Archived: Nayland Lodge

Nayland Lodge is a residential care home for up to 8 people. The service provides care and support to people with a learning disability and/or mental health needs. At the time of our inspection there were 6 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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.

People we spoke with were satisfied with the service.

The service was not well led. The provider did not have adequate oversight of the service and lacked a recognition and understanding of risks to people using the service. Not enough improvement had been made and breaches of regulation continued. Governance systems were not robust or used effectively and were failing to consistently assess, check and improve quality and safety of the service, and care delivered.

Right Support:

People did not receive the right support to maximise their choice and independence. There were not enough staff to meet people's assessed needs and commissioned support arrangements. This meant people did not lead fulfilling and meaningful everyday lives that promoted their wellbeing. Limited information was available about people's aspirations and goals and how staff could support them to achieve these. People did not receive an interactive and stimulating service that ensured they led inclusive and empowered lives.

Right Care: Care delivered to people was not consistently person-centred and tailored to their needs. People were at risk of avoidable harm because risks were not recognised and mitigated, staff were not sufficiently trained to support people when they were distressed and there was poor management of incidents.

Right Culture:

Whilst people said they liked living at Nayland Lodge and staff were caring, the ethos and values of the service did not ensure people led confident, inclusive, and empowered lives. People were not given opportunities to explore and develop their interests and achieve their goals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 22 June 2023). The provider completed an action plan after the inspection to show what they would do and by when to improve.

We carried out a targeted inspection on 6 July 2023 (published 12 October 2023) to check improvements made in response to warning notices issued to the provider. Although the provider was given added time we found they had not made enough improvement and remained in breach of regulation 12 (safe care and treatment) and 17 (Good governance), and the rating was unchanged.

Why we inspected

We undertook this focused inspection to confirm the provider now met legal requirements. This report only covers our findings in relation to the key questions of safe and well led which have those requirements. 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 is still inadequate.

We found no evidence during this inspection that people had come to any harm. Please see the safe and well led sections of this full report.

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

Enforcement

We found continued breaches in relation to management, governance and oversight, risk management, staffing and staff training at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 check progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Nayland Lodge is a residential care home providing accommodation for up to 8 persons who require nursing or personal care. The service does not provide nursing care. The service provides care and support to people who may have a learning disability or mental health condition. At the time of our inspection there were 8 people using the service.

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.

This was a targeted inspection that considered the areas of safe, risk, management, and governance. Based on our inspection of these areas we found the provider did not have effective oversight and governance to drive improvement in a timely way and breaches of regulation continued.

People’s experience of using this service and what we found

We found the provider had failed to respond effectively and promptly to our concerns; very little pro-active action had been taken to drive, embed and sustain improvement for people and stop previous breaches from continuing or re-occurring.

The service was not well-led. The provider failed to carry out their regulatory responsibilities and did not have adequate oversight of the service. They lacked recognition and understanding of risk and subsequently lacked robust assessments and controls to protect people and keep them safe. There was a high number of incidents requiring police intervention and a failure to identify and act on where things were going wrong.

There were no clear management systems followed in practice to ensure safe staffing levels. New and inexperienced staff members were not sufficiently supported to deliver safe and appropriate care. Learning and development was not managed and planned in a way that ensured staff had the opportunity to build on their knowledge base and develop their skills to carry out their roles and meet people’s specific needs.

The service was not meeting the underpinning principles of Right support, right care, right culture.

Right Support: People did not receive the right support to maximise their choice, control, and independence. There were not enough staff to meet people’s assessed needs and commissioned support arrangements. This meant people did not lead fulfilling and meaningful everyday lives that promoted their wellbeing. The model of care did not focus on people’s strengths or promote what they could do. Limited information was available about people's aspirations and goals and how staff could support them to achieve these. People did not receive a safe, interactive and stimulating service.

Right Care: Gaps in staff training, supervision and competency checks did not ensure people were cared for by staff with the necessary skills, knowledge, and expertise to deliver the right care and support. Care delivered was not person centred and did not promote people’s dignity, independence and safety.

