We carried out a review of the data available to us about Poplar Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Poplar Lodge, you can give feedback on this service.
Poplar Lodge is a residential care home providing personal care to up to 9 people. The service provides support to people with learning disabilities, autism and/or mental health needs. At the time of our inspection 7 people were using the service.
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.
The provider was able to demonstrate how they were meeting the underpinning principles of 'right support, right care, right culture.'
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; the policies and systems in the service supported this practice.
Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful life. Staff supported people to take part in activities and pursue their interests in their local area. People were supported in a safe and clean environment that met their sensory and physical needs. Staff supported people to make decisions following best practice in decision-making. Staff supported people to play an active role in maintaining their own health and wellbeing.
Right Care
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. Staff and people co-operated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
Right Culture
People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff knew and understood people well and were responsive; they supported people’s aspirations to live a quality life of their choosing.
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 1 October 2019) and there was a breach 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 improvements had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended that the provider considered how they may learn lessons. At this inspection we found the provider had acted on this recommendation and improvements had been made.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 carried out an unannounced comprehensive inspection of this service on 19 August 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve governance.
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. 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 requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Poplar Lodge on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Poplar Lodge is a residential care home which provides personal care for up to nine people. At the time of our inspection eight people with mental health needs and learning disabilities were using the service.
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 received planned and co-ordinated person-centred support that was appropriate and inclusive for them.
People’s experience of using this service and what we found
The provider did not have in place robust governance arrangements which effectively measured the quality of the service. The registered manager had carried out audits and acted to improve the service which had not been verified by the provider. We made a recommendation about the provider reviewing the service to check if any lessons could be learnt.
Staff kept people safe. Risk assessments were documented, and staff knew how to report any concerns. Staff employed in the service had undergone pre-employment checks to assess their suitability. There were enough staff on duty to meet people’s needs. The home was clean and tidy.
Staff supported people to eat healthy diets and drink sufficient amounts. People were supported to attend medical appointments and staff liaised with other professionals to ensure people’s needs were met.
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.
Staff approached people with kindness. They supported people’s independence and provided opportunities for people express their views. Complaints had been investigated and addressed by the registered manager.
Staff had revised and updated people’s care plans. They knew people well and understood their preferences. People were engaged in activities they enjoyed. The provider had guidance in place for staff to work with people at their end of their life.
People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 12 March 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 improvements had been made. However, the provider was still in breach of one regulation.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
Since the last inspection we recognised that the provider had failed to notify us of events which occurred in the service. This was a breach of regulation. Full information about CQC’s regulatory response to this 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 monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service:
Staff had documented people’s personal risks. However, these were not always up to date and/or accurate leaving one person at risk of a serious health condition.
Since our last inspection improvements to care plans had been initiated, although there were some plans which needed further revision.
Audits to measure the effectiveness of the service lacked rigour. This meant people were at risk of receiving poor quality care.
Cleaning was ongoing in the home to reduce the risk of cross infection. The manager told us night staff were required to carry out cleaning. However, we found some areas of the home required deep cleaning. The local Infection Prevention and Control team had visited the service and found areas for improvement. In a meeting with local authority representatives the provider agreed to employ a cleaner.
Menu planning did not always consider specific dietary needs. The manager had brought into the service cook books to diversify menus. We made a recommendation about the service reviewing the menu choices on offer.
Regular ‘residents’ meetings’ had lapsed and people had not had the opportunity to give their views about the service.
People were supported by staff to attend activities outside of the home. We found improvements were required to further engage people in meaningful activities.
The temporary manager was in place and they were responsive to issues we raised during the inspection. Staff were willing to learn and make changes.
Changes were in progress to improve the fabric of the home. The kitchen had been refurbished and downstairs had been redecorated. Further work was required upstairs to improve the décor. Regular checks were carried to ensure people lived in a safe environment.
Pre-employment checks were carried out to ensure staff were suitable to work in the home. Sufficient staff were on duty. Start times for staff were staggered to support people.
Staff were not always supported through training defined as mandatory by the provider and supervision. The service had welcomed additional training from other professionals. Staff felt they had been able to improve service delivery due to their recent training.
People were supported with their health by staff who had regular contact with other healthcare professionals to discuss people’s conditions and seek advice.
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; the policies and systems in the service did not support this practice.
