The Lodge

The Lodge is a residential care home providing personal and nursing care to nine people with a learning disability at the time of the inspection. The service can support up to 12 people. The service is a large house for up to 10 people with shared communal space and two supported single occupancy flats onsite.

The service was registered before Registering the Right Support was published. This meant the number of people living at the service was higher than the number recommended by this guidance. However, the service ensures that people who use the service can live as full a lifesas possible and achieve the best possible outcomes. The service provided care in line with the principles which reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. Nine people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

People’s experience of using this service and what we found

People were cared for by exceptionally kind and caring staff. All staff were employed on the basis of their values with patience and empathy being key qualities. There was a very strong person-centred culture which all members of the staff team were committed to. People were supported to make their own choices and to develop as much independence and autonomy as possible. People were supported to live as full a life as possible and staff were willing to go the extra mile to support them in this.

People were safe at the service. The culture of the service was focussed on developing a safe environment both physically and psychologically. We observed people were calm and relaxed with staff and each other. Staff were highly skilled at maintaining a safe environment by using their knowledge of people to ensure any friction or difficulty was minimised. The staff team was open and transparent and learnt from any incidents; they quickly put effective measures in place to prevent recurrence. Any concerns were shared with the appropriate professionals. Medicines were well-managed with good systems in place to minimise errors. People were supported by enough staff who had been recruited in a safe way.

People received an effective service. Their care was assessed and planned in accordance with their needs. They received support from staff who were trained and supervised. 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. People had a choice of meals and were able to shop and cook for themselves if they wished. Staff supported people to work with health professionals to improve their health and well-being.

People received a responsive service which placed their individual needs and preferences at the core of their care. Care plans were developed to maximise people’s independence and support them to live meaningful lives. Staff were passionate about doing their best for people and improving their quality of life. People were encouraged to try new things, develop new skills and consider what they would like to aim for.

The service was led by a registered manager who was passionate, had a clear vision of the direction of the service and able to implement this effectively. There was a very strong focus on the culture of the service which prioritised people who lived there. The staff team was cohesive and functioned well. Staff felt able to challenge practice or make suggestions and told us they were not afraid to admit making a mistake.

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 (report published December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge on our website at www.cqc.org.uk.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out a previous inspection of this service on 6 August 2014 where we found it was meeting the requirements in the areas we looked at.

This inspection took place on 12 December 2016 and was unannounced. At the time of our inspection there were 11 people being supported at The Lodge. People had a range of needs, with some people having highly complex needs. Some people were living with learning disabilities, autistic spectrum disorders, mental health diagnoses and physical health conditions.

People and their relatives spoke highly of the staff at the service and the quality of care provided. Comments from people included “It’s very nice” and “I like all the staff. It’s good here, I like it.” Comments from a relative included “They meet (my relative)’s needs 1001%. It’s a beacon of light in terms of social care” and “It is exemplary by every single measurable parameter in the extreme.”

Staff treated people with kindness and respect. People enjoyed pleasant interactions with staff which demonstrated people felt comfortable in their presence. Staff knew people’s preferences and communicated with people using their preferred methods of communication. For example, staff used pictures in order to enable one person to better express their wishes and enable them to make choices.

The provider and the registered manager placed high importance on people receiving caring support from kind and caring staff. Staff were reminded of the importance and the value of being caring, supportive and kind in the form of various 'staff appreciation' awards.

Staff knew people well and engaged people in conversations about their interests and preferences. Staff skilfully distracted people when they became upset or anxious by talking to them about their favourite topics and encouraging them to focus on positive thinking. Staff found inventive and personalised ways to meet people’s needs.

People were protected from risks relating to their health, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to minimise these risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence.

Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

Staff knew how to recognise possible signs of abuse which helped protect people. Staff knew the correct procedures to follow should they need to report concerns. Safeguarding information and relevant contact numbers were accessible to staff and people who lived in the service. People and staff told us they felt comfortable raising concerns.

Recruitment procedures were in place to ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were vulnerable.

Staffing numbers at the service were sufficient to meet people’s complex care needs. Care was provided by skilled staff who had been trained in the competencies they required in order to meet people’s needs. Staff received ongoing training as well as regular supervision and appraisal.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and used this to inform their practice and ensure people’s rights were protected. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety, the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

People were supported to have enough to eat and drink in ways that met their needs and preferences. People were encouraged to help prepare their meals and could choose what they wanted to eat. People’s mealtimes were relaxed and flexible to meet people’s individual commitments and routines.

