On the day of our inspection there were seven people men being supported by the service. We spoke with one person who used the service and the relatives of the six other people. Most of the people who used the service were not able to communicate verbally with us. However, we were able to find out about their experiences of living at Stoke Lodge by observing care and speaking with their family or representatives. The registered manager was unavailable during our inspection because they were on their day off, whilst the deputy manager was on annual leave. Therefore we spoke with the area manager, assistant manager and eight care staff.We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service caring?
' Is the service effective?
' Is the service well led?
' Is the service responsive?
This is a summary of what we found.
Is the service safe?
Representatives of people who used the service were complementary about people's safety being maintained by the provider. Parents of people told us that they trusted the manager and staff to keep their relatives safe and well. One relative told us, 'The staff really do care. He is definitely in the right place, which is why I can sleep at night.'
People were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.
We found that the provider had an effective process to manage medicines safely. During our inspection we observed two care workers administer medicines appropriately, in the way people preferred, detailed within their medication plan.
People were cared for by suitably qualified, skilled and experienced staff because the provider had an effective recruitment and selection process. The provider had completed all necessary checks to ensure that people received care and support from competent and trustworthy staff.
Where people did not have the capacity to consent the provider acted in accordance with legal requirements. We found that staff had received training in relation to the Mental Capacity Act 2005 and had a clear understanding of the main principles. We saw decisions effectively recorded using the local authority toolkit for mental capacity assessments. For example, one assessment dealt with a person's fluctuating capacity to make significant financial decisions. We saw that best interest decisions had been made involving the person, their parents, health professionals and staff from the service.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS )which applied to this service. The DoLS are a legal process supported by a code of practice to ensure that people who lacked mental capacity to make decisions were not deprived of their liberty, other than in accordance with the law. While no applications had needed to be submitted for the people who used the service, appropriate policies and procedures were in place. Staff had been trained to understand when an application had to be made, and how to submit one.
Is the service caring?
We observed that staff encouraged and supported people in a professional and caring manner throughout our inspection. Our observations confirmed that staff were patient and people were able to do things at their own pace and were not rushed.
Relatives of people who used the service told us that the staff treated people with respect and dignity. One relative told us, 'Care at Stoke Lodge has always been good but since the new key worker arrived it is simply wonderful. If you see them (key worker and relative) together you can see there is genuine warmth and friendship.'
Is the service effective?
Staff had received training to meet the specific needs of the people living at Stoke Lodge. Examples of such training included the management of special dietary requirements and appropriate intervention techniques.
The provider had sought expert guidance in relation to one person's care plan and had arranged for staff to be trained by a specialist dietician. Parents of one person told us, 'The food is excellent and all the staff know how much protein is in what. To be honest they know much more about what is good for him than we do.'
All staff had been taught a recognised system for supporting people to manage their behaviour where this was necessary. Positive behaviour management and sensitive physical interventions ensured people's human rights were protected.
Is the service responsive?
People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The support plans were detailed and had appropriate risk assessments in place. Care practices we observed demonstrated that staff knew the needs of people and care was delivered in accordance with their care plans.
We reviewed the transition plan of one person who hoped to move into Stoke Lodge in the near future. The service had arranged several familiarisation visits for the person and their representatives. This meant that the provider had allowed people time to decide whether or not they wished to use the service and to allay any fears or anxieties.
Where people had more complex health needs we saw there were specific plans which detailed the care required and how to deliver it. We saw that one person had an epilepsy care plan. We reviewed their daily records and found that care had been delivered in line with their epilepsy plan and that monitoring had been appropriately recorded. Staff we spoke with knew the immediate action required to ensure the person's safety if they had a seizure whilst engaged in activities within the community.
Is the service well-led?
The provider had systems in place to regularly assess and monitor the quality of service that people received. These included collecting feedback from people, their relatives and staff. The provider also completed quarterly compliance audits to monitor the quality of the service.
The provider had a satisfactory complaints process. We reviewed the complaints file and saw there had been one complaint since the last inspection. The manager had acknowledged this complaint and completed a brief investigation. The complainant had been satisfied with the provider's response.
We saw the provider's business improvement plan for the service. We noted that identified actions in relation to improving the communication aids within the service and people's living environment had been completed.