About the service:

Hales Lodge is a registered care home and provides accommodation and support for up to eight people living with a learning disability. There were eight people living at the service when we visited.

The care service had been developed and designed in line with the values that underpin the Registering 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 can live as ordinary a life as any citizen.

People’s experience of using this service:

¿ People had risk assessments in place to keep them safe and enable them to be as independent as possible. However, one person who was at risk of pressure sores did not have a risk assessment in place. We raised this with the management team who sent us a copy of a risk assessment and a care plan in relation to pressure area care, following our inspection.

¿ Relatives felt their family members were safe living at the service. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. There were sufficient staff with the correct skill mix on duty to support people with their required needs and keep them safe. Effective and safe recruitment processes were in place and consistently followed by the service.

¿ Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people from the spread of infection.

¿ People were supported to have maximum choice and control of their lives as much as possible and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ Staff received an induction and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions.

¿ People were able to make choices about the food and drink they had, and staff gave support to people to eat a balanced diet.

¿ People were supported to access a variety of health professionals when required, to make sure that they received additional healthcare to meet their needs.

¿ Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

¿ People’s privacy and dignity was maintained at all times. Support plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

¿ People knew how to complain. There was a complaints procedure in place which was accessible to all.

¿ Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

¿ Rating at last inspection: Good (report published 04 April 2016)

¿ Why we inspected:

This was a planned inspection based on the rating at the last inspection. The overall rating for the service remained Good overall.

¿ Follow up:

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Hales Lodge is a residential home that provides care, support and accommodation for up to eight people who have learning and physical disabilities. At the time of our inspection the home was fully occupied.

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

People were safe and lived in a safe environment because there were enough well trained staff to support people and appropriate recruitment checks were carried out before staff began working in the home. The premises were well maintained and any safety issues were rectified promptly.

Identified risks to people’s safety were recorded on an individual basis. There was guidance for staff to be able to know how to support people safely and effectively.

Medicines were managed and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who skilled and knowledgeable in their work. All new members of staff completed a full induction and staff were supported well by the manager.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. These safeguards protect the rights of adults using the services by ensuring that, if there are restrictions on their freedom and liberty, these are assessed by professionals who are trained to assess whether the restriction is needed. DoLS applications had been made for all eight people currently living in Hales Lodge.

People were supported to eat and drink sufficient amounts and people’s intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were treated with respect and staff preserved people’s dignity. Relatives were welcome to visit as and when they wished and people were encouraged and supported to be as independent as possible. People were also able to undertake activities or hobbies of their choice.

Assessments were completed prior to admission, to ensure people’s needs could be met. People were involved as much as possible in planning their care and received care and support that was individual to their needs. Risk assessments detailed what action was required or had been carried out to remove or minimise identified risks.

People were supported to raise concerns or make a complaint if needed and were listened to, with appropriate responses. Action was taken where possible.

The service was being well run and people’s needs were being met appropriately. The manager was approachable and open to discussion. Communication between the staff, management and people living in the home was frequent and effective.

There were a number of effective systems in place in order to ensure the quality of the service provided was regularly monitored. Regular audits were carried out by the manager and the provider’s operations managers, in order to identify any areas that needed improvement.

Most people using the service were unable to tell us verbally what they thought. However, one person we spoke with indicated that they were happy. They indicated this by showing us their new boots received as a Christmas present, and smiled. With help from staff they also showed us how they were changing the colour of their room from red to purple.

Staff we spoke with showed a good understanding of individuals' specific needs and requirements. We noted one person’s request to only have support from a female member of staff and we saw that staff adhered to this.

Hales Lodge was clean and tidy and one of the kitchens was undergoing cleaning during the visit. Bathrooms, toilets and the shower room were clean, tidy and free from obstruction.

We saw evidence of quality assurance audits and noted monitoring processes in place.

We visited the service during a weekday morning. We found that three people out of the current six people living at Hales Lodge had gone out to their various day centres. We spent some time with three people and spoke with members of staff on duty. Due to two people unable to verbally communicate we observed how they were cared for by staff and looked at their care plans. We saw staff communicated in a way that people understood in a respectful manner, treating each person as an individual. We also saw staff giving encouragement and involving those they supported at all times. A member of staff told us: "Even though people are very dependent on us, we still try and allow as much independence as possible by giving encouragement and praise."

People appeared relaxed and at ease with the staff and we saw people were offered choices for their lunch. People were treated with dignity and respect and encouraged to make a choice. Staff told us they supported people "To do things if they can" and "indicate or point to the options" and gave help when this was needed.

One person communicated they enjoyed living at Hales Lodge and that they felt 'well looked after' by the staff team.

We reviewed care plans, staff training records, maintenance of equipment and looked at policies and procedures on dealing with complaints and consent. There were clear systems in place to ensure that people were cared for as individuals as well as the safe practice we observed by staff.

People living at Hales Lodge all have difficulties communicating verbally so we looked at the way they were supported and at their wellbeing. People were comfortable with the staff members on duty. We saw they were calm and staff made efforts to communicate with them to find out what their needs and preferences were. We neither heard nor saw any signs of distress or anxiety from people living in the home.

We did not visit the service as a part of this review to find out what people experienced, and are not able to carry out surveys at this time. We will seek the views of people using the service and/or their representatives when we review compliance in the future.

People, or their representatives have told us they are satisfied with the support they receive when we have asked them in the past, including when we reviewed the service in February this year.