Archived: Angel Lodge

Angel Lodge is registered to provide accommodation for a maximum of five adults. On the day of our inspection there were five adults living in the home with mild learning disabilities and/or mental health conditions.

Angel Lodge is located on a residential road in South Croydon close to local shops and good transport links.

At the time of our inspection the provider was in administration. This means that the role of the provider company had been taken over by a licensed insolvency practitioner. The service was being run by a management company instructed by the licensed insolvency practitioner.

Rating at last inspection:

At the previous inspection in March 2018, the service was rated good overall. Although we found good practice, the rating for the key-question “Well-led” was requires improvement because the provider had not demonstrated consistent good practice over a significant period of time.

Why we inspected:

We inspected Angel Lodge on 21 February 2019. This was a planned comprehensive inspection to check that the service remained good and continued to be well-led. At this inspection the overall rating to this service remains Good.

People’s experience of using this service:

People were protected from abuse because staff knew how to recognise abuse and report any concerns. There were enough staff during the day and night to support people safely and meet their needs. Staff had been trained in the safe administration of medicines and there were systems in place to make sure that people received their medicines as prescribed.

Some parts of the home were in need of redecoration including the kitchen, hallway and some people’s bedrooms.

The home was clean and tidy. Staff were aware of the importance of protecting people from the risk and spread of infection and followed the provider’s infection control procedures.

People were cared for by staff who had the knowledge, skills and experience required to carry out their roles effectively. Staff worked well as a team and felt supported by the registered manager.

The registered manager and staff understood the principles of the Mental Capacity Act 2005 and the specific requirements of the Deprivation of Liberty Safeguards (DoLS).

People were supported to have enough to eat and drink and to maintain a balanced diet. People’s physical and mental health were regularly monitored and they had access to a variety of external healthcare professionals and services.

People’s needs were assessed before they began to use the service to make sure staff could meet their needs. People and their relatives were involved in their care planning and felt in control of the care and support they received.

The care people received had 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 lived as ordinary a life as any citizen.

People were supported by staff who were caring and committed to providing care which met people’s needs. People were satisfied with the quality of care and support they received. Staff respected people’s right to choose every aspect of their care and how they spent their time day to day. People led full and active lives which reflected their age, gender and interests.

There was a consistent staff team who knew people well. People and staff had a good rapport and there was a calm, relaxed atmosphere in the home.

People had regular opportunities to feedback to staff on the support they received, their home environment and the changes they wished to make.

The registered manager was very involved in the day-to- day running of the service and was accessible to people and staff. People felt able to approach her with any comments, suggestions or complaints and felt their comments would be acted on.

There were effective systems in place to monitor and improve the quality of care people received.

For more details, please see the full report.

Angel Lodge is registered to provide accommodation for a maximum of five adults. On the day of our inspection there were four adults living in the home with a mild learning disability and/or mental health conditions. Angel Lodge is located on a residential road in South Croydon close to local shops and good transport links.

Since our last inspection the provider had employed a new manager who had completed the CQC registration process. Like registered providers, registered managers 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.

At our last comprehensive inspection in September 2017, we found the provider was in breach of the regulations as there was a lack of staff training, a lack of person-centred care planning and ineffective systems to assess and monitor the quality of care people received.

After the inspection, the provider sent us their action plan for what they would do to meet legal requirements in relation to the breaches. We undertook this unannounced focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements. We inspected the service against three of the five questions we ask about services: is the service effective, responsive and well-led. This report only covers our findings in relation to those questions. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Angel Lodge on our website at www.cqc.org.uk.

At this inspection we found the provider had taken the necessary action and was now meeting the legal requirements. Staff had received annual refresher training in topics relevant to their role such as, safeguarding and infection control. People’s care was now planned with their input and their care plans reflected their preferences for how they wished to be supported and spend their time. People were satisfied with the quality of care provided and the care they received met their needs.

People’s care was designed and developed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability using the service were supported to live as ordinary a life as any citizen.

People living in the home were independent and went out alone when they pleased. Staff encouraged people to maintain good personal hygiene, supported people to take their medicines and helped people prepare their meals. People told us there were enough staff working at the home to meet their needs. Staff respected people's wishes and understood the importance of gaining their consent before providing support.

People were involved in planning their care. Care plans reflected their physical, mental, emotional and social needs, their personal history, individual preferences, interests and aspirations. Staff understood the information in people’s care plans and used it in providing people choice. Staff adhered to the principles of the Mental Capacity Act 2005.

The registered manager and staff had a good understanding of their role and responsibilities. The provider and registered manager had introduced new systems and improved the systems in place to assess and monitor the quality of care people received. These systems were now effective in identifying areas which required improvement; where areas for improvement were identified action was taken promptly by the provider. The provider maintained detailed and accurate records in relation to people, staff and the management of the service.

Although the management of the service had improved since our last inspection in September 2017, we could not improve the rating for “well-led” to good. This is because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

At our last inspection in November 2015, we found the provider was meeting all the requirements and regulations we inspected.

At time of our inspection the service had a registered manager. Like registered providers, registered managers 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 registered manager resigned soon after our inspection but will need to go through the process of deregistering. In the meantime, an experienced member of staff is managing the service with support from the provider.

People living in the home at the date of our inspection were independent and went out alone when they pleased. Staff encouraged people to maintain their personal hygiene, supported people to take their medicines and helped people prepare their meals.

People felt safe living in the home and in the way support was provided by staff. Staff had a good understanding of how to protect people from abuse. They knew how to identify abuse and the steps to take if they had any concerns about a person's safety. People and their relatives also knew how to report any concerns.

The provider had appropriate arrangements in place in relation to storing, recording and disposing of people's medicines. People received their medicines as prescribed. Staff supported people to maintain good health and liaised well with external healthcare providers. Staff effectively supported people to avoid the risk of dehydration and malnutrition. People were satisfied with the quality of their meals and had sufficient to eat and drink.

People told us there were enough staff working at the home to meet their needs. Staff respected people's wishes and understood the importance of gaining their consent before providing support.

Staff training was not up to date. They had not received recent training in relevant topics such as, infection control and the Mental Capacity Act (MCA) 2005. Staff attended regular supervision and staff meetings which gave them the opportunity to express their views on working practices. Those who had been employed by the provider for more than one year participated in an annual performance review.

People's care plans did not always reflect their individual needs. Two people's care plans had exactly the same information in relation to their social needs and the support they required to access the community. From speaking to staff it was clear that the information in one of these care plans was inaccurate. There was no evidence that people were involved in their care planning. However people were supported by a consistent staff team who understood their routines from their day-to-day interaction.

Staff were recruited using an effective procedure which was consistently applied. People told us the staff were kind and caring. People were treated with respect and their dignity was maintained. People were supported to express their views and give feedback on the care they received. People knew how to make a complaint and there were appropriate arrangements in place to receive, record, investigate and respond to complaints.

There were systems in place to assess and monitor the quality of care people received. However, these systems were not always effective as they did not always identify areas which required improvement and where areas for improvement were identified action was not always taken promptly by the provider.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the lack of staff training, the lack of person-centred care planning and the lack of effective systems to assess and monitor the quality of care people received.

You can see what action we told the provider to take at the back of the full version of the report.