People were happy with the support they received from staff. Staff treated people with kindness and respected people. They enabled people as far as possible to be independent.
A complaints procedure was available. No complaints had been made since our last inspection.
Rating at last inspection: At our last inspection we rated this service as requires improvement. (Report published 1 November 2018). This service has been rated Requires Improvement at the last two inspections.
Why we inspected: This was a planned inspection based on the previous rating of the service.
Improvement Action: Please see the ‘action we have told the provider to take’ section towards the end of the report.
Follow up: This is the third time the service has been rated as requires improvement. We will continue to monitor the service through the information we receive and discussions with partner agencies. We will be speaking to the provider about their next steps to improve the service to an overall rating of Good. We have rated the well-led key question inadequate. This means we will inspect the service within the next six months.
We carried out an unannounced comprehensive inspection of this service on 3 April 2018 and rated the service to be Good. On 13 and 23 February 2018 we completed a focused inspection and reviewed the domains safe, effective and well-led. We rated the service as requires improvement overall and in these three domains. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment; the need for consent; staffing; and having good governance systems in place.
After inspection in February 2018, we received continued concerns from Durham local authority in relation to the operation of the service. As a result, we undertook a focused inspection to look into those concerns. We reviewed the domains safe and well-led.
Poplar 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. Poplar Lodge provides care and accommodation for up to nine people who are living with a learning disability and who may have an offending history, so may present a risk of harm to others. On the day of our inspection there were eight people using the service.
The service has a registered manager in place. 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.
We found that the registered manager had been diligently trying to make improvements but was not supported by the provider to achieve effective changes to the service. They had proactively sought advice from forensic mental health specialists and sourced training for staff in this field. However, further training was required to ensure staff and the registered manager were equipped with the skills needed to complete risk management plans for people with forensic histories and complex behaviours.
At the previous inspection and again at this one, staff reported that the provider ran services in Whitley Bay for people with similar needs. Previously the regional manager had stated that they would ensure the Poplar Lodge team could work with staff from these units to enable them to develop their skills in this field. We found that other than a staff member being deployed from one of the units to work as care staff member, no one from these units had offered or been asked to provide support to staff and assist them develop their skills.
The manager had closely listened to external professional’s views about how to develop the care records and had since our last inspection rewritten people’s care records at least six times. We found that the care records were more informative and were written in a person-centred manner. However, the risk management plans needed to demonstrate what the current risks were and highlight how long ago historical risks were last present. They also needed to show how staff monitored people’s behaviour and identified trigger behaviours or potential re-emergence of risk and provide detailed evidence of what action was being taken to reduce risks.
We spoke with the local neighbourhood police who were very positive about recent developments at the home and found staff had developed their skills around managing behaviours that challenge. This had led to a much lower call out rate for police assistance.
We found that improvements were needed around the management of topical medicines. One person showed us topical medicines they had been prescribed in January and April 2017, which they kept in their bedroom. There were no arrangements in place for staff to monitor usage of these topical creams. We drew this to the attention of the registered manager who agreed to go through people’s room with them and identify topical medicines which required staff oversight.
The staff and people currently were responsible for cleaning the house, but had insufficient time to make sure deep cleans were completed on a regular basis. Thus, we found areas of the home that were dirty. We are aware that the infection control team recommended the employment of a cleaner and we concur that dedicated cleaning hours are needed each week to mitigate infection control risks.
People on the morning of the inspection, had left over broth from the night before for their breakfast. They enjoyed the food but we saw that it had been left out on the cooker overnight. Therefore, we were concerned that this did not meet the expected practice for storing food in the fridge to reduce the risk of bacteria forming on the broth.
People spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well, and throughout included them in all discussions.
We found that manager had identified areas that needed to be improved such as replacing first aid boxes, developing support systems but the provider’s process had led to none of these identified needs being action. Although the registered manager had been completing provider’s audits these had not picked up issues we highlighted, for instance the issues with topical medicines.
The regional manager continued to have limited time to spend at the home and we found the provider’s quality assurance tools did not pick up issues other professionals were noting.
People were very complimentary about the staff at the service and their attitude. They told us the service was very supportive and met their needs. People told us that staff were kind and caring.
We found the service continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment and having good governance systems in place.
You can see what action we told the registered provider to take at the back of the full version of the report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.”
We last inspected the service on 3 April 2017 and rated the service as ‘Good.’
