About the service:

Ecclesbourne Lodge is a residential home, which was providing personal care for up to ten young adults aged between 18 and 35 years, who have a learning disability and autism. The home is divided into two separate houses, Brook and Fern. Each house had its own kitchen and communal spaces. People had their own room with an ensuite. At the time of the inspection there were eight people using the service.

People’s experience of using this service:

The service met the characteristics of good in all areas, and meets ‘Outstanding’ in the Responsive domain.

People’s needs were at the heart of the service being provided. Staff were exceptionally knowledgeable about the care people required and the importance of people’s life history in establishing plans which were effective. Staff received the necessary training to enable them to have the skills for their role. There was a wide range of activities which were planned and tailored to each person. The environment had been considered to support people’s needs and the spaces available.

Where people had behaviours which challenged, the plans reflected an approach which was reviewed and monitored to ensure this reflected the correct amount of detail and interventions.

There was an education programme which provided people with skills to support them with daily life skills and improving their independence.

When new people came to the home, there was a comprehensive approach to ensuring staff had the knowledge and skills to support people with their transition and next steps in living at the home.

Staff were supported with a management structure which offered guidance and progressions within people’s roles.

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 support this practice. Health care had a focus to ensure people’s ongoing wellbeing.

People’s plans of care and other important information was provided in a range of formats to support understanding. People could access spiritual support to meet their religious beliefs.

There was a registered manager at the home. The rating was displayed at the home and on their website. When required, notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

Staff had established relationships with people and showed mutual respect for people to ensure their dignity was maintained. Relatives were encouraged to visit and staff supported people to retain their relationships.

The provider completed a range of audits to ensure the home was well run and used information to drive improvements. Complaints had been investigated and outcomes shared.

The provider looked to make improvements and we saw these in relation to end of life care and any lessons learnt. There were sufficient staff to support peoples needs and there was flexibility for this to be increased for events or appointments. Peoples risk were managed and guidance provided to support the staff and reducing the risks. Medicine was managed safety and measures in place to reduce the risk of infections.

Rating at last inspection: Good: report published on 6 July 2016

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 26 April 2016 and was unannounced.

There is a requirement for Ecclesbourne Lodge to have a registered manager. Although a registered manager was not in place in place, a registered manager from one of the provider’s other services was providing management cover. In addition, an acting manager had also been appointed. 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.

The service is registered to provide residential care for up to 10 younger adults between the ages of 18 and 30 who have learning or sensory disabilities and are on the autistic spectrum. The service is a transitional service and supports people to develop the skills needed to live with support in the community or to move into a suitable residential service. At the time of our inspection 9 people were using the service.

At the last inspection on 20 November 2014, we found a breach of regulation 11 of the Health and Social Care Act (Regulated Activities) Regulations 2014. We asked the provider to take action to ensure applications were made for Deprivation of Liberty Safeguards where people experienced restrictions to their freedom. At this inspection we found improvements had been made.

Safeguarding procedures had established an act of neglect had occurred since out last inspection and the provider had taken steps to reduce the risk of a repeat incident. The provider had also taken steps to reduce the risk of abuse to people as staff had been trained in safeguarding people and staff discussed safeguarding practice regularly. Other risks to people’s health were identified and care plans were in place to ensure any risks were reduced. We found medicines were being stored and administered safely so as to protect people from the risks associated with medicines. Improvements to further help clarify when people required medicine to manage pain were being made.

The service deployed sufficient numbers of staff to meet people’s needs. In addition staff had been recruited using pre-employment checks designed to ensure staff working with people using the service were safe to do so.

People were asked for their consent to their care and support. For people who lacked capacity to consent to their care and support the provider had followed the principles of the Mental Capacity Act (MCA) 2005. The provider had also applied for assessment and approval of any restraint on a person’s freedom in line with the Deprivation of Liberty Safeguards (DoLS). Staff received training and understood the principles of the MCA and DoLS.

Staff received supervision and demonstrated knowledge of people’s needs. People were supported to access other health care services as required. In addition, people were supported to enjoy flexible mealtimes and received sufficient food and drink that met their nutritional needs.

