Lammas Lodge

Lammas Lodge is a residential care home providing personal care and accommodation for up to 7 people. The service provides support to people with a learning disability or autism. At the time of our inspection there were 7 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Whilst people had some restrictions in place to keep them safe from harm, these were lawful and in line with their assessed need. 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 delivered care and support in line with people's needs and strengths. People received their medicines safely. Lessons had been learnt following incidents which decreased the risk of recurrence.

Right Care

Staff understood their responsibility to protect people from poor care, neglect, and abuse. Staff spoke affectionately and with understanding about the people they cared for. Individual risks were accurately assessed, and risk reduction measures were in place. People received caring support tailored to their individual needs.

Right Culture

Staff supported people to set realistic goals to live a more fulfilled life. Staff spoke about working at each person's own pace and ensuring the service was moulded to meet everyone’s needs. Effective quality monitoring systems were in place to ensure the quality-of-care people received improved. The culture was open and honest. The registered manager and deputy manager displayed a passionate attitude and worked with, and acted on, feedback from partners.

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 (report published 01 January 2020).

Why we inspected

The inspection was prompted due to concerns received about the management and reporting of incidents. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘All inspection reports and timeline’ link for Lammas Lodge on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Lammas Lodge is a residential care home providing personal care and accommodation for up to seven younger people with learning disabilities and/or autistic spectrum disorder. At the time of our inspection, there were seven people 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.

The service was bigger than most domestic style properties. It was registered for the support of up to seven people. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. Staff were 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

Staff knew how to identify and report potential abuse involving people who used the service. The risks associated with people’s individual care and support needs had been assessed, reviewed and managed. Staff received training and read people’s care plans and risk assessments to enabled them to work safely. Staffing arrangements at the service ensured people’s individual needs could be safely met. People had support to take their medicines safely and as prescribed. Measures were in place to protect people, staff and visitors from the risk of infections. Any accidents or incidents involving people living at the home were reported, recorded and action was taken to keep people safe.

The registered manager promoted a positive and open culture within the service. People’s relatives felt able to express their views to staff and management. Staff felt well-supported and were clear what was expected of them at work. Regular audits and checks were completed on the quality and safety of people’s care to identify and address areas for improvement. Staff worked with a range of community health and social care professionals to ensure people’s care needs were monitored and met.

Rating at last inspection

The last rating for this service was Good (report published 19 July 2019).

Why we inspected

This was a focused inspection to assure ourselves the service was meeting people’s needs, staff had the necessary skills and experience and management processes were effective. We reviewed the key questions Safe and Well-led only. No areas of concern were identified in the other key questions, therefore we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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.

Lammas Lodge is a residential care home providing personal care for up to seven people with learning disabilities or autistic spectrum disorder. At the time of our inspection, there were seven people 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

Staff understood how to identify and report any potential abuse involving people who lived at the home. Systems and procedures were in place to identify and manage any risk associated with the premises, equipment in use and people’s individual care needs. The provider followed safe recruitment practices to check prospective staff were suitable to work with people at the home. Staffing levels at the home meant people’s care needs could met safely. Any accidents or incidents involving people were monitored by the registered manager and provider, who took action to reduce the risk of reoccurrence. Measures were in place to protect people from the risk of infections.

People’s individual care needs were assessed and kept under regular review. Staff received an initial induction followed by formal training and regular supervision to enable them to work safely and effectively. People had enough to eat and drink and were supported to choose what they ate and drank on a day-to-day basis. Staff worked effectively with community health and social care professionals to ensure people’s care needs were met. 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 adopted a caring and professional approach towards their work. People had support to express their views about their care. Staff understood the need to respect and promote people’s rights to privacy, dignity and independence. Staff also recognised their role in promoting equality and diversity at work.

People’s care plans were individualised and contained information about what was important to them. Staff confirmed they read and followed these plans. People had support to participate in a range of social and recreational activities. People’s relatives knew how to raise any concerns or complaints with the provider. People’s wishes and choices about their end of life care were explored with them.

The registered manager recognised the importance of maintaining open communication and engaging effectively with people, their relatives, staff and community professionals. Staff felt well-supported by, and had confidence in, the registered manager. The provider had quality assurance systems and processes in place to enable them to monitor and, where necessary, improve the quality and safety of people’s care.

