This inspection took place on 11 October 2016 and was announced. Cypress Lodge is a service that provides accommodation for up to three people who have a learning disability. On the day of the inspection, there were three people living at the service.

There was a registered manager working at the service. 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 and associated Regulations about how the service is run. The registered manager was not based at Cypress Lodge. The service was overseen by a senior carer. We met with the senior carer on the day of our visit.

Appropriate plans were in place to guide staff in how to minimise risks to keep people safe. Staff knew what action to take to ensure people were protected if they suspected they were at risk of harm. They were encouraged to raise and report any concerns they had about people through safeguarding and whistleblowing procedures.

The service had sufficient staff to meet the needs of the people living there. Staff were recruited only after completing the necessary checks to make sure they were suitable to work at the service.

The service was following the guidance in people's risk assessments and support plans and the risk of unsafe care was reduced. People's records were up to date and indicated that care was being provided as detailed in people's assessments. The records had been updated to reflect changes in people's care needs. Medicines were managed safely.

There was an open and transparent culture within the service. People and staff could openly voice their opinion if they wished to without hesitation. They could be confident that they would be listened to and that any concerns would be acted upon. People were supported to make their own decisions about the care and support they received.

Support files were personalised to reflect people's personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet, which they enjoyed. Health and social care professionals were regularly involved in people's care to ensure they received the care and treatment which was right for them.

Good leadership was in place that provided staff with the necessary support and training to make sure people received good quality care. The provider did not have formal systems in place to monitor and improve the quality of care that people received, although relatives were complimentary about the service and the support their family member was receiving. There was information available if people or their relatives wanted to complain.

We looked at the processes in place at Cypress Lodge to obtain the consent of people to their care, treatment and support. We found that the service had in place processes to gain people's consent, such as signing their care plan documents.

We looked at the care records for all three people living at Cypress Lodge at the time of visit. We found that there was individualised care planning for each of these people, which set out how staff would support them to reach their goals and the desired outcomes of their care.

We found that there were enough suitably qualified, skilled and experienced staff to meet people's needs at all times. People had the support of an extra member of staff on Monday evenings to facilitate one to one time and outings.

We found that there was an effective complaints policy and procedure in place, which was presented to people in a format they could understand. We saw evidence that staff supported people to make complaints where they needed assistance to do so, and that the service paid due regard to their complaint, investigating it appropriately.

We found that the service kept records for all three people using the service that were fit for purpose, reflected accurately their needs which were kept securely and confidentially.

We spoke with all three of the service users, either together or on their own. People told us they were looking forward to their holiday the following week when they were all going to Hunstanton. They said that, “Staff are nice”, and that there was always a member of staff about when they returned from their day centres. People spoke about the overgrown state of the back garden and how long it had been since anyone had done any gardening there. They were pleased it was due to be done whilst they were on holiday. One person said, “I have flowers I want to plant”.

People said they had weekly house meetings when they decided what they were going to do for the week and the food they wanted to cook and eat. One person told us they liked to go to, “The pub down the road”. Whilst another said, “I like to go bowling”.

People spoke about their daily living arrangements and how they were able to get to and from their day centres by public transport without support. One person told us, “It makes me feel independent”.

One adult social care inspector visited Cypress Lodge. At the time of our inspection there were three people using the service.

We spoke with all three people who used the service, a director, the registered manager and care staff. We reviewed the care records for all three people. We also reviewed a selection of other records that included staff files, minutes from meetings and the provider’s policies and procedures.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty. At the time of our inspection no person living in Cypress Lodge had a DoLS authorisation in place.

During our review of people’s care records we found that people had been involved in assessing what their needs were. People had signed their care plans and risk assessments in agreement with them. We noted that people had been asked for their consent in relation to the sharing of their information with others and the administration of medicines. People could tell us what was documented in their care plans and told us that the risk assessments helped to ensure their safety.

