The Lodge

Updated 6 November 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of one inspector.

Service and service type

The Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 26 September 2019 and ended on 27 September 2019. We visited the office location on 26 September 2019.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service but due to their cognitive impairment and communication needs, we were only able to observe their body language.

We spoke with four members of staff including the registered manager and three support workers.

We reviewed a range of records. This included two people’s care records and two people’s medication records. We looked at one staff file in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at further compliance documentation and the provider sent further evidence to us around medicines. We spoke with one profession who regularly visits the service and one relative.

Updated 6 November 2019

About the service

The Lodge is a residential care home providing personal and nursing care to 2 people with learning disabilities and autism at the time of the inspection. The service can support up to 4 people in one adapted building.

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 service was a small home. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Audits were not always effective to check the quality of the service. Some audit checks did not identify inconsistencies in documentation.

Systems in place ensured people were kept safe. Staff understood how to protect people from abuse. Risks were assessed and reviewed effectively and staff understood how to manage risk to people. People were supported by a sufficient number of safely recruited staff who were flexible to meet people’s needs. Medicines were stored and administered safely and as required medicines were used appropriately as a last resort. People lived in a clean and tidy environment and staff understood how to promote infection control. Lessons were learned when things went wrong and action was taken to reduce the risk of reoccurrence.

People’s needs and choices were holistically assessed and considered people’s needs related to equality and diversity. Care was delivered in line with people’s needs and choices. People were supported by staff who were appropriately trained and had the skills to meet their needs. People were supported to eat in line with their care plans and dietician advice. People were referred to healthcare professionals in a timely manner when needed. People lived in an environment that had been adapted to meet their personalised needs.

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 were supported by kind and caring staff who treated them with empathy. People were supported to make decisions for themselves where possible. People were supported by staff who respected their privacy and dignity. People were encouraged to be independent.

People were involved in care planning and reviewing their needs to ensure they had as much control as possible over their care. People were supported by staff who knew how to meet their personalised needs. People were supported by staff who understood their communication needs and systems were in place to ensure compliance with the Accessible Information Standard. People were encouraged to engage in personalised activities of their choice and staff promoted family relationships. A complaints policy was in place and relatives were encouraged to use this when needed. People’s end of life wishes were considered.

The registered manager was aware of their statutory responsibilities and submitted notifications to CQC where required. A person centred approach to care was encouraged and staff followed this to promote good outcomes for people. Staff and relatives found the registered manager to be approachable and were confident they would address any concerns. The provider encouraged an open environment in line with the duty of candour. Staff and relatives were encouraged to engage in the running of the service and were given opportunities to make suggestions to improve care for people. The provider encouraged continuous learning for staff and worked closely with health professionals to meet people’s needs.

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.

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.

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 27 May 2015).

Why we inspected

This was a planned 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.