Winton Lodge

Winton Lodge provides accommodation and personal care for up to nine people who have learning disabilities and mental health needs. At the time of the inspection six people were living at the home.

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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People told us they felt safe and that staff had a good understanding of their needs and preferences.

Risks had been identified and measures put in place to keep people safe from harm. Medicines were managed safely and administered by trained staff.

Staff listened to what people wanted and acted quickly to support them to achieve their goals and outcomes.

Staff were well trained and skilled. They worked with people to overcome challenges and promote their independence. The emphasis of support was towards inclusion and enabling people to learn essential life skills.

Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff.

People, professionals and their families described the staff as being, “welcoming, calm, and friendly” and the atmosphere of the home as homely, relaxed and engaging.

People received pre-admission assessments and effective person-centred support. The service was responsive to people's current and changing needs. Regular reviews took place which ensured people were at the centre of their support.

Leadership was visible and promoted good teamwork. People, professionals and staff spoke highly about the registered manager, describing them as showing “strong leadership”; as a result, staff had a clear understanding of their roles and responsibilities. The registered manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe.

The registered manager had implemented many changes which had impacted positively on outcomes for people and staff.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve the service was noted and the registered manager was keen to make changes that would enhance people's lives.

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 requires improvement (published 14 May 2018).

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

Follow up:

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.

Winton Lodge was registered for up to nine people. There were six young adults living and receiving care and support from staff at Winton Lodge at the time of our inspection. People had a variety of care and support needs related to maintaining their mental well-being, learning disabilities or autistic spectrum disorders. The people living in Winton Lodge had some difficulties communicating their needs or managing their emotions. This meant at times they could become agitated and anxious. At times this resulted in verbal and physical aggression towards the property, themselves, staff and other people sharing the home.

This unannounced inspection took place on the 5 and 7 March 2017. We made further telephone calls to gather evidence up until 14 March 2018 and received further evidence from the provider following our visits to the home. The inspection was planned as a focussed inspection in response to information received by the Care Quality Commission about potential risks to people. We identified concerns regarding people’s safety and this meant the inspection was extended to a comprehensive inspection in line with our published methodology.

There was a registered manager for the service. 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.

People were living with others who may cause them harm and had difficulties managing their own emotions. One person and the relative of another person did not always feel safe as a result of this. Whilst we found inconsistent care had increased the likelihood of harm in one instance, staff understood the risks people faced and how to reduce these risks. Measures to reduce risk reflected the person’s preferences. Staff also knew how to identify and respond to abuse and told us they would whistleblow if it was necessary. However, a potential safeguarding occurrence had been reported to managers and this had been dealt with internally but agencies responsible for monitoring safeguarding had not been informed.

Staff encouraged people to make decisions about their lives. However, care plans did not always reflect the care that was being delivered or how it was developed within the framework of the Mental Capacity Act 2005. People were at risk of receiving inconsistent care that was not in their best interests or was overly restrictive. We have made recommendations about recording. Deprivation of Liberty Safeguards had been applied for when necessary.

People were supported by safely recruited staff who were committed, kind and enthusiastic but did not have the skills, knowledge or experience to fully undertake their roles. This had led to people being put at risk of harm. Of the workforce employed at the home, 50% had been recruited within the last 12 months. This meant that they had or were in the process of undertaking their induction programme and were developing their skills and knowledge. Staff told us they felt supported in their roles and had taken training that provided them with some of the necessary knowledge and skills. We have made a recommendation about staff training.

Oversight structures and ethos of care were clearly communicated. However, quality assurance systems had not been effective in identifying the issues identified during our inspection.

People and relatives and professionals felt that they were listened to. Their views were considered and acted upon although this action may not have been timely.

The environment was clean and maintained although damages and changes made during incidents were not always addressed quickly. This served as an unnecessary reminder of events for people.

Everyone described the food as good and there were systems in place to ensure people had enough to eat and drink.

People had access to activities that reflected their preferences, including individual and group activities. There were plans in place to further develop the activities available to people.

People were largely positive about the care they received from the home and told us the staff were kind. Staff were cheerful and treated people and visitors with respect and kindness throughout our inspection.

There were breaches of regulation with respect of safe care and treatment, staffing, safeguarding and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

Winton Lodge is a care home without nursing for up to nine young people and adults with a learning disability who may behave in a way that challenges others or puts themselves at risk. When we inspected, there were seven adults staying there.

The service is located in Charminster, which is a residential area of Bournemouth. There are seven individual ensuite bedrooms in the main house. One is on the ground floor and the rest on the first and second floors, which are reached by stairs. Communal areas downstairs include two lounges, a dining room and a kitchen. Two further individual ensuite bedrooms, with their own lounges and kitchenettes, are set in a ground floor annexe adjacent to the house. There is a garden to the front of the building, and a car parking area to the side. Entrances to the premises are secured by keypad locks.

The service had a registered manager, which is a condition of its registration. 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 service had a positive, welcoming, person-centred culture. People received the care and support they needed from staff who had got to know them well or were getting to know them. Throughout the inspection people looked comfortable with staff and were treated with kindness, compassion and respect. They freely approached staff to initiate conversations or when they needed assistance.

People’s rights were protected because the staff acted in accordance with the Mental Capacity Act 2005. People were able to exercise choices and their preferences were respected wherever possible. Wherever people were able to give consent to their care, this was sought. Where necessary, the service had made Deprivation of Liberty Safeguards applications to the relevant supervisory body. Conditions on an authorisation to deprive a person of their liberty were being met.

People were protected against the risks of potential abuse. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe.

Risks to people’s personal safety had been assessed and plans, including positive behaviour support plans, were in place to minimise these risks. People involved in accidents and incidents were supported to stay safe and action had been taken to prevent further injury or harm.

Staff responded calmly and positively when they noticed signs that people were becoming distressed, for example by providing distraction or reassurance. This was in line with people’s positive behaviour support plans, which identified possible meanings for people’s behaviours.

People were involved in choosing what they had to eat and, where they wished, to shop and cook their meals. Their dietary needs and preferences were recorded in their care plans. People had a varied diet that reflected their known preferences.

People had a health action plan that described the support they needed to stay healthy. They had access to a GP, dentist and other health professionals and attended appointments when required. However, two health and social care professionals identified that there was scope for improvement in the service’s communication with them. We have made recommendations in relation to protocols for liaising with local learning disability services and how information from health and social care professionals is communicated to staff.

A relative felt that staff would be more proactive in contacting them with regular updates about how their family member was and what they had been doing. We have made a recommendation regarding the service’s procedures for routine contact with people’s families.

Peoples’ medicines were managed and administered safely. However, we have made a recommendation regarding protocols for liaising with the community learning disability team if there are concerns in relation to a person’s medicines.

The premises were clean and well maintained.

Staff were supported through training and supervision to be able to perform their roles. There were sufficient staff with the skills and knowledge to meet people’s individual needs. People frequently took part in activities outside the house, for which they required staff to accompany them. However, staffing levels had recently been under pressure due to increasing levels of behaviour that challenged from people who had moved in and the impact this had on people already living at the service.

Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.

The registered manager valued feedback from people and staff. There were regular meetings for people who lived at the service and staff.

People and staff had confidence the registered manager would listen to their concerns, which would be received openly and dealt with appropriately. Concerns and complaints were encouraged, investigated and responded to in good time.

The provider ran regional and company-wide events for people at which they could celebrate and give feedback about their care. For example, the service had been the regional winner of the provider’s garden competition.

Quality assurance systems were in place to monitor the quality of service being delivered. Where internal audits had identified shortfalls action had been taken to address these.