St Ann's Lodge 2

St Ann’s Lodge 2 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. The service also provides care and support to people living in the ‘supported living’ scheme so that they can live in their own home as independently as possible. CQC does not regulate the premises used for supported living; this inspection looked at people’s personal care and support.

A registered manager was 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.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection in February 2016 we rated the service Good. At this inspection, we found the service had remained Good.

People told us they were happy living at St Ann’s Lodge 2 and said staff were kind, caring and respectful towards them. There was a relaxed, friendly and homely atmosphere at the service. Staff clearly knew people well and were person centred in their approach.

The managers led by example and offered a high level of support to people, staff and relatives, often supporting relatives with matters outside of their management role.

Relatives only had positive feedback and praise for the service. They were kept involved in people’s lives and were asked for their views about the support provided. They told us the staff team were caring, kind and compassionate. One relative described it as being part of ‘one big family’.

External health professionals were also positive in their feedback about the service provided at St Ann’s Lodge 2. They said staff were caring and worked well with them in achieving goals for people using the service.

The registered manager and staff team were committed to providing high quality person centred care and support. This ethos was central to how the service operated. The service was flexible and responsive to changes in people’s needs and individual family circumstances. The service had a stable and consistent staff team who had people’s wellbeing at heart.

Medicines were administered safely with accurate records available to show which medicines people had received.

Staff told us they received the support and training they needed to help them do their jobs well. The managers were proactive in ensuring staff completed training relevant to the needs of people living at the service. This included specialist training to enable staff to care for people with particular needs.

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.

Staff supported people to meet their nutritional and healthcare needs. Health professionals had been consulted to provide specialist advice and guidance to staff where needed.

People and their relatives felt able to speak to the registered manager or any of the staff team at any time if they needed help and assistance. They told us that they felt able to raise any issues or concerns and these were always listened to and acted upon. Special praise was received for the deputy manager who people described as ‘excellent’, ‘a star’ and ‘genuine’.

Further information is in the detailed findings below.

The service provides personal care and support for up to six people within a small care home setting as well as providing personal care to people who live in a supported living scheme opposite St Ann's Lodge 2. The service specialises in providing care to people who have a learning disability. There were six people using St Ann’s Lodge 2 and five people using the supported living scheme at the time of our inspection. There is an adjoining small care home next door to St Ann's Lodge 2 called St Ann's Lodge, run by the same provider. The registered managers of both services are both directors and work closely to run the two services together and people and staff can move between both services through an interconnecting door. We inspected both services on the same day. We have produced separate inspection reports as the two homes are registered separately and the similarities between the two are reflected in the two inspection reports.

There was 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.

Although the service operated some good medicines management practices the service was unable to account for all medicines which should have been in stock. This was because the service did not keep accurate records of medicines people took out and returned to the service when on social leave. This meant we could not always verify all people received their medicines as prescribed as we were unable to complete some medicines stock checks. The registered manager told us they would improve recording processes to rectify this issue immediately.

Staff understood how to recognise abuse and how to report any concerns they had relating to this. People had appropriate risk assessments in place with suitable risk management plans to manage the risks to them. The premises and equipment were maintained safely.

There were enough staff to meet people’s needs and the manager followed a robust recruitment process so that only suitable staff worked with people at the service.

The registered manager understood their requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The registered manager had assessed which people required DoLS and made the necessary applications as part of keeping them safe. However, although staff had received training in the MCA and DoLS a few did not always understand their responsibilities in relation to these legislations. When we raised this with the provider they told us they would put in place extra support for staff to help them achieve a better understanding.

People received a choice of food and drink and the right support in relation to their dietary needs. Staff also supported people to monitor and maintain their health and people had access to the healthcare professionals they needed.

Staff received a range of training, much of which was specific to the needs of the people with a learning disability they worked with, to help them to carry out their roles and understand people’s needs. The registered manager supported staff well through a programme of individual supervision and annual appraisal.

Staff understood the people they were working with including their needs and backgrounds and this information was recorded in care plans to guide staff in the best way to support people. Staff supported people to be as independent as they wanted to be and to take part in activities they were interested in. People were involved in making decisions about and reviewing their own care. Care plans contained accurate information about people's needs and the registered manager kept these under review. People, their relatives and staff were involved in the running of the care home. Healthcare professionals fedback to us that the service was particularly caring and well-led.

There was a suitable complaints system and relatives had confidence the manager would resolve any issues they rose with them. The manager and staff had a good understanding of their roles and responsibilities.

People who use the service understood the care and support choices available to them. People we spoke with told us that the "staff were nice" and some people were able to name specific staff to whom they would bring any problems. We saw that staff spoke with people in an appropriate and respectful manner. Staff were able to demonstrate through their conversations with people that they knew them well and knew how people liked to be supported.

People we spoke with told us they were happy living in the home. One person told us "I love it here and I have a nice room". People's needs were assessed and care and support was planned and delivered in line with their individual care plan.

We saw that the provider had established good links with social services and health services, with regular contact with social workers, GPs, Dentists and pharmacists. We looked at a sample of medication administration record sheets and found these to be accurate and up to date, together with the signature of the person administering the medication.

The provider had a copy of the multi-agency guidance regarding safeguarding vulnerable adults. We saw records which confirmed that staff had completed training in safeguarding through the local authority. People who use the service told us that they felt safe living at the home.

Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. People who use the service, their representatives and staff were asked for their views about their care and support and they were acted on.

People who use the service told us that they were happy living at St Ann's Lodge 2, saying "I like it here" and "it's ok". "I like my room", "I have all that I need", "I go and see my family" and "we have parties here that my friends come to" were some of the comments people made. We saw people had personalised their bedrooms with pictures, photographs and belongings and were told that people had chosen the colour their room was painted.

Staff spoke with people in appropriate ways. Staff knocked and asked permission before entering people's bedrooms. The manager and staff knew people and how to meet their needs very well.

There was a door into St Ann's Lodge, another small care home owned by the provider. We were told that the services operated separately although there were some joint activities, outings and meetings for people who use the service and their families.