We inspected Shore Lodge on 28 February 2017. Shore Lodge provide care and support for up to 10 people. Accommodation is provided from a building which was purpose built as a care facility for people with learning disabilities. The building is located within a residential area. There were 9 people living at Shore Lodge at the time of the inspection. Most people living at Shore Lodge were unable to communicate verbally.

The service had a registered manager in post. 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.

At our last inspection on 14 April 2016, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to the requirements of the Mental Capacity Act 2005 not being met. At this inspection, improvements had been made and the service was compliant with the regulation.

Mental capacity assessments were being carried out and these were decision specific. Staff and the registered manager demonstrated good knowledge of the Mental Capacity Act 2005. However, we found that assessments were recorded in one document and not separated into each individual decision. We have made a recommendation about this in our report.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people's freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

Medicines were stored securely and safely administered by staff who had received appropriate training to do so. However, we found that some liquid medicines did not have a date of opening written on them. We have made a recommendation about this in our report.

The registered provider had systems in place to protect people against abuse and harm. There were effective policies and procedures that gave staff guidance on how to report abuse. The registered manager had robust systems in place to record and investigate any concerns.

Risks to people's safety had been assessed and actions taken to protect people from the risk of harm. The environment was clean and appropriate measures had been taken to reduce the risk of infection.

There were sufficient staff to provide care to people throughout the day and night. When staff were recruited, they were subject to checks to ensure they were safe to work in the care sector.

People were being referred to health professionals when needed. People’s records showed that appropriate referrals were being made to GP’s, speech and language therapists, dentists and chiropodists.

Staff were well trained with the right skills and knowledge to provide people with the care and assistance they needed.

People were being supported to have a nutritious diet that met their needs, and were supported to eat by suitably trained staff.

Relatives spoke positively about staff. Staff communicated with people in ways that were understood when providing support. People’s private information was stored securely and discussions about people’s personal needs took place in a private area where it could not be overheard.

People were free to choose how they lived their lives. People could choose what activities they took part in and could decorate their bedrooms according to their own tastes.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Records showed that outcomes of the investigations were communicated to relevant people. People and their relatives were encouraged to give feedback through resident meetings and yearly surveys.

The registered manager was approachable and supportive and took an active role

Shore Lodge provides accommodation for up to ten adults who have physical and learning disabilities. It is part of the Leonard Cheshire Disability (LCD) organisation. The home is situated on the outskirts of Dartford in Kent.

This inspection was carried out on 04 March 2016 by one inspector. It was an unannounced inspection. There were 9 people using the service at the time of the inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Following the last inspection in July 2015 the registered provider and registered manager were served with warning notices in respect of breaches the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan addressing the requirements of the notices. At this inspection we found that the required improvements detailed in the warning notices had been made. At the last inspection we also issued a requirement notice in relation to consent. At this inspection we found that, although improvements had been made, the registered manager and staff did not fully understand the requirements of the Mental Capacity Act 2005.

Staff were trained in the principles of the Mental Capacity Act 2005 (MCA), however we found that assumptions had been made in respect of people’s mental capacity to make decisions. It was recorded on people’s care plans that they did not have the capacity to make decisions. The registered manager and staff had not understood that an assessment of a person’s capacity needed to be carried out for each decision to be made, where they believed the person may be unable to make the decision. This placed people at risk of losing their right to make a decision because assumptions were made or because they had not been able to make a previous decision. This was a breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were completed based on the needs of the individual. Staff understood what action they needed to take to keep people safe. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Action had been taken to reduce the risks to people’s safety.

There were sufficient staff to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were suitable to work with people.

Medicines were stored, administered and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

The service was clean, well maintained and designed to meet the needs of the people that used it. Risk within the premises and in the use of equipment had been assessed and managed effectively. Staff knew how to minimise the risk of infection spreading in the service.

Staff knew people well and were trained and competent to meet people’s needs. They had the opportunity to receive further training specific to the needs of the people they supported. Staff felt supported and received one to one supervision sessions and an annual appraisal of their performance. Staff were clear about their responsibilities. This ensured they were supported to work to the expected standards.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted where needed and the least restrictive

Due to the complex nature of the needs of people living at the home, they were unable to tell us in detail about their experiences of living at Shore Lodge. In order to resolve this issue, we used variety of other methods. For example, we spoke with two relatives, one of whom told us, "My family member has been in other homes before and this is the best by far". Another said, "Yes, the care is very good there. My relative is very happy". We noted that the home provided a wide variety of social and educational opportunities for people, both at the home and in the wider community.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. There were enough qualified, skilled and experienced staff to meet people’s needs. We also found that systems were in place for people and relatives to make a complaint about the service if necessary and that complaints were managed in a timely and satisfactory manner.