Medicines were stored securely in locked cupboards. However, temperature sensitive medicines were kept in a plastic box in the fridge in the kitchen, rather than a secured medicines' fridge. We have highlighted this to the provider. People administered the majority of their own medicines and these were kept in a locked drawer in their own room. Medicines Administration Records (MARs) contained the necessary information for the safe administration of medicines and there were no gaps. We saw evidence that the staff who administered medicines had received the appropriate medicines management training.

The majority of staff were up to date with their mandatory training. Those that were not, were currently undertaking the training as part of an e-learning programme. This helped to ensure that staff were competent to meet the needs of the people they cared for, besides maintaining their safety and welfare.

There were systems in place to record and investigate accidents and incidents. Trends analysis was undertaken by the registered manager and action plans were put in place to help reduce the risk of repeat occurrences.

The provider had arrangements in place to manage foreseeable emergencies. These included plans in relation to fire and evacuation and loss of utilities. Both the staff and the people who used the service could tell us what they would do in the event of an emergency.

Is the service effective?

People’s needs were assessed, and care and support was planned and delivered in order to meet these needs. Plans of care and risk assessments were regularly updated to reflect any changes in people’s needs. All of the people we spoke with told us that they aspired to living as independently as possible. We saw that this was encouraged by the staff, and support was given where necessary. People told us that their day to day skills had improved whilst living in Cypress Lodge and that they felt relatively confident going in the community on their own.

During the review of people’s care plans we saw that the provider worked closely with other health and social care professionals. These included people’s general practitioner, social worker, dentist and podiatrist. This meant that people received care and treatment from a multidisciplinary team that helped to effectively address all of their needs.

Staff were supported to undertake additional specialist training to further meet the needs of the people they cared for. This included training in relation to diabetes and epilepsy. We saw evidence that staff received regular supervisions and appraisals. Staff told us that these were meaningful and effective. They said that they helped them to identify their further training needs in order to best meet the needs of the people they cared for and supported.

Is the service caring?

One person we spoke with said, “I love living here and the staff are lovely. All of the care staff know my needs well. Staff are helping me to prepare our supper.” Another person said, “I undertake activities that I enjoy, and we can come and go as we please. All of the staff are great, all of them. They look after us really well. I really like living here. I like the other people. We have a really nice time together.” A third person said, “I like living here. There’s lots to do and I do the things I like. All of the staff are lovely. We can all say what we think and the staff listen to us. If we have any complaints then they sort them out. I haven’t got any complaints. I am really happy here.”

We observed positive interactions between staff and the people who used the service. Staff showed kindness and patience. It was evident that they knew the needs of people well.

Is the service responsive?

People’s care plans responded to and reflected their needs in a holistic manner. People were supported to maintain as much independence as possible for themselves. Where people required assistance to meet their needs, the staff responded in a way that helped to keep the person safe, but maintained a level of independence for them as well.

Information throughout the service and in people's care records was available in an ‘easy read’ format for the people that required this. This helped to ensure that people understood what was being said.

People’s likes, dislikes and preferences were taken into account. People could choose what activities they did during the day and told us that they found these meaningful to them.

People’s relatives and friends were welcomed at Cypress Lodge. Staff responded to any of their questions once they had received consent to do so by the individual concerned.

We saw evidence that the provider took account of complaints or comments to improve the quality of the service. All of the people who used the service told us that they knew how to make a complaint.

Is the service well-led?

The care staff we spoke with told us that they felt supported by the management team. They said that they felt confident to raise any issues or concerns and that these would be listed to and acted upon as appropriate.

Staff told us that there were staff meetings and that they found these meaningful and productive. However, there were no minutes from the staff meetings available at Cypress Lodge. We have highlighted this to the provider.

The provider had a quality assurance system in place to assess and monitor the quality of service that people received. Questionnaires had been recently issued to the people who used the service, their representatives and health professionals. We saw that all of the results and comments were positive. The registered manager told us that if there had been any negative comments, then these would have been acted upon to help improve the quality of the service.

People told us that there were ‘house’ meetings. They said that the manager responded to their comments and suggestions most of the time. However, people’s concerns about the uneven path and muddy back garden had not been addressed. These concerns had been raised in July 2014. We have highlighted this to the provider.