Mimosa Lodge

Mimosa Lodge provides accommodation and personal care for up to eight people who have learning disabilities. There were seven people living in the main house and one person was living in a separate annex which was not connected to the main house at the time of this inspection

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The inspection took place on the 8th February 2018 and was unannounced which meant the staff and provider did not know we would be visiting. When the home was last inspected on 22nd January and 2nd February 2016 the service was rated Good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This report is written in shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

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 and associated Regulations about how the service is run.

Staff were aware how to protect people from abuse. Staff received annual training and understood how to identify safeguarding concerns and report these to keep people safe. The provider had a safeguarding policy. Information about safeguarding was displayed in the home in an easy read format informing staff and people what to do if they had any concerns.

Staff received the training they needed to carry out their roles effectively and meet the needs of the people living at the home. Staff were supported through regular supervision and appraisals and had access to training.

There were sufficient numbers of staff to provide people with the support they needed.

People were involved in the running of the home. Their nutritional and health needs were met and people were supported to receive their medicines safely. Staff demonstrated a good understanding of infection control procedures; the home was clean and tidy.

Care plans were detailed and person centred. They detailed what was important to and for the person. People were involved in their care planning and were supported to have maximum choice and control of their lives. Care plans were reviewed every month by their keyworker.

People were safe because there were effective systems in place to protect them. Individual risk assessments identified potential risks and provided information for staff to help them avoid or reduce the risks of harm.

The requirements of the Mental Capacity Act 2005 were being met and staff understood their roles and responsibilities to seek peoples’ consent. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us that they liked the staff working at the home. Staff treated people with kindness, respect and compassion.

Staff felt valued and respected. The manager was easily accessible. Staff felt supported and were aware of their roles and responsibilities. Regular team meetings were in place to ensure staff were kept up to date with changes to peoples’ needs. Staff told us that the communication was good and they had daily handovers.

There were quality assurance systems in place to monitor and continually improve the quality of the service. The provider had policies and procedures in place which were reviewed regularly.

The home had received one complaint which had been dealt with promptly and investigated in accordance with the provider’s policy.

Mimosa Lodge provides accommodation and personal care for up to eight people who have learning disabilities. At the time of our inspection eight people were using the service. Seven people were living in the main house and one person was living in a separate annex which was not connected to the main house.

Mimosa Lodge has a registered manager 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.

Staff had received safeguarding training and were able to describe sources and signs of abuse and potential harm. Staff were aware of how to protect people from abuse. Relatives told us their family member felt safe.

Risk assessments, referred to by the provider as support guidelines, were in place for each person on an individual basis. People using the service were living with a learning disability and were at risk of harm from participating in a large number of everyday activities. Staff were aware of the risks and knew how to mitigate them.

Incidents and accidents were recorded appropriately and investigated where necessary. Any learning or changes to support plans or support guidelines were discussed at staff meetings. Where necessary investigations were carried out to ensure the risk of repeat incidents was reduced.

There were enough staff on duty to meet people’s needs. The registered manager explained how staffing was allocated based on how many people had been assessed as requiring one to one support and the known needs of the other people using the service. Emergencies such as sickness were covered by staff working extra shifts, and sometimes the use of bank and agency staff. The registered manager told us the home was currently recruiting for extra care workers. The provider had a service level agreement in place with the agencies that provided staff to ensure that appropriately trained and qualified staff were engaged to support the home. Recruitment procedures were carried out safely to ensure that potential members of staff were suitable to work in the home.

Medicines were administered safely by staff who had been trained to do so. Medication competencies were checked by the registered manager annually to ensure staff were knowledgeable and skilled to continue. Medication Administration Records (MAR) were kept for each person and completed fully. Medicine stock levels were monitored and recorded on a daily basis by the member of staff administering medication. Medicines were also checked weekly and monthly.

