This inspection took place on the 28 January 2019 and was unannounced. At the previous inspection of this service on 25 May 2016 we found no breaches of regulations and rated them as Good.

Lotus Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service supports adults with learning disabilities and on the autistic spectrum and people with an acquired brain injury. It is registered to provide support to seven people and six people were using the service at the time of our inspection.

The care service has 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.

The service did not have a registered manager in place. There was an acting manager in place and they told us they were in the process of applying for registration with the Care Quality Commission. 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.

During this inspection we found three breaches of regulations. We found health and safety concerns relating to medicines, infection control and cleanliness and food safety. The service had not carried out assessments of people’s mental capacity and there was no record that decisions made on behalf of people were in their best interests. The service did not operate effective quality assurance and monitoring systems. You can see what action we told the provider to take at the back of the full version of the report.

Systems were in place to help safeguard people from the risk of abuse and staff were aware of their responsibilities for reporting abuse. There were enough staff to meet people’s needs and robust staff recruitment practices were established. Risk assessments were in place setting out how to support people safely.

People’s needs were assessed before they commenced using the service. Staff were supported to develop knowledge and skills through regular training and supervision. People were supported to eat a balanced diet and they told us they enjoyed the food. Where required, the service supported people to access relevant health care professionals.

People told us staff treated them well and that they were caring. We observed staff interacting with people in a caring manner. Steps had been taken to support people in relation to equality and diversity.

Care plans were in place which set out how to meet people’s individual needs and these were subject to review. People had access to a variety of activities. Complaints procedures were in place and people told us they knew who they could complain to.

People and staff spoke positively about the acting manager at the service and the working culture.

This unannounced inspection took place on 25 May 2016. The service was last inspected on 15 May 2014 and met all regulations inspected.

The service had a registered manager. 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.

We observed staff were kind and respectful when treating people. Relatives told us that they felt people were safe in the service. Records showed risk assessments were developed and staff had an understanding of adult safeguarding. We noted staff had attended various training programmes including health and safety, medicine and Mental Capacity Act 2005 (MCA). Records showed that new staff had been checked appropriately and were provided with an induction programme before starting work. This meant that there were good staff recruitment systems in place.

The care plans were personalised and were based on the needs of each person. The use of a handheld electronic system to record, review and monitor care meant that the provision and checking of support for people was more reliable and effective. Staff told us the system, together with the supervision and support they received from management, was useful to them carry out their duty.

People were provided with a range of activities. We noted that people took part in activities of their preference within the service and in the community. Staff offered people choices and supported them to make decisions. People were provided with food that reflected their preference. Where they assistance, some people were supported with their meals. Records showed that people had access to medical check and healthcare professionals.

A complaints procedure was in place and people and stakeholders could be sure that their concerns were taken seriously by the registered manager. Relatives told us that they could talk to staff and make a complaint if they were not happy about the service. People, relatives and staff were able to give feedback through various meetings and surveys. We also noted that incidents and accidents were monitored, and the registered manager ensured that the health and safety of the equipment and premises were checked. Records showed that medicines were administered and signed for by staff to confirm that people had their medicines as prescribed by their healthcare professionals.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found

Is the service safe?

The provider had taken steps to ensure that people were supported in an environment equipped with appropriate facilities. Staff had received various training courses including safeguarding. The provider had an effective recruitment process which ensured that people using the service were supported by staff who were appropriately checked. One person told us that they felt "safe" in the home.

Is the service effective?

We saw staff respected and involved people in their care. Each person using the service had a care plan which was regularly updated. The provider and senior managers visited the service to monitor the quality of care and to support staff. Progress reports on various aspects of the service were completed monthly and information was shared with the stakeholders.

Is the service caring?

People using the service told us they were happy living at the home. Staff listened to people and provided them with appropriate care and support. We noted that people’s preferences were recorded and they were provided with services that reflected their cultural and religious needs.

Is the service responsive?

People told us they were satisfied with their care. We saw that staff responded to people’s requests, for example, to go out to the shops. People were supported to attend medical appointments and we noted that the provider had enabled one person to obtain specialist equipment by through a referral to an Occupational Therapist (OT) assessment.

Is the service well-led?

The home did not have a registered manager. However, the provider visited the service at least twice a week and provided management and support to staff. We were informed by the provider that an acting up manager ran the home while a permanent manager was being recruited.