We undertook an announced inspection on 1 August 2017 of Franklyn Lodge 9 Grand Avenue. Franklyn Lodge 9 Grand Avenue is a small care home registered for a maximum of six adults who have learning disabilities. At the time of this inspection, there were five people using the service.

There was a registered manager in post. 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.

During the inspection, the registered manager was not available. However the home was being managed by the acting deputy manager. The acting deputy manager was being supported by the provider who regularly visited the home.

At the last inspection on 12 June 2015 the service was rated Good.

At this inspection we found the service remained Good.

Care plans were person-centred, and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. Care plans were reviewed and were updated when people's needs changed.

Relatives informed us that they were satisfied with the care and services provided.

Systems and processes were in place to help protect people from the risk of harm. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy. Bedrooms had been personalised with people's belongings to assist people to feel at home.

Staff had been carefully recruited and provided with training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of people’s care in which the person’s liberties were being deprived. Records showed that the relevant authorisations had been granted and were in place.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information about people and the service, and had an opportunity to share good practice and any concerns at these meetings.

There were systems in place to monitor and improve the quality of the service.

We undertook an unannounced inspection of Franklyn Lodge 9 Grand Avenue on 12 June 2015.

Franklyn Lodge 9 Grand Avenue is a care home registered to provide personal care and accommodation for up to six adults who have a learning disability. At the time of the inspection, six people were using the service. People had learning disabilities and complex needs and could not always communicate with us and tell us what they thought about the service. They used specific key words and gestures which staff were able to understand and recognise.

At our last inspection on 23 May 2014 the service met the regulations inspected. There was a registered manager in post. 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.

There were safeguarding and whistleblowing policies and procedures in place and staff undertook training in how to safeguard adults. Staff were not aware of what whistleblowing was but were able to identify different types of abuse and were aware of what action to take if they suspected abuse. The registered manager told us she would ensure staff received refresher training on the service’s whistleblowing policy and procedures.

Risks to people were identified and managed so that people were safe and their freedom supported and protected. Each person had risk assessments however the information they contained was limited. There was limited information about the safe practice of moving and handling and when people went out in the community.

Care workers we spoke with during this inspection were agency care workers. The registered manager told us a number of permanent staff had left due to their personal circumstances and the agency care workers were an interim measure. The service was in the process of recruiting new permanent care workers to the home.

Care workers spoke positively about working at the home and felt supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities.

There were effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by people who were unsuitable.

We saw people being treated with respect and dignity. When speaking to care workers, they had a good understanding and were aware of the importance of treating people with respect and dignity and respecting their privacy.

People were actively engaged with activities at a day centre, however when people were at home, they did not have much to do apart from having the television on in the lounge. Care workers were present, attentive to people’s needs and spoke to people in a caring manner however we observed times where people were not being spoken to and no effort was made to engage people in a meaningful manner. The registered manager told us they would look into what people enjoyed and arrange activities that people could be actively engaged with at the home.

Relatives and care worker spoke positively about the registered manager. Relatives told us “The home is very well run”, “The manager is excellent. If I need to say something, I am able to say it” and “ “We have been very lucky with Franklyn Lodge. I couldn’t complain.”

During this inspection, the management structure in place was three agency workers, a permanent care worker, registered manager, senior managers and the provider.

Systems were in place to monitor and improve the quality of the service.

We made a recommendation that risk assessments are reviewed to identify all the risks people may face and implement measures to manage those risks to ensure people are kept safe.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

At the time of our inspection, the home was providing care for four people.

We used a number of different methods to help us understand the experiences of people who used the service, because people who used the service had complex needs which meant they were not able to tell us their experiences.

We observed the care provided and the interaction between staff and people who used the service. We also spoke with two care staff and the Registered Manager. We also read feedback from relatives.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service had support plans and risk assessments which helped to ensure their safety and welfare.

We found the home had safeguarding, whistle blowing and Deprivation of Liberty Safeguards (DoLs) policies and guidance in place. Training records showed staff had received training in safeguarding and DoLs. When speaking to them, they were able to provide examples of what constituted abuse and how they could identify abuse. They were aware of action to take and how to report allegations or incidents of abuse to the relevant authorities.

The Care Quality Commission (CQC) monitors the operation of the DoLs which applies to care homes. While no applications have been submitted, appropriate policies and procedures were in place. When speaking with staff we found they had an understanding of the Mental Capacity Act (MCA) 2005 and the DoLs and how it applied to the people they were providing care and support to on a daily basis.

Is the service effective?

We found the home had taken steps to ensure that people were included and involved as much as possible in their care and support. We found they used various methods of communication to engage and involve people who used the service as much as possible such as pictures, facial expressions, sign language, key objects and words and simple Makaton signs.