We completed this focused inspection, as we were aware the placing authority had recently raised concerns about the operation of the service. In January 2018, the local authority commissioners discussed their concerns around the way potential risks for people were managed.
Poplar 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. Poplar Lodge provides care and accommodation for up to nine people who are living with a learning disability and who may have an offending history so may present a risk of harm to others. On the day of our inspection there were eight people using the service.
The service has a registered manager in place. 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.
We found staff needed to receive training around meeting the specialism the service was designed to deliver, for instance completing risk management with people who have an offending history and understanding the use of the Mental Health Act 2983 (amended 2007) in the community.
Also staff needed to be supported to understand the actions they were able to take to ensure people were safe when going out independently. They needed to be more proactive and find out if people were subject to any court restrictions, Ministry of Justice conditions or Community Treatment Order conditions. Although some links had been formed with the local Protection of the Public Unit at present no information was available to assure staff that the courts had not imposed additional restrictions when sentencing people. Also no information had been gathered in respect how the police dealt with any incidents.
Staff knew the people they were supporting but the care records did not reflect this knowledge. Also the records did not provide evidence that could be used to support staff to fully understand people’s histories, the impact of their learning disability or mental health needs on their behaviour, be able to contextualise and formulate risk profiles for people or determine what restrictions were in place. For instance one person had an electronic tag fitted but we could not determine why, what conviction had led to this and what requirements the Court expected the person had to adhere to. The person told us they were subject to a curfew but staff also thought the tag might offer them safeguards if the person became violent again but were unclear as to how this worked.
The care records contained no information about people’s capacity and no MCA assessments had been completed. We found people were required to only go out when accompanied by staff but neither a ‘best interests’ decision or formal agreement from the individual for this arrangement was on file. Staff we spoke with did not know if people had DoLS authorisations in place or when they were subject to restrictions via legal processes such as conditional discharges and court orders what were the conditions of these orders.
Although the registered manager had been completing audits these had not picked up issues we highlighted, for instance the lack of ‘as required’ protocols for medicines, the uninformative care records, the lack of robust risk management plans and that staff had not received specific training to enable them to work in this specialism.
People were very complimentary about the staff at the service and their attitude. They told us the service was very supportive and met their needs. People told us that staff were kind and caring.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment; the need for consent; staffing; and having good governance systems in place.
You can see what action we told the registered provider to take at the back of the full version of the report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”
Poplar Lodge provides care and accommodation for up to nine people who have a forensic learning disability and may present a risk of harm to themselves or others. On the day of our inspection there were eight people using the service.
The service had a registered manager in place.
We last inspected the service in December 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.
People told us they felt safe. Staff we spoke with were knowledgeable about safeguarding procedures and external professionals raised no concerns regarding people’s safety or how the service managed public protection considerations. We saw information about how to keep people safe was clearly displayed.
People who used the service and staff we spoke with told us that there were enough staff on duty to keep people safe and meet people’s needs and we found this to be the case.
There were policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). 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 supported this practice.
Individual care plans contained risk assessments which were reviewed regularly. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. Staff liaised regularly with a range of external agencies and professionals to keep people safe and meet their needs.
Staff had received a range of training, including mandatory courses such as safeguarding, fire safety, infection control and food hygiene as well as specific training to meet people’s needs, such as Positive Behaviour Support (PBS) and challenging behaviour awareness.
There was a regular programme of staff supervision and appraisals in place, as well as regular staff meetings.
The service encouraged people to maintain their independence. People were supported to be involved in the local community and access regular activities.
There was a system in place for dealing with people’s concerns and complaints. People we spoke with knew how to complain and felt confident that the staff or registered manager and provider would respond and take action to support them. Complaints were treated seriously and responded to appropriately by the registered manager.
People were encouraged to choose healthy food options and helped in the kitchen regularly. People confirmed they had a choice of meals and were involved in menu planning.
Detailed care plans were in place which had regard to people’s medical and personal needs, life histories, preferences and risks. Staff demonstrated a good knowledge of people’s needs and we saw people were involved in regular reviews of care plans and risk assessments.
We found that people received their medicines safely and there were clear guidelines in place for staff to follow.
We found that the building was clean, appropriate for people’s needs and had ample outdoor space that had been meaningfully adapted to encourage people’s interests in horticulture and other outdoor activities. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety requirements were met. We saw that audits of infection control practices were completed.
