Date of assessment 12 August 2024 to 23 August 2024. Hunters Lodge is a residential care home providing accommodation and personal care for up to 17 people with a learning disability and or autism, some people also have a physical disability. At the time of the inspection, 11 people were living at the service. Hunters Lodge is also a domiciliary care agency which provides personal care to people in their own homes. They support adults who have learning disabilities. At the time of our assessment, the service supported 1 person, in their own property, this assessment did not review the domiciliary care agency. As part of this assessment activity, we undertook site-visits on 12 and 13 August 2024. The assessment was prompted in part by a notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this assessment did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk in relation to moving and handling. This assessment examined those risks. We assessed a total of 21 quality statements. At the last inspection, this location was rated good. We found the location remains good. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.
PDF cached but not yet analysed by Claude — set ANTHROPIC_API_KEY and re-run npm run etl:reports -- --location 1-4328237157.
This was a targeted, unannounced inspection of Hunters Lodge, a residential care home for people with learning disabilities and autistic spectrum disorder, focused solely on infection prevention and control during the COVID-19 pandemic. The service demonstrated robust IPC practices and met vaccination requirements, with only minor environmental maintenance issues noted.
Concerns (1)
minorInfection control — “some chair covers on dining chairs were ripped and chairs required re-covering. Additionally, flooring in the dining room required replacement.”
Strengths
· Staff and people followed robust COVID-19 testing in line with current government guidance
· People were supported to visit friends and family and receive visitors safely
· Staff understood and followed robust infection prevention and control procedures including PPE use
· PPE stations available throughout the service with sufficient stocks
· Environment was clean and hygienic with regular cleaning schedules for high contact areas
Hunters Lodge improved from Requires Improvement to Good across all five key questions, having remediated multiple regulatory breaches identified at the previous inspection in 2018. The service demonstrated person-centred care, effective governance, and strong partnership working for people with learning disabilities in both residential and supported living settings.
Strengths
· Provider resolved previous safeguarding breach by supporting a person to move to more suitable accommodation, improving safety and wellbeing for all residents
· Care plans were comprehensive, personalised, and regularly updated to reflect changing needs
· Strong multi-agency working with GPs, district nurses, physiotherapists, speech and language therapists, and day centres
· Registered manager demonstrated effective incident learning, e.g. updating induction training after a medical device detachment incident with no recurrence
· Accessible information standards met with easy-read documents and communication needs recorded in care plans
Hunters Lodge received 'Requires Improvement' across all five key questions at its first inspection under current registration, driven primarily by the provider's failure to protect people and staff from ongoing abuse by one resident, a lack of staff training in managing challenging behaviour, and multiple regulatory breaches including failure to notify CQC of safeguarding incidents. Strengths included safe medicines management, good infection control, kind and compassionate staff, and compliance with the Mental Capacity Act.
Concerns (8)
criticalSafeguarding — “The provider had failed to adequately protect people from the risk of abuse. This was a breach of Regulation 13 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
criticalIncident learning — “The provider had not made the required statutory notifications to CQC in relation to safeguarding incidents which had taken place at the service.”
criticalGovernance — “Action had not been taken to mitigate the risk posed to people and staff at the service...breach of Regulation 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good governance.”
criticalPerson-centred care — “People's individual needs were not always being met...breach of Regulation 9 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Person-centred care.”
criticalStaff training — “Staff had not been trained in this area...struggling to manage some of the behaviours. One staff member said, 'I think we need more. I don't think we have the training we need. Nothing around restraint.'”
moderateStaffing levels — “Staff's time was often taking up managing one person's behaviours and this restricted the amount of time they were able to spend with other people.”
moderateLeadership — “There had been a lack of action to address this by the provider and the registered manager...had not been adequately acknowledged or addressed by the registered manager or the provider.”
minorCommunication with families — “People were not always given information in ways they could understand...food menus were in small type face and would be difficult to read and understand for people who used the service.”
Strengths
· Medicines were safely managed; staff were knowledgeable about safe administration and records showed medicines given at prescribed times.
· Safe staff recruitment procedures were followed, including DBS checks and references from previous employers.
· Risk assessments were regularly reviewed and updated, providing clear guidance for staff on mitigating risks.
· People's consent was sought and the principles of the Mental Capacity Act 2005 were followed, including appropriate DoLS applications.
· Nutritional needs were assessed and people had choice in food and drink; fresh and nutritious options were available daily.
Quality-Statement breakdown (25)
safe: Protection from abuseRequires improvement
safe: Staffing levelsRequires improvement
safe: Risk assessmentsGood
safe: Safe recruitmentGood
safe: Medicines managementGood
safe: Infection controlGood
effective: Staff training and competencyRequires improvement
effective: Mental Capacity Act / DoLSGood
effective: Nutrition and hydration
Good
effective: Health and well-being monitoringGood
effective: Premises designGood
caring: Activities and independenceRequires improvement