We looked at four care plans and saw that people's needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. Risk assessments had been carried out. We found these were person-centred, detailed and specific to each person and their needs.

Although the care plans included information about people’s mental state and cognition, we saw no evidence that mental capacity assessments had been carried out. We raised this with the Registered Manager and they confirmed they would carry out a mental capacity assessment for each person in the home.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff were trained in areas of relevance to their job roles and demonstrated knowledge of people’s individual needs and requirements.

Is the service caring?

We found good feedback had been received about the home. Feedback from one relative read their relative was “always happy” and another relative commented their relative “…is very happy at Franklyn Lodge and the staff are very kind and considerate towards them”.

We saw people being treated with respect and dignity. Staff communicated well with people and explained what they were doing and why. We observed people were supported to make choices and were given a choice by staff and asked what they wanted to do. During the inspection, we observed people who used the service were relaxed and seemed happy.

Is the service responsive?

We saw the home had a complaints policy and procedure in place which was easily accessible to staff and people who used the service. We found staff were aware of how to make a complaint and felt comfortable approaching the manager with any concerns they had.

We also found regular reviews were being held between people who used the service, their family or representatives, the Registered Manager and Director of Services, where all aspects of their care were discussed and any changes actioned if required.

People's health and medical needs were assessed and we viewed records demonstrating that they were supported and had access to health and medical services when necessary.

Is the service well-led?

We found the home had a system in place to obtain feedback through surveys which showed good feedback had been received.

There were regular consultations and resident meetings with the people who used the service which gave them the opportunity to relay any issues or concerns they had and if they had any complaints they wished to make.

We also found regular monthly staff meetings took place which ensured staff had the opportunity to communicate their views about the service and to discuss the care and support needs of people who used the service.

We found the home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Checks had also being conducted on all electrical equipment and maintenance checks and service records were up to date.

We received comments from people who use services, relatives and care professionals as part of this review. The vast majority of people spoke positively about the service. For instance, a person who uses the service told us, “It’s fine here.” Relatives’ comments included, “An excellent service overall, very happy with it” and “Can’t fault them.”

There was generally good feedback about how well the service respects and involves people who use services. A care professional told us that when they visited recently, “We saw staff talking politely to residents, and the residents looked happy.” People who use services told us about a number of recreational activities that they are involved in, and about the household tasks they do. A relative confirmed to us that the service understands the communication of non-verbal people.

There was generally good feedback about the care and welfare provided at the service. People who use services said that they like the service, and told us about practical matters of importance to them. The comments of relatives and care professionals included, “They take very good care of people” and “They do implement my advice.”

Relatives told us that they are invited to and involved in individual care review meetings. A relative and a care professional told us however of concerns with the standard of care-planning by the service. We found that the service should consider making improvements in this area, to help ensure that all aspects of the needs of people who use services are sufficiently planned for.

Most people were satisfied with the standard of food and nutrition provided at the service. The comments of people who use services included, “Good food” and “Nice.” A relative told us that they had seen the home-cooked meals being prepared, and added, “Put it this way, I’d be happy to have a meal there”.

There was generally good feedback about the home environment. People who use services said that they like their rooms, and relatives spoke positively about the décor of the home. “The standard of cleanliness throughout the house is very good” was a typical comment about how clean the home is kept. When we asked if anything needed fixing, one person who uses services said “curtains”. We found that a few minor improvements were needed with the furnishings in some areas of the home, but that the service was addressing these.

One relative told us of concerns about the recruitment of staff to the home. We found that the service did need to uphold improvements in this area, to ensure that future recruitment processes do not compromise the care and welfare of people who use services.

Most people otherwise feedback positively about staffing arrangements at the service. Comments from relatives included, “If extra staff are needed for a specific activity such as for trips out, the manager does supply them” and “Staff are very kind to all the residents”.

People who used the service had learning difficulties and some were not able to express their views to us. However, two people who used the service and two relatives told us that care staff had treated people who used the service with respect and dignity. Their views can be summarised by a comment made by a relative, “I am very satisfied with the care provided for my relative. The staff are friendly and they keep me informed. The home is clean and tidy”.

We observed that people who used the service appeared well cared for and were dressed appropriately. Staff supported and interacted with people who used the service in a gentle manner. Plans of care addressed the diverse needs of people who used the service. The healthcare needs of people who used the service had been attended to.

Staff had consulted with people who used the service and their representatives to ensure that the care provided was appropriate and their preferences were respected. There were suitable arrangements in place to manage medicines. Arrangements were in place for the prevention and control of infections and staff had been provided with relevant training.

The home had a policy on confidentiality. Records were well maintained and kept securely locked when not in use.