment and enthusiasm for delivering quality, person-centred support. The service did not use agency staff, which helped the service provide consistent care from staff that knew people well.

Staff were kind, caring and respectful in their approach. Staff had developed close relationships with people using the service. They had a good understanding of people’s needs and preferences. We observed people smiling and laughing with staff and they appeared relaxed and comfortable when receiving support.

Staff received the training and support they needed to meet people’s needs effectively. The provider checked staff were competent to provide the care and support people needed.

Staff provided opportunities for people to engage in a range of activities that met their needs and preferences. People were supported to access the local community and community groups. Some people had been supported to attend events of interest to them such as music concerts and the rugby.

The service worked alongside a range of health and social care professionals in order to meet people’s needs. We saw staff had developed detailed care plans that were updated as people’s needs changed. Care plans reflected people’s needs and preferences in relation to how their care was provided.

Relatives told us staff communicated well with them. They told us they would feel confident to raise a complaint if they had any concerns.

There were systems in place to help the registered manager and provider monitor the quality and safety of the service.

Staff understood the principles of the mental capacity act, and we saw evidence of good practice in relation to completion of capacity assessments and best-interest decisions. However, as at our last inspection, some consent forms had been signed by others when there was no evidence that they had authority to provide consent on that person’s behalf.

The provider sought and acted on the views of people using the service or their representatives. They considered and acted on feedback received from relevant persons such as the CQC and the coroner.

The coroner had issued a prevention of future deaths report in April 2018 following the inquest of a child who had died when staying at the neighbouring service, EAM House in July 2016. This was relevant to this inspection because of shared processes, staff and management teams between the two services. However, we found the provider had acted on all the concerns raised in the coroner’s report to make improvements at both services. We have reported in more detail on this issue in our report for EAM House published in October 2018.