Fair View Lodge

We found the following examples of good practice.

Facilities were in place to wash hands or use hand sanitiser on entering and leaving Fair View Lodge. Visitors were supported to wear a face covering when visiting, and wash hands before/after use. All visitors were screened for symptoms of COVID-19 before being allowed to enter the service. There was prominent signage and instructions to explain what people should do to ensure safety. Information was easily accessible on arrival and before visits to ensure visitors followed guidance, procedures and protocols to ensure compliance with infection prevention control.

The management team communicated with people, staff and health and social care professionals regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe. The service was following government guidance regards to visitors. Relative comments, “They (staff) are handling things very well. They have been 100% cautious and careful when it comes to Covid” and “I have no worries, they (staff) are doing really well keeping (relative) safe.”

Staff were following current infection prevention and control guidance to help people to stay safe. There were suitable risk assessments and an up to date infection control policy and procedure in place. The registered manager ensured staff understood why every measure was essential.

Personal Protective Equipment (PPE) was readily available around the buildings. We saw there was a good supply of PPE for staff to use. Staff were observed to be wearing PPE appropriately and disposed of it in clinical waste bins. Whole home testing was undertaken, with frequency of testing people and staff in line with current guidance.

Staff had completed training to ensure safe infection prevention and control measure were in place and knew how to keep people safe during the COVID-19 pandemic.

Infection prevention and control audits were carried out to ensure the premises was meeting infection control measures. A cleaning schedule for all areas of the service was in place and implemented to ensure the whole service was effectively cleaned on a regular basis, including high touch points.

Staff supported people to occupy themselves whilst maintaining their safety. Staff helped people to stay in touch with their friends and family. Alternative forms of maintaining social contact were used for friends and relatives; for example: keeping in touch using video calls.

This inspection took place on 10 January 2018 and was announced. The service was given short notice of the inspection (24 Hours). This was to ensure someone was available to support us with the inspection, and to ensure people living at the service were aware in advance people were visiting.

We had previously inspected the service on 25 November 2015, when the service was rated as good in all areas. We found this good practice had been sustained. The service had demonstrated continuous improvement since this inspection in 2015 and we have rated them as Good overall with a rating of Outstanding for the key question of well led.

The service has 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 2008 and associated Regulations about how the service is run.

Fair View Lodge had a well understood, positive and open culture, with a clear set of values and ethos. We saw evidence of strong leadership both within the service and the wider organisation. The service had a strong person centred focus in all areas, and a positive and supportive atmosphere. Staff understood their roles and worked well as a team to support people to achieve and have new experiences as well as manage risks. Success was celebrated and learning took place to help improve the service and people’s lives. The registered manager and management team were enthusiastic and creative in supporting people, recognising people’s potential and ensuring resources and facilities were available to support this.

Feedback we received about the service was overwhelmingly positive. Relatives for example told us “This is the best placement ever” and “When I get there, I do see the caring. It is there, it is genuine, I am thrilled with them. It’s the best place they have ever lived.” Visiting professionals told us the service provided a high standard of person centred care.

The service operated along the principles of positive behavioural support or PBS. This is a way of helping people with learning disabilities who are at risk of anxious or distressed behaviours to have the best quality of life they can. The registered manager had achieved a BTEC qualification in positive behavioural support, and the service was supported by a PBS practitioner, who was involved in writing support plans, delivering training and working with the staff teams to support people with specific issues. We saw and heard how people had been supported consistently to have new experiences, establish communication in more positive ways and build more positive relationships. A relative shared with us their experience of how their relation had progressed since being at the service, including how their world was “opening up”. Another person had recently been able to re-establish contacts with family members and have a greater involvement in the community.

Staff told us “I love it here – I’m really passionate about it” and “I love it, it’s great…I ask a lot of questions, and there is very good support from the management and the team”. Staff spoke positively about the people they were supporting. A staff member told us “I can’t wait to get in here every morning and see what we can do today, how we can keep working to give people new opportunities.”

Each person had a comprehensive care plan, based on a regularly updated assessment and positive behavioural support principles. Plans were very person centred and gave clear, detailed step by step guidance on the detail of how each person liked and wished to be supported, their communication and any risks associated with their care. Plans were regularly updated and included an activity planner, which the person reviewed with their key worker each month. Plans ensured staff worked consistently with people and followed their wishes.