People were asked for their consent before care or support was provided and where people did not have the capacity to consent, the provider acted in accordance with the Mental Capacity Act 2005. This meant that people’s mental capacity was assessed and decisions were made in their best interest involving relevant people. The registered manager was aware of his responsibilities under the Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications for people using the service.

Relatives told us they were very happy. Staff understood people’s preferences and knew how to interact and communicate with them. People behaved in a way which showed they felt supported and happy. People were supported to choose their meals. Snacks and drinks were available in between meals. People were given dietary supplements when needed. Staff were kind and caring and respected people’s dignity.

Support plans were detailed and included a range of documents covering every aspect of a person’s care and support. The support plans were used to ensure that people received care and support in line with their needs and wishes. We saw this reflected in the support observed during the visit.

There was evidence in support plans that the home had promptly responded to people's health needs and this had ensured people's safety and welfare was maintained.

There was an open and transparent culture within the home. Staff were able to raise any issues or concerns with the registered manager who listened and responded. The home had a pleasant atmosphere, where staff worked well together and supported the registered manager in his role.

The service maintained a detailed system of quality control in order to ensure the quality of service was maintained and improved. This included daily checks weekly checks and quarterly provider audits. Actions were identified as a result and included in a consolidated action plan which was regularly monitored by the registered manager to ensure actions were being completed within appropriate time frames.

Staff said they had been involved in the development of the home. Most recently there had been a consultation about the development of the lounge into two separate rooms. Evidence demonstrated that people and staff had been consulted.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found '

Is the service safe?

Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. People's needs were assessed before admission to help ensure the service could meet their needs. Detailed support plans and risk assessments provided staff with information and guidance about the care and support people needed and how it should be provided. Staff we spoke with demonstrated a good understanding of people's needs.

Systems were in place to help ensure people were cared for and supported by suitably qualified, skilled and experienced staff. We saw appropriate checks were undertaken before staff began work. New members of staff received an induction during their first few weeks of employment. They also 'shadowed' experienced staff until they were assessed as competent to work independently.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager and operations manager were aware of recent changes to the legislation and were awaiting further guidance from the provider organisation.

Is the service effective?

The service was effective in supporting people to be able to eat and drink sufficient amounts to meet their needs. Personalised support plans showed that people's dietary needs and preferences were taken into account. Staff provided people with different options, including the use of pictorial menus, so that they were able to make an informed choice.

Effective support was provided to help people to maintain and develop their independence and community involvement. Staff we spoke with told us how their induction into the service had included reading people's support plans, getting to know them and their needs.

Is the service caring?

We observed that staff treated people with respect and supported them in ways that upheld their dignity. Staff were friendly and respectful in their interactions with people, and took the time to respond to requests for assistance and to answer questions. There was a relaxed atmosphere in the home and staff communicated well with the people who used the service and promoted an inclusive, supportive environment.

Is the service responsive?

Each person using the service had a named key worker, whose role was to help co-ordinate the person's care and support. This included involving them in regular care reviews and keeping their relatives informed of changes, if appropriate. We saw people's health needs were monitored and referred to health professionals appropriately. This helped to ensure that the delivery of care was responsive to people's needs and based on up to date information and guidance. The records showed that any concerns were followed up and appropriate action was taken.

Is the service well led?

We found the service was well led. Regular audits of the quality and safety of the service took place and action plans were developed and followed to address any issues that had been identified. People who use the service, their representatives and staff were asked for their views about their care and support and they were acted on. We saw that people were asked for their feedback as part of the review of their support plans.

An annual quality assurance survey of people's views took place. The responses from people's relatives to the 2014 survey indicated their overall satisfaction with the service. One relative had commented 'Our daughter is always very happy to go back to Mimosa and never distressed'. Another person's relative had written 'Staff always happy to see us and very welcoming'.

Records of staff meetings showed staff had opportunities to provide feedback about how the service was being delivered. Staff we spoke with said they were able to raise concerns with the manager or provider and were confident that they would be addressed.