Rating at last inspection

The last rating for this service was Good (report published 15 February 2017).

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.

Lammas Lodge provides accommodation and personal care for up to seven people who have been diagnosed with autism. There were six people living at the home when we visited.

The home is required to have a registered manager. 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. There was no registered manager in post at the time of our inspection. The current manager, with whom we met, was in the process of applying to the Care Quality Commission to become registered manager of the service.

At our last inspection on 28 April 2016, we found a breach of Regulation 17 of the Health and Social Care 2008 (Regulated Activities) 2014. We gave the service an overall rating of requires improvement. This breach related to the provider's failure to act on feedback gathered from people using the service regarding the quality of the care provided. The provider sent us an action plan setting out the improvements they intended to make. At this inspection, we found the provider had made significant improvements to the service.

The provider had taken steps to protect people from the risks of harm and abuse. Staff understood how to recognise and report abuse. The risks associated with people’s care and support had been assessed, recorded and plans implemented to manage these. Systems and procedures were in place to ensure staff had up-to-date information about the risks to people and themselves. The manager assessed and organised their staffing requirements based upon people’s individual care and support needs. The provider adopted safe recruitment practices to ensure people were supported by suitable staff. People’s medicines were handled and administered safely by trained staff.

People were supported by staff with the right skills and knowledge to meet their individual needs. The manager ensured staff had the support they needed to carry out their job roles effectively. Staff sought people’s consent to the care and support they provided. The provider protected people’s rights under the Mental Capacity Act 2005. People had the level of support needed to eat and drink enough, and to maintain a balanced diet. People were able to access healthcare services and attend routine medical appointments and health monitoring with staff support.

Staff encouraged positive, caring relationships with the people who lived at the home. Systems and procedures were in place to encourage and facilitate people’s involvement in decisions that affected them. People were treated in a respectful and dignified manner by staff who understood the need to protect people’s human rights.

People received care that was shaped around their individual needs, interests and preferences. Care plans promoted a person-centred approach, and staff made use of these. People’s relatives were clear how to complain to the provider. The provider had developed formal procedures to ensure their complaints handling reflected good practice.

The manager and provider promoted an open culture within the service. People’s relatives found the manager approachable and had confidence in their ability to act on things. Staff felt well supported by the manager. The provider and manager made use of effective quality assurance systems to assess and address the quality of the service people received.

Lammas Lodge provides accommodation and personal care for up to seven people who have been diagnosed with autism. There were six people living at the home when we visited.

A registered manager was in post, but at the time of our inspection they were on leave. 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 had not been fully supported and empowered to give their views about the care they received and to be involved in decisions which affected them.

There was no consistent management and leadership and this had had an adverse impact upon the care and support provided. The provider’s quality assurance systems had not been used consistently and shortfalls in the quality of the care provided had not been identified or addressed.

Staff had not been well-supported or directed by the management team. They did not have the right skills and knowledge to communicate as effectively as possible with all of the people living at the home. Staff lacked knowledge about the requirements of the Mental Capacity Act 2005 and what this meant for their day to day work with people.

People were safe because staff recognised the signs of potential abuse and knew the action to take if they were concerned about people’s safety or wellbeing. The provider had clear procedures for dealing with any concerns of abuse.

The risks associated with people’s individual care and support needs and the overall running of the home had been assessed and managed to keep people safe. Accidents or incidents were monitored on an ongoing basis to minimise the risk of reoccurrence.

There were enough suitable staff to meet people’s needs because the provider adhered to safe recruitment practices. Staff treated people with dignity and respect.

The provider had developed systems and procedures to ensure that people received their medicines in a safe manner. People also received appropriate support with eating and drinking. The risks associated with people’s eating and drinking had been assessed and managed.

People were supported to maintain good health with the involvement of a range of external healthcare professionals.

Staff helped people to keep in contact with those important to them. People’s friends and relatives were able to visit them without unnecessary restrictions. People’s relatives knew how to raise concerns or complaints about the service and felt confident that they would be listened to.

Below is a summary of what we found. The summary describes what the relatives of people using the service and the staff told us, what we observed and the records we looked at.