Senior carers and the registered manager used a range of quality audits to scrutinise the service. The registered manager also regularly invited people to give their opinions on how well the service was performing.
Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to notifying CQC and other agencies of relevant incidents and this had been done consistently.
The registered manager had developed and maintained a person-centred culture that balanced the need to manage risks effectively with the need to respect and encourage people’s independence and rights.
Poplar Lodge provides care and accommodation for up to nine people. The home specialises in the care of people who have a forensic learning disability and supported men with a range of criminal offences. Some people who used the service were detained under the Mental Health Act 1983. On the day of our inspection there were nine people using the service.
The home did not have a registered manager in place as the registered manager had recently left the service. 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. A new acting manager was in post and was in the process of registering with CQC at the time of our inspection.
The provider had policies and procedures in place for recognising and reporting abuse. We spoke with two members of staff about keeping people safe. Staff we spoke with were able to describe to us the different types of abuse and how to report any suspicions they may have.
We looked at the care plans of four people who used the service and found where a risk had been identified an appropriate risk assessment was carried out and included in the care plan. Risk assessments identified the potential risk, the likelihood of it happening and action to be taken in order to best mitigate the risk.
An ‘Infection Control Inspection’ inspection carried out by the Clinical Commissioning Group Infection Control Team in April 2014 revealed some areas that needed improvement in the home. We saw that some of the work had been carried out but there were still some areas that needed further work. For example we saw there was a supply of liquid soap and paper towels in bathrooms, seating had been replaced and the bathrooms had been decorated with new showers and shower curtains, however, there was still work required to replace bathroom flooring and the shower enclosure. We were told by the acting manager the remaining work was expected to be completed by the end of February. In addition to this a cleaning rota had been put in place and infection control training has been booked for all staff to ensure they are up to date with the most recent legislation.
We saw robust recruitment and selection processes were in place. We looked at the files of three staff, the most recent member of staff employed, and two others who had worked in the home for several years. We found appropriate checks were undertaken before people started work. Staff files included evidence that pre-employment checks had been made including written references, Disclosure and Barring Service (DBS) checks, and evidence of their identity had also been obtained.
The home had an appropriate medication policy in place. We saw staff who dispensed medication had received training in the management and storage of medicines. We looked at the medication administration records (MAR) and found they were completed clearly and correctly.
Staff files contained evidence of regular supervisions and appraisals taking place. We saw where supervisions had taken place a detailed record was kept in staff files. We saw staff appraisals were carried out annually and a record was kept in personnel files
People who used the service had access to healthcare services like GPs, opticians, and podiatrists. In addition people received ongoing support from social workers and where appropriate, forensic mental health teams.
Everyone who lived at Poplar Lodge received care and support that was personalised to their individual needs. Care plans were in place for all the people who used the service.
Areas of risk were identified based on the persons individual needs and detailed risk assessments were formulated which were used to minimise potential risks. Risk assessments were regularly reviewed to ensure they were relevant and that there had been no changes.
Some of the medicines people were taking required regular tests be carried out to ensure that there were no adverse effects on people’s health. We saw reviews and tests were completed with the results logged in care files. Changes to medicines were made accordingly when necessary meaning people’s care was adapted to take account of their changing needs.
We saw the provider had a formal complaints procedure in place. We saw there was a record of complaints that had been made and evidence of investigations which had been carried out as part of the complaints procedure. People we spoke with were aware of the complaints procedure but they did not wish to make a complaint. We were told “I tell the staff if there’s anything wrong”.
We looked at the care records of four people who used the service. We saw care plans were comprehensive and person centred with a detailed pen picture included. All care plans included a full description of the individual, information relating to physical difficulties, addictions, medications and hospital admissions as well as preferred daily routine and social history.
We saw a notice board in the home providing people who used the service with information. This included access to support services and how to make complaints. We saw some of the people in the home had accessed advocacy services and advocates were in place.
We found there was a culture of positive reinforcement and reassurance with support being given by staff that were trained to deal with behaviour that challenged the service.
The provider had a quality assurance system in place which was used to ensure people who used the service received the best care.
After audits had been carried out we saw the acting manager used them to identify areas of concern and to put an action plan in place allowing for improvements to be completed. This meant the provider was working toward continuously improving the service.