Some of the people in the home had complex needs which meant that they were not able to tell us their experiences of using the service; we therefore used our observations to help inform some of our judgements. We saw that people were being supported around the home by staff in a kind and sensitive manner, in a way that promoted individual independence. For example we observed that people who required help to eat their meal were given appropriate assistance by staff.

People we spoke with indicated that they liked living in the home and the staff. People and relatives we spoke with said there was plenty to do both inside and outside the home. We saw that people who used the service were encouraged to help with the day to day running of the home and were involved with tasks such as menu planning and food shopping.

We arranged to speak with some relatives over the telephone. They told us that they were happy with the care and support provided by the service. Comments included “My relative loves living in Shore Lodge, everyone is well looked after” “We are very happy with the home and so pleased our relative is there” and “We can’t praise the service enough”. We found that relatives and people who used the service had been involved in their care. One relative told us, “We have been involved from the start with our relative’s initial assessments and their care plan” Another relative told us “We are kept involved, I regularly attend my relative’s care reviews.”

There were nine people living at Shore Lodge at the time of our visit. All people who used this service were over the age of 60. Most of the people who used the service were out at a variety of activities including college, swimming and a trip to a nearby canteen throughout the two days of the visit.

We spoke with five people who used the service, however due to communication difficulties we were unable to discuss things at length. All the people we spoke with either said or indicated that they were “happy” living in Shore Lodge. One person who used the service told us that they took part in many activities within the home such as cooking. Another person told us that they were happy with the progress they had made since moving into Shore Lodge.

We were unable to verbally communicate with all the people who used the service; we therefore used our observations to help inform some of our judgements. We observed positive interactions between people and staff. Observation showed that people using the service were relaxed and enjoyed taking part in activities inside and outside of the home.

We spoke with five relatives of people using the service who told us that they were happy with the service provided and praised staff for their care and support. Comments included “The staff here are marvellous, they are patient and encouraging”, “The way staff support XX is so good, they encourage XX to do things and to be as independent as possible”; whist another relative told us that the care their relative received at Shore Lodge was “Fantastic”.

The relatives we spoke with told us that they were kept informed about their relative’s progress. Some commented on the improvement in their relative’s lives since they had moved to Shore Lodge. One relative said, “I have never seen XX so happy or to eat so well, I’ve never known XX to do so much”.

Some of the relatives we spoke with told us that they were kept involved in care decisions and reviews. All the relatives we spoke with told us they felt their relative was safe at the service and knew who to speak to if they were unhappy with aspects of their relative’s care or support.

This inspection was carried out on 20 and 21 July 2015. The inspection was unannounced.

Shore Lodge provides accommodation for up to ten adults. It is part of the Leonard Cheshire Disability (LCD) organisation. The home is situated on the outskirts of Dartford in Kent. At the time of inspection, the home was fully occupied. People had a variety of complex needs including learning, physical disabilities and were limited in their ability to communicate verbally. During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was not providing care in a safe way, Safe hygiene standards were not maintained, and staff training and supervision was not effective. Meals and mealtimes did not promote people’s wellbeing. People’s health care was not planned or delivered effectively. People were not treated with dignity and respect or provided with personalised care. Staff were not responsive to people’s needs or choices. People were not provided with meaningful activities. There was an instructional culture and reactive leadership style at the service.

The service had a registered manager. 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 and associated Regulations about how the service is run.

Before our inspection we received information of concern from the local authority safeguarding team. Relatives made complimentary comments about the service their family members received. However, our own observations and the records we looked at did not always match the positive descriptions relatives had given us.

Systems to assess, monitor and improve the quality and safety of the service or identify and manage all the risks to people’s safety were not effective. Unsafe practice meant that people were at risk of harm.

People were not always treated with respect or with regard for their privacy and dignity. They were not offered choices or consulted with about the care provided to them.

The provider did not have a clear system to assess how many staff were required to meet people’s needs and to ensure there were enough staff to be on duty at all times. The approach to care was task focussed rather than person centred. Staff were under pressure to carry out a variety of tasks including household tasks in addition to providing care and activities for people. This meant they were not able to spend quality time with people.

People were not involved in planning their care or consulted about how their care was delivered. There was not enough information in care plans to make sure staff knew how to care for people’s physical, emotional and social needs. People were provided with opportunities to take part in a range of activities.

Staff were supported by the management team. New staff received induction training. Not all staff had essential training or opportunities for additional training. Staff were not trained to deliver safe and appropriate care to each person. Although staff received regular supervision this was not effective in ensuring staff understood and practiced good values and behaviours. Staff did not recognise or understand how to safeguarded people from abuse.

There was a system for managing complaints about the service. The complaints procedure was provided in pictorial format so that people were helped to understand how to make a complaint.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time. People were asked about their views through the provider’s ‘Have your Say’ forms. Recent results were good and showed people were ‘happy’ or very happy with the overall service.

People received their medicines as prescribed. Medicines were stored securely to ensure people’s safety.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.