Denmark Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Denmark Lodge can accommodate up to seven people who have a learning disability, autism and a mental health diagnosis. At the time of our inspection five people were living there. People had their own bedrooms with en suite facilities with access to a bathroom. They shared a lounge and dining room. Grounds around the property were accessible.

Denmark Lodge had been developed and designed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service lived as ordinary a life as any citizen.

This inspection took place on 2 January 2019. At the last comprehensive inspection in April 2016 the service was rated as Good overall. The key question Effective was rated as requires improvement with a recommendation for improving recording systems for the supervision of staff. Improvements had been made in relation to this. At this inspection we found the evidence continued to support the rating of good overall and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

A registered manager was in post who had been registered with the Care Quality Commission (CQC) in 2010. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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’s care and support was individualised and reflected their needs and wishes. They had lived together for some time and had been supported by a core group of staff providing them with consistency and continuity of care. People made choices about their day to day lives. People 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 involved in the planning and review of their care and support. They chose the activities they wished to take part in. They went bowling, swimming, to the cinema and attended a fitness class. They went on holidays, day trips, to social clubs and attended local places of worship when they wished to. People kept in touch with those important to them

People’s preferred forms of communication were highlighted in their care records. Staff were observed spending time chatting and socialising with people. Good use was made of easy to read information which used photographs and pictures to illustrate the text. People had access to easy to read guides about advocacy and complaints.

People’s health and wellbeing was promoted. A weekly menu encouraged people to have vegetables and fruit in their diet. They helped to prepare and cook their meals. People had access to a range of health care professionals. They had annual health checks. People’s medicines were safely managed. People were supported at the end of their live and others were helped with their bereavement. A relative commented, “Thank you for giving so much help and care, with so much love and patience.”

People had positive relationships with staff, who understood them well, anticipating what would make them anxious or uncertain. Staff treated them with kindness and compassion. They understood and respected people’s diverse needs. Staf

This inspection took place on 8 and 13 May 2016 and was unannounced. Denmark Lodge provides care and support for up to seven people who have a learning disability. The service is located near the centre of Gloucester close to a range of local amenities. At the time of our inspection there were six people were using this service.

We last inspected the service on the 9 September 2014. At this inspection we found the provider was meeting all of the requirements we inspected.

The service had 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 and associated Regulations about how the service is run.

Support workers had not always received access to supervisions and appraisals. Support workers were supported by a committed registered manger and had access to training and professional development. There were enough staff with appropriate skills, deployed to meet the needs of people living at the home. People, their relatives and support workers spoke positively about the home and the continuity of care staff.

People and their relatives were positive about the home, the support workers and registered manager. People were safe and looked after well at the home. Support workers managed the risks of people’s care. They ensured people had the medicine they needed to meet their needs and their on-going healthcare needs were met. People received a healthy and balanced diet.

People enjoyed living at the home and were supported to live active social lives, which included attending activities and events in the community. People were supported to be involved in day to day activities, such as baking and cleaning.

The registered manager ensured people, their relatives and external healthcare professional’s views were listened to and acted upon. The registered manager ensured support workers were involved in day to day decisions and promoted support workers to take on responsibilities such as key worker duties. Relatives and healthcare professionals spoke positively about the registered manager and the home.

We carried out an inspection on 9 September 2014 to check what improvements the provider had made following a previous inspection on 13 February 2014. An adult social care inspector carried out this inspection.

During our inspection we spoke with the registered manager and three other members of staff. We also reviewed records relating to the management of the home which included seven support plans and staff training records.

The focus of this inspection was to answer one of the five questions we always ask; is the service safe? Below is a summary of what we found. The summary describes what staff told us, what we observed and the records we looked at.

Is the service safe?

The staff had received training to help them assess whether someone had the capacity to make a decision and what to do if they lacked capacity. Staff demonstrated they understood the principles of the Mental Capacity Act 2005 (MCA) and were acting on them.

Records were being kept of capacity assessments and best interests decisions. The most important information was being recorded but some relevant detail was lacking. The registered manager told us they would review the records and add the missing information.

No applications to deprive someone of their liberty had been submitted under the Deprivation of Liberty Safeguards to date. The registered manager was in the process of submitting applications to the local authority and understood when an application should be made and how to submit one.

There were seven people living at the home at the time of the inspection. Some of the people living at the home were not able to verbally communicate their views so we observed the care being provided to them. We were able to speak to two people in detail to gain their views on the care provided.

People appeared relaxed and those people we asked told us it was 'alright' living at the home.

We observed staff seeking people’s consent whilst providing care in all interactions with people with the exception of one instance. Clear guidance was not in place in relation to assessing people’s capacity to make decisions.

We observed care being delivered in line with people's individual care plans. People we spoke to told us about a range of activities they were supported to do. One person told us ‘I go to my club every Wednesday, I cook. I like fish and I have it every Friday’.

There were systems in place to ensure medicines were kept and administered safely. We observed staff administering medicines in a competent manner. People confirmed that staff gave them the support they needed with their medicines.

There were enough staff on duty with sufficient training to meet people’s needs. One person told us ‘I have (staff) as my keyworker. They take me out, talk to me’.

There was a complaints system in place and one person told us that if they had a problem ‘I would talk to someone. I talk to everyone here’.

During our inspection, we found that all concerns relating to the care of the people living at the home had been addressed. All necessary paperwork had been completed so that risk assessments, health action plans and care plans were current and readily available. Professional advice to support the staff manage behaviour changes had been sought as necessary.

We spent time in the communal areas and staff interacted positively with the people living in the home. People told us that they were happy. Everyone appeared calm and happy during our visit.

Some of the people living in the home found it difficult to speak with us as a result of their learning disabilities and other complex needs. We were able to have brief conversations with three people. One person said “I’m happy to live here”.

We spent time observing the care provided and saw positive interactions between staff and people using the service. People were supported to be as independent as possible. People were encouraged to take part in general tasks around the home such as making drinks and emptying the dish washer. We could see that people felt comfortable with staff.

The environment in the home was pleasant and well planned. This enabled effective cleaning and also ensured people could move around safely and easily.

A range of activities was open to people, including voluntary work at a garden centre, swimming and craft sessions. There were planned activities and these varied depending on how well people felt. One person told us that “there are lots of activities to do”.

Staff told us that they felt well supported by the service manager. They felt confident about their skills and training. Most staff felt that they worked together as an effective team.

One person was shouting at other people living in the home. There was not enough evidence of actions taken by the home to minimise the risk of this behaviour upsetting other people living in the home.