People were supported by staff who were kind and caring. Staff promoted people’s choices and independence. In addition, staff were mindful of respecting people’s dignity and supporting their privacy.

People, and where appropriate families or their representatives, were involved in planning people’s care and support. People were able to maintain relationships with those who were important to them. People received support to engage in interests and activities and to pursue their goals and ambitions planned to support their independence and transition.

Records and audits were available to check on the quality and safety of services provided to people using the service. The interim management team were viewed as being approachable and were supported by a motivated staff team.

People, families and staff were involved in the development of the service. We saw info

We completed an unannounced inspection of Ecclesbourne Lodge on 20 November 2014. Ecclesbourne Lodge is a transitional home for 10 younger adults with learning disabilities or autistic spectrum disorder who require specialised care and support. A transitional service supports people to gain and practice skills so that they can live more independently. There were 10 people using the service at the time of our inspection.

Ecclesbourne Lodge 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. The manager had been appointed in April 2014. They had submitted an application for registration to the CQC which was being assessed at the time of our visit.

At our previous inspection visit we asked the provider to take action so that people’s care records accurately reflected the support provided to them. At this inspection we found this action had been taken.

Deprivation of Liberty Safeguards (DoLS) are safeguards that require assessment and authorisation when a person lacks mental capacity and needs to have their freedom restricted to keep them safe. Some people were restricted in movement outside the building for safety reasons and there were no DoLS authorisations in place.

The provider had taken steps to reduce the risk of abuse to people by following robust recruitment practices and training staff in safeguarding. Quality assurance systems were in place to identity where further improvements were required. Medicines were safely managed and administered and people received medicines when they needed them.

Staff were supported to work to the best of their ability and received support from managers, training opportunities and input from other professionals involved with people’s care. Successes and achievements for both staff and people using the service were celebrated and shared. Enough staff were available at the service to safely support people with their care and interests.

People using the service and their families told us they enjoyed living there. People were supported to pursue their own interests and goals. Staff were observed as being friendly and warm when interacting with people. Assessments of people’s needs were accurate and placed the person using the service at the centre of any plan of support.

People, their families and staff had been able to make complaints and comments and these had been acted on. The provider had a clear aim to be open and transparent and people were able to contribute to plans to develop the service.

You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with one person who used the service. Due to the complex needs of people who used the service we were unable to speak with others. We therefore spoke to four relatives. We also spoke with six members of staff.

People we spoke with were happy with the care provided. One person described their relative as “thriving” in the environment. Other comments included “We are very happy”, “they are safe and well locked after”.

People spoke highly of staff. One person commented “staff are very caring and very good”, another told us they were “very helpful, calm and patient”.

We saw that appropriate checks had been made to ensure that the premises were safe. We did find a few areas of concern but these had been reported to the maintenance team and they were waiting for the work to be carried out.

We saw that the provider had carried out sufficient pre-employment checks on staff to help ensure that they were suitable to work in this environment.

The provider had a complaints system in place. There was evidence that complaints had been investigated. One relative told us that they had complained and that the provider had “responded well to this” and that the issue had been resolved.

We found that not all care records contained a reflection of the actual work that was being carried out with a person. They did not all contain guidance for staff about how to deal with specific behaviours displayed by people who used the service.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs, they were not all able to tell us their experiences. We spoke to one person and two relatives of people using the service. They spoke positively about staff respecting their privacy and maintaining their dignity. One relative told us “I am really pleased with the home, the staff really committed to meeting his needs”.

We found that people were receiving the care and treatment that they needed in line with their care plans. We saw that care plans were comprehensive in regards to peoples present care needs, but they did not reflect peoples long terms aims and goals.

Staff we spoke with told us that they received regular training and supervision to support them in their roles. All of the staff we spoke with told us they enjoyed working at the home and felt supported by the manager.

We found that the provider had systems in place to assess and monitor the standards at the home and action plans showed that they address items that came to their attention.