Background to this inspection
Updated
8 March 2024
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.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
Two inspectors carried out this inspection.
Service and service type
Nayland Lodge 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. Nayland Lodge 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 not a registered manager in post.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 14 December 2023 and ended on 18 December 2023. We visited the location’s service on 14 December 2023.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
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 all this information to plan our inspection.
During the inspection
We spoke with 2 people who used the service. We looked at records in relation to 2 people's care.
We also spoke with the director of the company, the manager and 1 staff member. We looked at records relating to staffing, recruitment, training and development of staff, management of the service and systems for checking the quality and safety of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
8 March 2024
About the service
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.