There was open and effective management at The Lodge. People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were effective systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People living in the home were treated with dignity and respect by the staff that supported them. We received a number of positive comments, a care worker said "this is their home, we are here for them" and a person living in the home told us "I'm happy here". One visitor told us the staff were very supportive towards caring for their relative.

We saw that care workers were patient and gave encouragement when supporting people. We heard one staff saying "you can have more sugar but it might be healthier for you if you took a bit less, but it's up to you."

Staff we spoke with were able to tell us what action they would take if they saw abuse taking place and where to find the correct contact information and procedures. One staff told us "we must always give the people here our best."

Staff carried out a range of health and safety checks to ensure people were kept safe. Records showed that fire drills were carried out and people had their personal emergency evacuation plans.

Where there were risks associated with people's health, these were assessed and appropriate support plans put in place. For example, we saw that people using the kitchen had been assessed as to whether people were at risk of harm and the actions to be taken to keep risk to a minimum.

Is the service effective?

People living in the home and their representatives were involved in the care planning and review process. This helped ensure that support was person centred and reflected the needs of each individual. One visitor had just attended a meeting with staff and a social worker to discuss an aspect of their relative's health, told us 'the staff keep me informed of any changes'.

Staff told us that communication was good in the home, so that staff would be aware of any particular issues relating to individuals. This information was discussed at handovers.

Staff confirmed they had regular supervision and the records showed that the supervisor held meaningful discussions to ensure staff understood their role and responsibilities.

Is the service caring?

People that we spoke with during our inspection gave positive feedback about the home and the staff. One person told us 'I want to be independent and the staff help me to do that'. Another person told us 'staff are good'.

We observed staff knocking on people's doors before entering and this practice of respecting a person's privacy was confirmed by a person living in the home and their relative who said 'yes, staff always knock'.

We made observations of people receiving the support they needed, in line with their care plan. For example, we saw one person being supported with their breakfast meal and holding a discussion with staff about their dietary needs. Another person who had injured his finger was being dealt with by staff in a caring, supportive way.

Is the service responsive?

We saw that the service worked well with other healthcare professionals. For example, one person had recently had a visit from an occupational therapist and a social worker visited the home on the day of our inspection. We saw from the care records that a GP and a dentist were contacted because staff had concerns about a person's health.

The ways people expressed their likes and dislikes had been recorded so that staff could understand people's wishes. Relatives told us that staff contacted them on a regular basis to discuss any changes to care and support.

Relatives were involved in contributing towards people's annual care review and their views were taken into consideration. One relative said "I feel very involved."

People could make choices. We regularly heard staff asking people to make a choice. One staff asked a person "I know you want to smoke your cigarette first so if we can't do it before, we can we do it afterwards?" The staff then waited until they got a response from the person who wanted a cigarette.

We also saw minutes of health and safety committee meetings where any accidents and incidents were discussed. This provided opportunity to identify any learning points and put any required action plans in to place. On the day of inspection we identified a potential hazard and the registered manager responded by investigating the issue.

Is the service well led?

We saw that there were systems in place to monitor the quality and safety of the service. This included gathering the views of people living in the home and their relatives. People had opportunity to attend a monthly home meeting called 'your voice' and the minutes showed that all the people at the meetings were asked for their view and their responses recorded. One person told us "at the meeting I told them what I want but another person disagreed".

The home received regular visits from the representatives of the registered provider. One of the external manager's reports which we viewed provided an overview of their visit, an evaluation and recommendations. On the day of our inspection an internal compliance and quality manager arrived unannounced to the home to monitor the service. We saw monitoring visit reports assessing the premises, service records and care records.

Any accidents and incidents that occurred in the home were recorded and analysed on a monthly basis. We saw evidence of where action was taken to reduce the risk.

The registered manager explained how the service worked hard on selecting staff which were suitable for meeting the needs of people using the service. The recruitment records showed the detailed interview questions used to select the right staff and other records showed several people had left.

The atmosphere in the home was relaxed and inclusive; we saw that people were making choices about their daily activity. Staff explained and discussed with people their choices and any actions needed to support activity, for example, wearing suitable clothing when going out.

We read that each person had a plan which described the support they required; in this we read people's choices were recorded and implemented. We saw there were risk assessments in place for some people which promoted well-being and prevented crisis. Staff we spoke with were positive about working in the home and the contribution they made to people having fulfilling lives.

The environment was comfortably furnished and the communal areas were well maintained.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. The acting manager who was present during our visit was Rachel Wharton-Stone.