This inspection visit took place on 15 August 2017 and was announced. We gave the provider 24 hours’ notice to ensure someone would be available at the service. We spoke with relatives via telephone on 22 August 2017.

The service had a registered manager in place. 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.

We last inspected the service in November 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Staffing was provided at safe levels and any staff absences were covered by the provider’s own permanent and bank staff.

Accidents and incidents had been appropriately recorded and risk assessments were in place for people who used the service and staff.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show the service verified the conduct of prospective staff members.

People and relatives we spoke with told us they felt safe at Cosin Lodge. Staff were aware of procedures to follow if they observed any concerns.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.

Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals and told us they felt supported.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). People are were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external healthcare specialists.

Care records showed that people’s needs were assessed before they started using the service, they were supported to transition to the service at their own pace and support plans were written in a person centred way. Person centred means the individual needs of the person, their wishes and preferences were central to the support plan.

Staff supported people who used the service with their social needs. We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with staff members and there was a warm and positive atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and relatives and people told us that staff were kind and professional.

People who used the service and family members were aware of how to make a complaint. Information had been provided in an easy to read format.

Staff told us they felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Cosin Lodge and actions plans and lessons learnt were part of their on-going quality review of the service.

Some people who used the service understood the care, treatment and support choices available to them. For those people who lacked capacity. We saw their relatives had been fully consulted and were involved in making decisions about their care, treatment and support needs.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

The relationships between staff the people who they supported were good. We saw lots of evidence about how the provider co-operated with others involved in the care, treatment and support of the people who used the service. For example, when people were admitted to hospital, each person had a hospital passport. This document informed the hospital staff all about the persons heath and personal care needs and how they preferred to be supported.

We saw detailed practices were in place to prevent the spread of infection. The cleanliness and hygiene of the premises were maintained to a high standard.

There was a competent staff team who had been appropriately recruited and had the training, skills and experience to meet the specific conditions of the people who they supported.

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

Suitable arrangements were in place for people to take part in appropriate activities in line with their needs and preferences.

The relationships between staff and the people who lived there were good and personal support was provided in a way that promoted and protected their privacy and dignity.

Suitable arrangements were in place for handling complaints and for protecting people from abuse. One person told us they could share any concerns with the staff and felt their views were listened to.

There was a stable and competent staff team who had the training, skills and experience to meet the specific conditions of the people who lived there.

There were four people living at Cosin Lodge at the time of our visit. We met with all four people. Although it was difficult to find out what people thought about the service through informal interview we saw how staff interacted with people. We watched how staff communicated with people using Makaton (Makaton is a sign language developed for people with a learning disability).

We saw that people were offered choices and supported to develop their independent living skills, like shopping, and that they could choose how to spend their day.

We watched how the staff supported the people in their care. We saw that staff talked with people in a respectful manner and had a good understanding of their communication and psychological needs.

In a recent survey by the home we saw that one relative had said, “I am very satisfied with the care. It is the best care they have received throughout their life.”

We inspected this service on 10th 11th November 2014.Cosin Lodge provides care and accommodation for up to four people. The home specialises in the care of people who have physical and learning disability needs. On the day of our inspection there were a total of four people using the service.

The home had a registered manager in place. ‘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.’

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a very friendly and respectful manner. One person told us, “I love living here, I feel very safe and I don’t ever want to leave.” Another said, “I like it here, the staff are nice to me.”

The six support staff we spoke with described the management of the home as open and approachable. Throughout the day we saw that people and staff appeared very comfortable and relaxed with the registered manager on duty.

People had their physical and mental health needs monitored. There were regular reviews of people’s health and the home responded to people’s changing needs. People were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

People said staff were ‘good’ and ‘they are my friends.’ On two recent surveys we saw two GPs reported that the service was “very good.” One stated that the service was “five star, and that staff were very attentive, professional, caring and thorough.” A behavioural practitioner said, “Cosin Lodge is one of the best homes I have ever visited." All staff are very friendly and caring towards the people they support. The management structure is effective and the communication between staff and our agency has been fantastic.”

We saw people’s care plans were very person centred and clearly described their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for people who used the service to understand by using of lots of pictures and symbols. We saw lots of evidence to demonstrate that people were involved in all aspects of their care plans. For example, one person told us, “I help my key worker to keep mine up to date, and I am always the chairperson when I have my reviews.”

We found the quality of care which people received in their last days was as important as the quality of life which they experienced prior to this. The operations manager who was present on the day of our inspection showed us the new end of life profile format about to be introduced. This meant all people’s physical and emotional requirements would be addressed sensitively, their comfort and wellbeing attended to and their wishes respected. The manager told us that for two younger people who used the service their thoughts, wishes and beliefs regarding this subject had not been routinely addressed with them. The manager said the new format would make it easier to address this with them.

All staff we spoke with said they received appropriate training, good support and regular supervision. We saw records to support this.

Staff had received training in how to recognise and report abuse. We spoke with four staff and all were clear about how to report any concerns. Staff said they were confident that any allegations made would be fully investigated to ensure people were protected.

Throughout both days we saw staff interacting with people in a very caring and professional way. We saw a member of staff supporting one person with their mobility chair. They were interacting happily and laughing together. We saw another member of staff offering to assist a person to go out for lunch. The staff were gentle and encouraging and the person happily agreed to their support.

We noted that throughout the day when staff offered support to people they always respected their wishes. For example, during breakfast, everyone was asked what they would like to eat and were offered various choices for people to choose from. We saw one person helped themselves to cereal and a drink.

People who were unable to verbally express their views looked happy and comfortable with the staff that supported them. We saw people smiling and happily engaging with staff when they were approached. One person embraced two members of staff before they left to attend a day centre; we saw the staff responded in a caring respectful way.

We saw activities were personalised for each person. People also made suggestions about activities and outings during monthly house meetings. Where necessary additional staff were provided to enable people to access community facilities appropriate to their ages and abilities.

All people received additional one to one support (agreed with the placing authority) for their health, personal care and support needs, this also enabled regular community support on a daily basis. On the day of our inspection, three people were escorted to go shopping and have lunch in Durham City using the service mini bus.

People received a wholesome and balanced diet in pleasant surroundings and at times convenient to them.

We saw the provider had policies and procedures for dealing with medicines and these were adhered to.

The provider had an effective pictorial complaints procedure which people felt they were able to use.

We saw people who used the service were supported and protected by the provider’s recruitment policy and practices.

The home was very clean and well maintained, and equipment used was regularly serviced.

The provider had a quality assurance system, based on seeking the views of people, their relatives and other health and social care professionals. There was a systematic cycle of planning, action and review, reflecting aims and outcomes for people who used the service.