Meadow Lodge is a residential respite service located in Chippenham, Wiltshire. It provides short term care breaks for adults with a learning disability. The service is able to accommodate up to four people at a time. At the time of our inspection there were four people using the service.

At the last inspection in August 2015, the service was rated as ‘Good’. At this inspection we found the service had remained ‘Good’.

A registered manager was employed by the service and was present during our inspection. 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.

There were systems in place which ensured the quality and safety of the service was reviewed and monitored to identify where improvements could be made. These were completed by the county manager and an action plan had been completed identifying areas requiring improvement. However, no audits had been completed in 2016 and only one audit had been completed for 2015 and 2014. We spoke with the registered manager who explained that these should have been completed every six months. There had now been a change of senior management and she assured us that the county manager would now be taking on the responsibility of completing the audit on a regular basis throughout the year. Two audits had already been completed for 2017.

People were happy and relaxed in the home. During our visit we observed people approaching staff for support and chatting about what they were going to do during their stay. Staff spoke with people in a caring and considerate manner responding to requests for support without hesitation.

Processes were in place to safeguard people from potential harm or abuse. Staff were aware of their responsibilities to report any concerns and were confident that action would be taken to address these. Risk assessments and guidance were in place to support people to be independent whilst maintaining their safety.

People’s care needs had been assessed prior to them coming to stay at the service. Care records contained guidance for staff on how people wished to receive their care and considered their emotional, health and social care needs. Prior to the person’s stay, their care needs were reviewed to ensure people received appropriate and safe care, particularly if their

care needs changed.

People were supported to eat a varied diet which included their food preferences. Where required people had access to specialist diets. People we spoke with said they liked the food choices.

Medicines were stored securely and administered by staff to ensure people received them safely. Processes were in place to safely receive and discharge people’s medicines during their stay. People’s wellbeing was monitored during their visits and staff had access to healthcare services to ensure people received appropriate healthcare support.

Accidents and incidents were recorded and monitored for trends to ensure changes in people’s care needs were identified and implemented where needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. We observed people being supported to make daily living choices during our visit.

Sufficient numbers of staff were available to meet people’s needs. Staff said they received training appropriate to their role and the opportunity to refresh and keep training up to date was available each year.

The service worked in partnership with other agencies to ensure people received appropriate support and consistent care. Information was only shared on a need to know basis with other agencies to maintain confidentiality.

Meadow lodge is a respite service in Chippenham in Wiltshire. It provides short term residential care breaks for adults with a learning disability. The service has places for up to four people at a time.

At the time of our inspection there were four people using the service. The main focus of the service is to treat everyone as individuals and involve them in making choices which promote their independence. The inspection took place on 5 June 2015 and was unannounced.

The service had a registered manager who was responsible for the day to day operation of the home. 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. The registered manager was present on the day of the inspection.

People liked the staff who supported them and positive relationships had formed between people and staff. Staff treated people with dignity and respect.

The care records demonstrated that people’s care needs had been assessed and considered their emotional, health and social care needs. People’s care needs were reviewed prior to the person’s stay to ensure they received appropriate and safe care, particularly if their care needs changed.

Staff worked closely with health and social care professionals for guidance and support around people’s care needs. Staff were knowledgeable about the rights of people to make their own choices, this was reflected in the way the care plans were written and the way in which staff supported and encouraged people to make decisions when delivering care and support.

Staff had received training in how to recognise and report abuse. There was an open and transparent culture in the service and all staff were clear about how to report any concerns they had. Staff were confident that the registered manager would respond appropriately to their concerns. People we spoke with knew how to make a complaint if they were not satisfied with the service they received.

There were systems in place to ensure that staff received appropriate support, guidance and training through supervision and an annual appraisal. Staff received training which was considered mandatory by the provider and in addition, more specific training based upon people’s needs.

The registered manager and the regional county manager carried out audits on the quality of the service which people received. This included making sure that the accommodation and the environment was safe.

We carried out a follow up inspection to the home on 22 November 2013 as we had identified areas for improvement in an earlier inspection.