Right Culture: The culture of the service did not empower people to lead their best life. Leaders and care staff did not demonstrate values, attitudes and behaviours that ensured people at Nayland Lodge led confident, inclusive, and empowered lives. Staff were unable to demonstrate their understanding of 'Right support, right care, right culture' guidance and how this should influence the support people received.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 1 February 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had not made enough improvement and remained in breach of regulations.

This service has been in Special Measures since December 2022.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked compliance with Regulation 13 and 18. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified continued breaches in relation to safeguarding, staffing, staff training, risk management and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Nayland Lodge is a residential care home supporting seven people who may be autistic people, people with a learning disability and or people with a mental illness. At the time of inspection three people were receiving the regulated activity of personal care out of seven people living in the home.

People’s experience of using this service and what we found

Right Support

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

The home had been closed to visitors at the time of inspection for three weeks due to people and staff at the home having contracted Covid. At the time of inspection one person had Covid and was isolating in their bedroom.

Some blanket restrictions were in place, such as a locked front door, a blanket ban of alcohol in the home and cigarette regime. Individual risk assessments and capacity assessments had not been completed around restrictions in place.

Right Care:

Care plans were not routinely updated and had not been reviewed for six months. At times peoples risk assessments and care plans did not reflect the needs staff told us people had.

Staff had not always undergone safe recruitment in line with legal requirements. Staff informed the provider at staff meetings across a six-month period that they did not feel able to manage people in extreme distress who were presenting as a risk to others. Training had been requested, but not yet offered. Staff had not received all the training they needed to support people well.

Right Culture:

Staff were observed to speaking to people in a kind way. However, we identified a number of restrictions at the service and a lack of provider understanding around capacity and decision making. This left people at risk of being cared for in a closed culture.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 March 2021). This service has deteriorated to Inadequate. This is the fourth consecutive inspection where the provider has failed to achieve a good rating.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to staffing numbers, restrictive practices and poor governance and oversight. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 deteriorated from Requires Improvement and is now rated Inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective 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 Nayland Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to fit and proper persons employed, safe care and treatment, staffing, mental capacity and good governance and oversight of the quality of the service provided by Nayland Lodge at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 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.

Nayland Lodge is a residential care home providing care and support to people who have a mental health disorder. Nayland Lodge accommodates up to eight people in one adapted building and there were eight people using the service at the time of our inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help or prompting with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

There was a lack of consistency in how well the service was managed and led with no stable management for over three years. This had impacted on the provider’s ability to influence the service positively, support the delivery of person-centred care, and drive improvement.

The provider was open and transparent with us; they recognised serious issues had not been picked up and a failure in their systems to provide effective oversight and governance. They have started to be responsive, listen to staff and know what they need to do to improve.

People had not been supported to take an active role in their care and support and general blanket restrictions had been put in place and imposed without an assessment of individual’s needs. The provider had taken action to lift blanket restrictions and to consult and support people to make choices and promote independence.

People’s care records held on the home’s electronic system were in parts brief. Improvement was needed to ensure care records showed how the service was fully supporting people and how they were responding to the risks people faced.

At the time of our visit the service was at the end of an outbreak of Covid-19. The service was working closely with the local authority, Public Health England and the Clinical Commissioning Group (CCG) infection control team to ensure their infection prevention and control (IPC) practice was safe and people’s needs were being met. Recommendations for improvement had been addressed by the provider. There was plentiful supply of personal protective equipment (PPE) and staff had received training in IPC. National guidance was being followed on the use of PPE and care home visiting.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 20 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. We also received concerns in relation to restrictive practice. The provider has taken some action to address restrictive practice, but further improvement is needed.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the well led section of this report.

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

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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nayland Lodge provides rehabilitation and support for up to eight adults who have a mental health

disorder. There were seven people living at the service on both days of inspection however only one person was receiving a regulated service.

People’s experience of using this service and what we found

Environmental risks in the service had not been identified and mitigated despite known risks to people.

