About the service: Melody Lodge is a care home that provides accommodation with support for up to 11 people with a learning disability or autistic spectrum disorder. On the day of our visit there were seven people using the service.

The care service had not 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: The culture of the service was poor. The registered manager and staff did not recognise or understand their practice placed restrictions on people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Consent to care and treatment was not sought in line with the principles of The Mental Capacity Act 2005 (MCA).

Whistleblowing procedures were ineffective. Staff raised concerns with the registered manager and provider but did not escalate their concerns with other authorities when they failed to act.

Incidents of a safeguarding nature were not reported to CQC.

Timely action had not been taken to address concerns regarding the environment. This placed people at risk of avoidable harm.

Staff had not been recruited safely as all of the relevant checks had not been completed and there were not enough staff employed to meet people needs.

People were not always treated with dignity and respect. Staff did not follow best practice guidelines and positive behaviour support strategies were not used. Punitive practice was embedded within the culture of the home.

The service was not well led. People had experienced restrictions to their liberty because of poor practice and ineffective governance systems and processes.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Rating at the last inspection: The service was rated as good and the report was published in June 2016.

Follow up: Following the inspection we referred our concerns to the local authority responsible for safeguarding. In addition, we requested an action plan from the provider, and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by the Care Quality Commission (CQC). The purpose of special measures is to:

¿ Ensure that providers found to be providing inadequate care significantly improve.

¿ Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

¿ Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their regi

We inspected Melody Lodge on 4 May 2016. This was an unannounced inspection. The service provides care and support for up to 11 people. When we undertook our inspection there were 7 people living at the home.

People living at the home were of mixed ages. Some people required more assistance either because of physical illnesses or because they were experiencing difficulties coping with everyday tasks. The home had a small occupancy and the majority of people had lived together for a long time.

There was a registered manager in post. 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.

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. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection there was no one subject to such an authorisation.

We found that there were sufficient staff to meet the needs of people using the service. The provider had taken into consideration the complex needs of each person to ensure their needs could be met through a 24 hour period.

We found that people’s health care needs were assessed, and care planned and delivered in a consistent way through the use of a care plan. People were involved in the planning of their care and had agreed to the care provided. The information and guidance provided to staff in the care plans was clear. Risks associated with people’s care needs were assessed and plans put in place to minimise risk in order to keep people safe.

People were treated with kindness and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff in the home. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People were supported to maintain their independence and control over their lives.

Staff had taken care in finding out what people wanted from their lives and had supported them in their choices. They had used family and friends as guides to obtain information and accessed a number of different resources within the community.

People had a choice of meals, snacks and drinks. And meals could be taken in a dining room, sitting rooms or people’s own bedrooms. Staff encouraged people to eat their meals and gave assistance to those that required it. Some people helped with the preparation of meals and setting tables for meals.

The provider used safe systems when new staff were recruited. All staff completed training courses to update their knowledge about people’s individual health care needs. The staff were aware of their responsibilities to protect people from harm or abuse. They knew the action to take if they were concerned about the welfare of an individual.

People had been consulted about the development of the home and quality checks had been completed to ensure services met people’s requirements. Since our last inspection the provider had continued with building development at the premises and refurbished many parts of the home. The building work was still on-going.

Everyone we spoke with talked positively about the staff.They said they fully supported their care needs. People told us the staff spoke with them in a respectful manner. One person said, "I like the staff who look after me."

The people we spoke with told us their care was personalised to their needs. One person said, "I go through my care plan." Another person told us about the social activities they did each week. Another person told us, "The staff helped me put on some different coloured nail polish so I could go out looking nice today."

Improvements to the refurbishment programme had been made since our list visit. People told us they liked their bedroom area. One person said, "I like staying in my room. Its nice."

We did not ask people whether they thought there was sufficient staff on duty to meet their needs. Staff told us they had time to meet peoples needs with the amount of staff on duty each day and night.

People told us how well staff looked after them. One person said, "Staff are nice here." We saw details of when staff had attended training sessions which included all mandatory training and topics about specific illnesses.

Improvements had been made in the way the manager monitored the quality of service being provided. However a more robust system needed to be in place to ensure all audits were commenced and any actions completed. This would ensure the premises were a safe place to live and peoples needs were being met.

We did not speak with people during this follow up visit.

Following a serious untoward incident at the service on the 10 May 2012 we completed a responsive review to look at the outcomes relating to care and welfare for people using the service and staffing. The incident is currently being investigated by Lincolnshire police and Lincolnshire county council safeguarding team.

During our visit we spoke with the manager, two care staff and three people who used the service.

People we spoke with were very positive about the care and support they received. They told us they liked living at the home and confirmed they were supported to make choices and decisions about the care they received. They told us they were assisted to be as independent as possible. Comments included, "I like the staff”,” The staff are nice and help me” and “I do the gardening and my laundry. Staff show me what to do and I can do it.”

We were told by one person that they had chosen to go on a separate holiday from the other people who lived in the home. This was because they liked going to a different places.

We spoke to another person who said, “I like it here, I can choose what I want to do.”

One person told us they were responsible for the gardening that they enjoyed this work.

We were told that there was a lot of building work going on. They said that they were really pleased and that it would be nice when it was finished. Three people told us they had just moved to new bedrooms and they were very happy with them.

People we spoke with told us they felt safe in the home and they trusted the staff that cared for them

We spoke with seven people during our second visit on the 16 November 2011 who all told us they were happy with the staff. They felt they could talk to any member of staff about any concerns or issues they may have.

People who used the service told us they liked living at the home and could talk to the staff and manager about their problems and needs. One person said, "I like the staff."

The views of people who used the service were recorded in care plans on a daily basis and the manager held reviews throughout the year to reassess people's needs. One person told us, "XX (the manager) talks to my family all the time and we have meetings."

Staff recorded in care plans the needs and wishes of people who used the service. These were updated at least monthly or as a need changed. People who used the service told us they knew staff kept notes on them." One person said, "I can read the pictures and staff read the words to me."

Work on the new part of the building was still in progress but areas where work was taking place had been made safe for people who lived on the premises, staff and visitors. Some areas of the home had been refurbished. One person told us, "We were asked what colour carpet we would like in the upstairs corridor, but I wasn't bothered." A revised action plan on work in progress is being sent to us.

The quality assurance audit programme had been reviewed since our last visit. A number of audits had taken place so the provider could see how good the quality of the service was for people who used the service. One person who used the service told us, "I speak to staff each day and don't need a meeting."