We found that significant improvements had been made which had also benefitted employee's within the whole of Wiltshire Council.

A wide range of documentation around safeguarding vulnerable adults and whistleblowing had been devised to ensure that people who used services, their families and staff had access to appropriate information. A whistleblowing poster, a revised policy and a new leaflet for people who used the service had been written. The leaflet was written in easy English with pictures, which explained how to tell someone if you were being treated unfairly. Staff would now be able to use the leaflet with people, if anyone who stayed at Meadow Lodge had a concern around being safe. The revised whistleblowing policy had more information so that staff knew who to contact if they had a concern.

The training department in Wiltshire Council had changed the way they provided training in safeguarding, so that there was more face to face training. Staff said they preferred this method as it was easier to understand. We spoke with one agency worker who told us they had received refresher training in safeguarding and they had found the 'face to face learning better than just learning from a computer'.

The department who supplied agency and relief agency staff to services such as Meadow Lodge had put a new system in place to ensure that all staff who worked for the Council, were competent and knowledgeable in safeguarding procedures and were able to support people appropriately.

During our visit we spoke with three people who used the service and had a telephone conversation with a relative of a person who used the service. We also spoke with three members of staff. People were happy to talk with us and share their experiences of using the respite unit. People told us they were well looked after and they liked the staff.

We saw that people were supported to make choices about their stay, such as what items to bring with them from home, what to do in the daytime and their preferences for meals. We observed that people moved freely around the home and had access to the main lounge to watch television if they wished. The equipment which people used was safe and fit for purpose.

During their stay, people were supported to access health and social care appointments such as the dentist or optician.

We looked at the systems in place within the home and spoke with representatives of the Governance, Training and Relief agency departments within Wiltshire Council. We found that people were not fully protected against the risks of abuse as the quality assurance systems in place were not fully effective.

We saw that people staying at the home looked well and appeared happy. We spoke with one person who was staying at the home. They told us "I like coming here, the staff are very nice and they look after me". We looked at the care records and risk assessments for three people, two of whom were receiving respite care at the time of our visit. The risk assessments gave guidance on keeping people safe, for example one person was prone to sleep walking, the instructions stated, 'Do not wake me up just gently put me back to bed'. Appropriate checks were undertaken before staff began work. We asked one person what they thought of the staff who supported them. They said, "They are lovely".

The home was clean and odour free with adequate ventilation. Each bedroom was furnished and people could bring in their own personal items when they stayed for respite care. The home had been decorated throughout in neutral colours to promote a calm environment.

The home had a compliments, comments and complaints policy and procedures. The policy gave guidance on what could be considered a complaint and how the home should respond and support people to make a complaint.

People told us they liked to stay at Meadow Lodge. They were able to maintain their daily routines, as if they were at home. People were therefore able, if they wanted to, to continue with their day services, clubs and leisure interests. People’s day service transport arrangements continued as if they were at home, to ensure consistency.

In addition to their usual activities, people were supported to be as independent as possible and to learn new skills whilst at Meadow Lodge. People said they could choose what they did with their time and could access community services such as the local leisure centre, pubs and restaurants. People were encouraged to help with all day to day activities within the home such as cooking, cleaning and personal laundry.

People were encouraged to make decisions about the support they received. Some people received staff assistance to help them with their personal care routines. People helped staff develop a plan of their care which included those areas important to them. The plans were well written with pictures and photographs to assist some people with easier understanding.

People’s rights to privacy and dignity were fully promoted. People had a single bedroom either on the ground or first floor, dependent on their individual needs. People were encouraged to respect each other and not to intrude into other people’s rooms without permission.

People were supported by a staff team who knew them well. People were confident and animated with staff which indicated that positive relationships had been established.

The manager was responsible for the day to day management of Meadow Lodge and another respite service within the local area. We carried out a review of the other respite service before visiting Meadow Lodge. As some aspects of the services were very similar, these were commented upon in both reports. This particularly applied to staff training in outcome 14.