The provider had not raised concerns with the local authority to safeguard people.

Systems were in place to monitor the quality of the service. However, these were not effective and did not highlight concerns raised during the inspection

The environment was not always clean and required improvement. We have made a recommendation about the environment of the service.

End of life planning required further development. We have made a recommendation that the service consults a reputable source to further develop end of life planning.

Staff were recruited safely, were visible in the service and responded to people quickly.

People were given choice and supported to be independent. They were treated with dignity and respect.

Staff knew people well and had developed meaningful relationships with them.

People's health was well managed and there were positive links with other services to ensure that individual health and nutritional needs were met.

People received their medicines when they needed them.

People who received support, and their relatives, made positive comments about the care provided.

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; policies and systems in the service supported this practice.

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 (report published 02 August 2018) At this inspection, the required improvements had not been made.

Why we inspected

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end 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.

Nayland Lodge provides rehabilitation and support for up to eight adults who have a mental health disorder. Nayland Lodge is a large two storey house situated in Colchester and close to all amenities. The premises provide each person using the service with their own individual bedroom and adequate communal facilities for people to make use of within the service.

At the last inspection on 10 November 2015, the service was rated ‘Good’. At this inspection we found the service was now rated overall ‘Requires Improvement’. This is the first time the service has been rated ‘Requires Improvement’.

This inspection was completed on 20 June 2018 and there were eight people living at Nayland Lodge.

A new manager was appointed since our last inspection to the service in November 2015. The manager commenced employment on 3 August 2017, however they were not formally registered with the Care Quality Commission. 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.

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service. These arrangements had not identified the issues we found during our inspection. The registered provider lacked oversight as to what was happening within the service to make the required improvements and provide suitable support to the manager to ensure compliance with regulatory requirements and the fundamental standards. Improvements were required to ensure lessons were learned and actioned when things go wrong.

Improvements were required to the recruitment practices at the service to ensure these were robust. There was limited evidence to show staff employed at the service had received and attained suitable training. Improvements were required to ensure newly employed staff received a robust induction, formal supervision and an annual appraisal of their overall performance; with aims and objectives set for the next 12 months.

People were protected from abuse and people living at the service indicated they were safe and had no concerns about their safety and wellbeing. Policies and procedures were being followed by staff to safeguard people, apart from safeguarding concerns not being notified to the Care Quality Commission. People received their prescribed medication as they should, however minor improvements were required to ensure the correct codes were recorded on the Medication Administration Records. Risks to people were identified and managed to prevent people from receiving unsafe care and support. Staffing levels and the deployment of staff was suitable to meet people’s needs. People were protected by the registered provider’s arrangements for the prevention and control of infection.

Staff understood and had a good knowledge of the key requirements of the Mental Capacity Act [2005] and Deprivation of Liberty Safeguards. Suitable arrangements were in place to ensure that people’s rights and liberties were not restricted and people’s capacity to make day-to-day decisions had been considered and assessed.

People were treated with kindness, dignity and respect. People received a good level of care and support that met their needs and preferences. 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. 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. Social activities were available for people to enjoy and experience both ‘in house’ and within the local community.

People’s nutritional and hydration needs were met and they received appropriate healthcare support as and when needed from a variety of professionals and services. The service worked together with other organisations to ensure people received coordinated care and support. Suitable arrangements were in place to support people who required end of life and palliative care.

There were effective arrangements to manage medications. Staff were trained and had the skills required to administer medications safely.

We saw that staff were checked appropriately before they commenced working at the service.

We spoke with three people living in the home during our inspection. They told us that staff were very supportive and helped and encouraged them to access the local community. They felt fully involved in setting their goals and in identifying the level of support they needed. One person told us, 'Staff help you to unravel life's confusions.' Another said, 'It feels very homely here. There's a good atmosphere.'

The service had systems in place to monitor standards of support and services in the home. Standards of care records were generally good and the manager was addressing any lack of consistency during staff meetings and during supervision with individual members of staff.