We carried out a review of the data available to us about Garden 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 Garden Lodge, you can give feedback on this service.
About the service
Garden Lodge is a residential care home providing personal care for to up to 8 people. The service provides support to people living with learning disabilities and/or autism. At the time of our inspection there were 7 people using the service.
People’s experience of using this service and what we found
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. 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 communicated with people in ways that met their needs.
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.
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 13 March 2020) and there were breaches 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.
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 20 January 2020 when breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent and 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, Effective 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 Garden 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.
Garden Lodge is a residential care home providing personal care for people living with learning disabilities and/or autism. Up to eight people can be supported in in a large, detached house. At the time of our inspection seven people 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. However, the service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance for the following reasons. One person was being restricted in a room at times without clear supporting evidence that this had been agreed in line with the Mental Capacity Act 2005 (MCA).
People’s experience of using this service and what we found
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 and in their best interests; the policies and systems in the service did not support this practice.
Systems to monitor the quality and safety of the service needed to be more robust. Staff said they could raise concerns with the management team. However, they had not received regular supervision and team meetings had not taken place on a regular basis.
The provider had safeguarding policies and procedures in place for staff to follow if they suspected a person was being abused. Most risks to people were identified and measures had been put in place to address those risks identified. However, there was limited evidence available on inspection that risk control measures for one person had agreed by all appropriate bodies. Medicine management was safe. The provider’s recruitment procedures reduced the risk of unsuitable candidates being employed.
Relatives and people told us staff were caring. The service worked closely with a range of health professionals.
Staff encouraged people to be as independent as they were able. Support was based on people’s individual needs and preferences. People took part in a range of outings and activities and accessed the local community. Families told us communication with the service was good.
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 good (published 14 August 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to safe care and treatment, the need for consent and the governance of the service. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
At the last inspection, the service was rated Good. At this inspection we found the service remained Good.
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 the time of our inspection there was a registered manager in post.
Relatives told us the registered manager was exceptionally caring and was approachable and easy to talk to.
Without exception people and relatives we spoke with told us that staff were extremely caring. We were given lots of examples of when staff had gone the “extra mile” to show excellence in caring. All interactions we observed between staff and people were caring and respectful, with staff being patient, kind and compassionate. Feedback from relatives was exceptional, with comments like, “I have never seen a more caring group of people."
Staff demonstrated a good understanding of safeguarding and the provider’s whistle blowing procedure. This included knowing how to report concerns.
Medicines were managed safely. Records showed people received their medicines when they were due. Only trained and competent staff administered people’s medicines.
Health and safety checks were completed regularly to help keep the building safe. Up to date procedures were in place to ensure people continued to be supported in emergency situations.
The provider was meeting the requirements of the Mental Capacity Act 2008 and the Deprivation of Liberty Safeguards.
Staff told us they were well supported and trained appropriately.
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.
We saw the provider had in place comprehensive person centred plans for each person which gave staff detailed guidance on how to support people.
People had opportunities to participate in their preferred activities.
The provider carried out a range of internal and external quality assurance audits to monitor the quality of people’s care.
This inspection took place 12 February 2015 and 20 March 2015 and was unannounced. This meant the provider did not know we were carrying on the inspection on that day.
We carried out our last inspection in October 2013. The provider during that inspection met our regulatory requirements.
Garden Lodge provides accommodation and personal care for up to eight people. The home is a purpose built house with eight bedrooms, a lounge, kitchen dining room and recently built conservatory and terrace. The home is set in its own gardens in a residential area, near to public transport routes and local shops.
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 the time of our inspection we found the service had a registered manager in post.
The provider was meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
People who were employed by the service had been checked by the provider to ensure they were safe to work with vulnerable adults.
We saw the staff had been trained to work with people in a positive way which protected their human rights.
The provider had put into place checks on the building to make sure people were safe.
We found staff received support from the provider using supervision, appraisal and training.
People had specialist assessments in place which recommended actions to be carried out by staff. We observed staff carrying out the required actions.
Staff promoted the well-being of people living in the home and had helped them achieve their goals.
Every member of staff that we observed showed a very caring and compassionate approach to the people who used the service. Staff spoke with great passion about their desire to deliver high quality support for people and were extremely understanding of peoples’ needs.
Using pictures and photographs staff engaged people to help them express their wishes, likes and dislikes and the activities they wanted to do. We found people were engaged in their care and the running of the home.
We saw the provider had in place comprehensive person centred plans for each person which gave staff detailed guidance on how to care for people.
Staff were able to recognise and intervene when people’s mood changed to prevent the situation from escalating and having a negative impact on them and those around them.
We saw each person had their own individual timetable of activities and people received personalised care.
Relatives told us the registered manager was approachable and easy to talk to.
The registered manager carried out a comprehensive set of audits to monitor the quality of the service. Where they found areas could be improved they were proactive in ensuring improvements were made.
We saw all records were kept secure, up to date and in good order, and maintained and used in accordance with the Data Protection Act.
During our visit we found people were asked for their consent before they received any care or treatment and the provider acted in accordance with their wishes.
We found care and treatment was planned and delivered in a way which ensured peoples' safety and welfare. We spoke with people about how they felt about the home. They said things like 'happy here,' 'very, very good,' and 'home form home.' One person told us he was 'happy working with (staff name) and happy at Garden Lodge.'
The provider had made suitable arrangements to protect vulnerable people and responded appropriately to any allegation of abuse. One staff said, 'People who live here are very aware of how they should be treated so we have to make sure what we say and do are very clear so they cannot be interpreted as being abusive.'
The provider had taken steps to make sure people at the home were protected from staff who were unsuitable to work with vulnerable people. This was because they had carried out thorough background checks.
We found people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. In feedback from a survey the provider had carried out with relatives. They told us all staff were 'excellent' at communicating with them and they 'couldn't agree more strongly that staff are excellent.' Other comments included. 'It's a warm feeling as you enter the building' and 'Staff have a good sense of humour which I think is important.'
The assistant manager told us that most people who lived at this home could find it difficult to express their overall views about the service directly. To overcome this they had carried out surveys (in a format that people could understand) with the people who lived at the home and their relatives and / or advocates.
The most recent survey found that,
Everyone said that they were happy at Garden Lodge, they said that the staff team helped them take part in activities they liked. They liked the food, they were warm and they liked their home.
Relatives said that the homes strengths were training, dedicated staff and management, staff team work, well maintained premises, good staff ratio, good activities and holidays, and good healthcare and diets
People were happy with the support they received with their care and welfare.
During our visit we saw that staff respected people's privacy and dignity. They were friendly and very polite and they knocked on bedroom doors before entering.
One person who lived at the home told us, 'I'm going horse riding now.'
Another said, 'Yes I'm fine here.'
Relatives said that staff and the manager had a really good understanding of their relative's likes and dislikes and the home supported people to have good healthcare.
One relative said, '(Persons name) is fed better than I could ever provide at home.'
Other relatives had made comments about staff. They said things like,
'Staff have a sense of humour, I think it's important.'
'Staff acted on (my request) immediately'
Another relative said, 'The key worker is the most conscientious and caring person I know.'
The most recent survey carried out by the manager in 2010 found that:-
Everyone said that they were happy at Garden Lodge, they liked the food, they were warm and they liked their home. They said that the staff team helped them and some said what activities they liked.
Relatives said that the homes strengths were training, dedicated staff and management, staff team work, well maintained premises, good staff ratio, good activities and holidays, and good healthcare and diets