There were clear lines of management within the organisation with procedures for escalating any issues or concerns, and robust systems were in place to assess and manage the quality of the service. The registered manager and overall service received clear feedback from the provider organisation on their performance, and the service also operated their own series of audits. The service learned from incidents and accidents following a thorough review, and took advantage of learning opportunities to develop.

Risks to people from their care were identified and plans were put in place to minimise these risks. The service took great pains to ensure their response to risks was personalised and based on supporting the individual person. For example one person had received an injury which needed an operation to help the wound heal. Staff supported the person at the hospital, along with the person’s family, and support from the hospital nursing and medical staff. The person was supported to make decisions, for example choosing the staff they wanted to be with them when they awoke from the anaesthetic. The person was subsequently able to tolerate the procedure and aftercare without undue distress.

People had access to good healthcare services. Medicines were stored and administered safely, and staff had received training in safe administration. Staff told us they did not administer medicines until they were confident to do so.

People were able to make their own meal choices and were involved in making decisions over shopping and meal preparation. No-one was at risk of poor nutrition and assessments had been carried out to review anyone at risk of choking. People could be involved in cooking if they wished, and we saw on person being involved in preparing their lunch. Another person had taken control of buying and ‘rationing’ their own snacks each week.

People were protected from the risk of abuse. Staff understood signs of potential abuse and how to report any issues, both within or external to the organisation. Systems were in place for the management of complaints, incidents and any concerns. Information was available to people in ways they could understand. We saw people were supported to raise concerns. For example one person had been supported in writing a statement about a concern in an easy read format.

Staff understood people’s communication needs, and were aware of how each person would communicate if they were unhappy or distressed about something. Information was available for people in assisted or easy read formats to help them understand the principles of safeguarding and ‘keeping safe’. People were involved in developing information systems to manage their own need for information, for example on a visual aid with pictures of staff and activities to act as a daily planner for one person.

Staff had a clear focus on the people they were supporting, their rights and the opportunities available to them. This included the operation of the Mental Capacity Act 2005 (MCA). Appropriate applications had been made for authorisations of Deprivation of Liberty Safeguards (DoLS). Statements were available in easy read formats about human rights and anti-discriminatory legislation. The service had a meeting planned to work with one person looking at how they could use online services and keep safe.

There were enough staff available to ensure people’s needs regarding activities could be met. People living at Fair View Lodge had a one to one staffing allocation for most of the day period. Staff had been recruited safely, following a full process, including disclosure and barring service (police) checks.

Fair View Lodge comprised an adapted chalet bungalow, situated in a residential area of Newton Abbot. All areas of the service we saw were clean, well maintained and had been adapted to meet people’s individual needs in a homely way, as far as people would tolerate this. The service was near local shops, transport links and services, such as the GP practice. We saw evidence of people being involved in keeping their own environment clean and flats were personalised and individual. One person liked a more minimalistic environment, another liked lots of soft toys and things of value to them around. The building was well maintained and under constant review. This was done as far as possible in conjunction with the people living there. For example, one person was going on holiday for a few days as their bathroom needed replacing and the service understood the person would not tolerate people working in their flat.

Records were well maintained and kept securely. The service had notified the CQC of incidents at the home as required by law. Records were written in ways that demonstrated respect for the person. For example the service had a policy on confidentiality of information in an easy read format. It explained people’s rights to privacy of information and when people might need to share this, for example with a doctor. This helped ensure people understood their rights.

Although people were not able to articulate their feelings clearly, they were clearly relaxed, happy and comfortable around staff. One person told us they were 'happy" living at the service. Another person said 'yes, yes, yes' when we asked if they were happy living here. Both people smiled when they responded.

We saw that staff treated people respectfully and encouraged each person to be as independent as possible. People were occupied in activities that they appeared to enjoy. One person went out for the morning, whilst the other person spent time preparing to go out later in the day. Staff were patient and supportive with both people.

Staff told us they received regular training and felt supported by the manager. One staff said "we know what people need and how to provide it". Another staff told us "the training is good because we tend to talk a lot and get a lot of discussions going".

All staff had received safeguarding training and demonstrated a good understanding their responsibilities in whistleblowing and preventing and reporting abuse.

The service monitored quality and looked to improve standards whenever possible.