Cotswold Lodge

Cotswold Lodge is an adapted care home providing accommodation and personal care for eight people living with complex learning disabilities who are aged 18 years and over. At the time of the inspection six people were living in 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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

People were safe and had not been placed at risk of harm. Staff showed kindness, compassion and respect in their engagements with people, they respected and upheld their dignity. They supported people to attain a level of independence suited to their abilities and developed at a pace to suit each person.

Staff received appropriate induction and training to give them the right skills to fulfil their role and support people safely. Staff received training to raise their awareness and understanding of safeguarding issues and protecting people from abuse, they were proactive in challenging discrimination and raising alerts to the safeguarding team. Risks were appropriately assessed.

There were enough staff to provide people with good levels of care and support. People were protected because there was a safe system of recruitment in place. Medicines were stored and managed safely. The registered manager and provider analysed accidents and incidents for trends and patterns and implemented measures to mitigate further risks. People lived in a clean well-maintained environment.

Systems were in place to ensure people referred to the service had their needs assessed prior to admission to ensure these could be met. Staff monitored people’s health and wellbeing and supported them to access routine and specialist healthcare. Staff understood people’s food likes and dislikes and consulted with them to provide a varied menu.

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 understood How the Mental Capacity Act 2005 (MCA) impacted on their support of people and how people could be helped to make decisions.

People had detailed plans of care and support that guided staff in how people preferred their support to be delivered. Peoples concerns were listened to and acted upon. Relatives said they felt able to express any concerns they might have to staff and were confident these would be addressed.

A quality assurance system provided the registered manager and the registered provider with a detailed overview of service quality and where improvements needed to be made. Feedback from people, relatives, and professionals helped inform this.

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 21/03/2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. The provider acted to mitigate these risks during the inspection and we will check if this has been effective when we next inspect. Please see the Well led section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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.

Cotswold Lodge is registered to provide accommodation and personal care for up to seven people who live with complex learning disabilities. There were seven people accommodated at Cotswold lodge at the time of this inspection. There were plans in place to refurbish and carry out some required maintenance at the home in the coming months. This was being planned in accordance to people’s needs and wishes.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last inspected the service on 23 January 2014 we found the service was meeting all the standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People who lived at Cotswold lodge were kept safe by staff who understood and had been trained on how to keep them safe. Risks were assessed and actions put in place to reduce or mitigate them to reduce the risk of harm. There were sufficient staff on duty at all times.

The provider used a robust recruitment process and pre-employments checks were undertaken to help make sure staff were suited to working in a care home setting.

People received their medicines safely by staff who had been provided with training and had their competency checked.

Staff were supported through supervision and an annual appraisal. Staff felt supported and valued by the manager. People received the support they needed to eat and drink and healthy and balanced diet. Health needs were taken care of and people were assisted to attend health appointments if required.

People and their relatives were positive about all aspects of the home, in particular the management and staff who were kind, caring and inclusive. Staff knew people’s needs and wishes very well and involved them in the planning and review of their care where possible. Visitors were always welcomed.

The provider had processes in place to obtain feedback from people who used the service and used feedback to improve the quality of care people received. There was an open, honest and respectful culture in the home and the team worked well together to ensure people who lived at Cotswold lodge enjoyed the best quality of life they could. There were quality monitoring systems in place to monitor and improve the service.

We found that people's capacity to consent was assessed and documented, and there was access to local advocacy services for people who were unable to make their own decisions. We saw that care plans had been written and regularly reviewed based on assessments of people's individual needs and contained detailed information. We saw evidence of monitoring and regular evaluations of the support that was provided.

We found that records were maintained which demonstrated that medicines were dispensed accurately and stored safely. Staff told us that they received regular training and assessment in medicines handling and administration.

We saw that there were suitable recruitment and selection procedures in place, and found that personnel files contained current information on the suitability of a staff member for their role. We found that staff were supported through the induction process, and had access to a programme of regular training.

We found that there was information on how to complain in formats which enabled the people who used the service to make their views on the service known. We saw that where people complained, the service's own procedures were followed, and documented appropriately.

We spoke with one person who used the service. They told us they had monthly meetings with their key worker to review their care plan and discuss their activities. We reviewed three care plans and saw they were individualised and identified people's needs. The person we spoke with said, "I chose my bedroom colour because I like green colour and this makes me happy'.

Our observations of the service showed that staff spoke and interacted with people who used the service in a patient and pleasant manner. An individual told us "Staff are friendly, helpful and supportive'.

We saw that the home was clean and tidy, and there were records to show that regular cleaning was carried out.

People told us this was a lovely place to live and that they were well supported by the provider. One person said, 'I have been here for several years and I have a key worker whom I like and able to tell what I want and how I want it done'.

There were effective recruitment and selection processes in place.

We saw that the provider had systems in place to assess and monitor the quality of the service provided.