The Lodge

Updated 9 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by 2 inspectors, a senior specialist with expertise in learning disabilities and autism, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Lodge Trust is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Lodge Trust is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

The first day of this inspection was unannounced. The second and third day of the inspection were announced.

Inspection activity started on 24 October 2023 and ended on 7 November 2023. We visited the location’s service on 24 October, 25 October and 1 November 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 16 people who live at the service and carried out observations to understand people’s experience of the care provided. We spoke with 5 relatives to understand their experience. We spoke with 15 members of staff including the nominated individual, the registered manager, the creative enterprise manager, 3 senior co-ordinators and 9 support workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of documents and records. These included 7 people’s care records and multiple medicine records. We reviewed 4 staff files and a variety of policies, procedures and documents. Following the inspection, we continued to seek clarification from the provider to validate our findings.

Updated 9 December 2023

About the service

The Lodge Trust is a residential care home providing personal and nursing care to up to maximum of 30 people. The service provides support to autistic people and people with a learning disability. At the time of our inspection there were 29 people using the service.

The Lodge Trust is a Christian home and supports people to lead a Christian lifestyle. The service is situated amongst a substantial country park, some of which is accessible and used by the public.

There are 6 different bungalows and houses across the site where people live. Some people lived in their own self-contained flats, whilst others had their own bedroom and ensuite and shared a dining room and living room area.

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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

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; however, there was not always clear written guidance in place to support staff with this. Some people’s specific health needs were not always assessed and documented. Some staff had not received mandatory training regarding supporting people living with learning disabilities and autism.

People received their medicines as prescribed, but some audit processes required improvements to ensure any issues were identified in a timely manner. People were supported to engage in activities and interests and were able to personalise their bedrooms and living spaces as they wished.

Right Care:

Systems and processes were not always effective to ensure safeguarding incidents were identified, investigated and referred to the appropriate agencies. This meant the opportunities to assess safety and take steps to mitigate risk were not always taken. Some people did not have specific health condition care plans in place such as mental health diagnoses. People were supported by staff who were passionate and committed to providing care in accordance with the Christian ethos of the service. Staff were caring and provided support to people with warmth, compassion and preserved their dignity. People were able to make choices and were involved in decisions about their care needs and lives. Staff worked closely with people and made referrals to health and social care professionals in a timely manner.

Right Culture:

Oversight of the service was not always consistent. We found areas of concern that had not been identified prior to our inspection. These included audits not efficiently identifying improvements required, and processes not always being effectively followed. People were encouraged to be independent, and staff listened to people’s views. Staff formed good working relationships with people. Staff and management were open and transparent, and acted upon feedback to improve people’s outcomes. Systems and processes to govern the service required improvement to ensure the areas of risk were identified, and improvements to drive quality care could be delivered.

Overall, the service was not always meeting ‘right support, right care, right culture.’ We are aware this is a large service supporting up to 30 people, and therefore is significantly larger than good practice guidance suggests.

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 21 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to how safeguarding concerns were responded to and how the service was governed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.