When we visited we met five of the seven people who lived at the home. They were not able to tell us about their experience of living at the home due to their communication and special needs. We observed people being supported by the care staff.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Risks to people had been identified, assessed and kept under review. Staff had the skills and knowledge to know how to meet people's needs and keep them safe. They had undertaken training including fire safety, how to respond positively to people's behaviours and manage people's health conditions.

Procedures were in place to ensure people who lacked mental capacity had decisions made for them that were in their best interest.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. Restrictions were in place to help keep people safe. The home was working closely with funding authorities to ensure any restrictions were correctly authorised under the DoLS. This meant that decisions were made by a multidisciplinary team which helped protect the vulnerable people using the service.

The registered manager had made appropriate safeguarding referrals to the local authority. They and the provider reviewed all accidents and incidents.

There were well developed systems to make sure health and safety risks within the home were minimised.

Is the service effective?

We found that people's on-going needs were regularly assessed and the care and support provided for them was well planned and purposeful. People had benefitted from this and developed new skills or taken part in new activities that had enhanced their lives. One person's relative told us they were very satisfied with the care provided to their family member. They said, 'I have visited unannounced and have no criticisms about the personal and physical care' and 'They are getting X (person's name) to be as independent as possible'.

Changes in how the care was provided were discussed with people when possible and their relatives, the staff and professionals involved in their care. Behaviour monitoring records were kept up to date and accurate. This provided reliable information to staff and professionals to ensure the support provided met people's current care needs.

There were systems in place to ensure the staffing arrangements met people's needs. Each person had staff assigned to them each day. Activities were planned ahead based on what people enjoyed, so staff knew what to offer people. Each person had their own activities planned for the day we visited. Staff discussed people's needs during their shift to ensure that there was a continuity of the care provided. Staff meetings and supervision sessions were held regularly and staff were expected to attend training and gain qualifications. This meant that staff were well trained and skilled in their work.

Is the service caring?

We observed that the staff worked calmly and were well organised. They smiled and engaged with people in a natural and caring way. The atmosphere was relaxed and homely.

One person's relative told us, 'X (person's name) interacts well with the staff and the transition has gone amazingly well' and 'I can tell they are happy' and 'The staff are open to ideas and I feel part of it'.

Staff discussed what people enjoyed and shared ideas of activities to try. Decisions were made in people's best interest after consultation with their relatives and professionals.

We saw that staff did not rush people and they encouraged them to make choices and gave them time to make their decision. Discussions and observation showed that staff knew people's preferred routines, likes and dislikes well.

Is the service responsive?

We found that the management team were open to feedback. Ideas were listened to and used continually to try to improve outcomes for people living in the home.

The service worked in close cooperation with people's relatives and others involved in people's lives to help ensure the best outcomes for people. Concerns were listened to and taken seriously.

The service had responded positively to people's behaviours that had an impact on the environment and been creative with finding solutions so people's freedom was not restricted unnecessarily.

Staff felt that their views were listened to and any concerns were taken seriously.

Is the service well led?

We found that there were good care outcomes for people living at the home. The team were committed to giving people enjoyable lives and new opportunities.

One person's relative told us, 'I have a good relationship with the manager and feel I can raise any issues'.

Staff told us that they felt part of a good team and that they were well supported. They said the registered manager listened to any issues and took action quickly when needed.

The service operated in an open way and welcomed the involvement of people's relatives and other professionals. People's relatives had confidence in the service and felt they could give their ideas and views.

We found the management team were committed to continually improving the service and outcomes for people living at the home. There were well developed quality assurance systems and risks to people's safety were kept under close review.

People were being supported by some staff who knew them very well. Five new staff had recently joined the team and the improved staffing levels meant that people were being offered more activities. A team of specialists employed by the providers reviewed people's emotional, behavioural, communication and medication needs regularly.

Incidents were monitored and the more serious incidents had been appropriately referred to the local authority. The manager was working with external agencies to make improvements and reduce the risk of incidents reoccurring. They were making good progress towards completing their action plan. Systems were in place to monitor the quality of the service. The staff team felt supported by the new manager and morale had improved. Suitable training and staff supervision arrangements were in place.