This inspection took place on 12 and 15 February 2018 and was announced. The inspection was announced to ensure people who used the service would be present.

At the last inspection, the service was rated good. At this inspection, we found the service remained good.

Park 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. Park Lodge accommodates eight people. At the time of inspection the service was providing support and care for seven people.

The manager had started the application to become the registered manager at Park Lodge. 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.

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 provider had safeguarding systems in place to ensure people were protected from abuse and harm. Staff were aware of the provider’s whistleblowing process and expressed their confidence that the manager would deal with any concerns appropriately.

The provider recorded, collated and analysed safeguarding concerns and accidents and incidents to identify any patterns or trends for lessons learnt.

Where risks were identified, they were assessed and managed to minimise the risk to people who used the service and others.

An effective recruitment process was in place. Sufficient staff were deployed to ensure people remained safe. New staff completed an induction and shadowing period. Training was up to date. The manager had an action plan in place to ensure staff received supervision.

Appropriate arrangements were in place for the safe administration and storage of medicines. The provider ensured checks were in place to maintain the safety of the home. Systems were in place to ensure people would remain safe in the event of an emergency.

Staff understood and applied the principles of the Mental Capacity Act (MCA), and were aware of people’s rights when they could not consent themselves. People were involved in all aspects of decision making about their care and treatment.

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

The manager consulted with people and their relatives when making changes at the home. People were supported to personalise their own rooms.

The service ensured people received care and support from healthcare professionals including GPs and community nurses. People were supported in maintaining a healthy and balanced diet.

People were treated with dignity and respect. Staff had a sound knowledge of the people they supported. Care plans were detailed and reflected people’s specific needs. Reviews were regularly completed.

People were supported to follow their interests and take part in social activities. Relatives told us they were made welcome at the home.

The provider had a comprehensive system to audit various aspects of the running of the service. These included checks of the medicines and care plans. The manager had developed an action plan to deliver improvements throughout the service including accessible information as standard.

Further information is in the detailed findings below.

Park Lodge provides care and support for up to eight people who have autistic spectrum conditions. At the time of the inspection there were five people living at Park Lodge all of whom had been placed there from out of area due to the specialist care that could be provided.

Due to the complex needs of people living at the home not everyone was able to share their views about the service with us but we did spend time with people in communal areas observing the care and support they received.

A registered manager was in post and had been registered since 26 January 2016. They had been in post since November 2015. 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.

We carried out a comprehensive inspection on 29 and 30 June 2015 and breaches of legal requirements were found. We issued warning notices and requirement notices. We asked the provider to take action to make improvements. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service, staff or visitors. Care and treatment was not always planned and delivered in a way that was intended to ensure people’s safety and welfare. Staff had not received all the training they needed or professional development, supervision and appraisal. The provider submitted an action plan detailing how they would achieve improvements. The service was expected to be compliant by 21 September 2015.

During the inspection on 3 and 4 February 2016 we found improvements had been made.

Some relatives told us they thought communication from the organisation could improve. They felt communication around the care of their family member was good.

Comprehensive risk assessment and management plans were in place. Staff explained they were involved in completing care records and their experience was being used to benefit people.

Accidents and incidents were recorded and analysed to identify trends and triggers. Support strategies were reviewed in response to findings from the analysis.

Medicines were managed safely. Some people received their medicines in liquid form as staff had identified they did not like the texture of certain tablets. Staff understood why people had been prescribed certain medicines.

Staff said they felt well supported by the registered manager and had attended supervisions on a regular basis. Appraisals were being completed and staff had been asked to assess their own performance over the past year.

Training had been delivered. Staff told us it was more in-depth and informative than previous training they had received. Staff were knowledgeable about positive behaviour support and had all attended relevant training to enable them to provide appropriate support and understanding to people whose behaviour may, at times, challenge.

Mental capacity and consent was understood. People and their relatives were involved in decision making and assistive technology was being used to support people to communicate. The registered manager had plans to increase the use of technology in the future.

There was a lot of laughter in the service and we observed warm and compassionate relationships between people and staff. Staff were respectful of people and asked permission before sitting with people or providing care and support.

Relatives told us they were more involved with the staff in thinking about activities and goals for their family members. Staff were enthusiastic and motivated to support people to have a presence in the local community. Goal plans were in place to support people to do this.

Staff said they thought the service was well-led. They commented that changes had been made for the better. One staf

People present during our visit were not able to communicate verbally and so we observed people in their recreation spaces, reviewed records and spoke to staff.

We viewed all of the private living spaces and the communal areas in the home and found a safe, inviting and friendly atmosphere throughout. There was a large, bright and airy communal lounge that could be used at all times of the day. There was also a large quiet space which people could use whenever they wished and the kitchen had a dining area.

We spoke to five members of staff who all spoke positively and without prompt regarding local management, training and working conditions.

We reviewed the comments and complaints file kept in the office. There had been no complaints in the two years preceding our visit.

We haven't been able to speak to people using the service because they had complex needs, which meant they were not able to tell us their experiences. However, we gathered some evidence of people's experiences of the service by observing care practice.

We undertook a short observational framework for inspection (SOFI) exercise to observe the interactions between them and the staff. SOFI is designed to be used when inspecting services for people who have some difficulty in communicating their opinions on the services they receive.

During the SOFI, we observed people being offered choices; for example, people were offered a choice of drinks and a choice of meal. Staff were seen to be attentive and gave people the information about the drink and meal options in a way that was appropriate to their needs. One person was supported by staff to put their shoes and coat on prior to them going out to a local pub for lunch. In addition, we observed staff trying to engage people in discussions about the activities they had taken part in that day. We observed staff discreetly speaking to one person when they were showing signs of becoming anxious.

Due to the complex needs and different communication styles of people who were using the service, the information we received verbally from people was limited.

Park Lodge provides care and support for up to eight people who have autistic spectrum conditions. At the time of the inspection there were six people living at Park Lodge all of whom had been placed there from out of area due to the specialist care that could be provided.

Due to the complex needs of people living at the home not everyone was able to share their views about the service with us but we did spend time with people in communal areas observing the care and support they received.

An established registered manager was in post and had been registered since October 2010. They had recently returned to work following a period of absence during which time an acting manager was overseeing the day to day running of the service. 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.

We carried out a scheduled inspection of this service on 10, 16 and 17 September 2014. Breaches of legal requirements were found.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. Care and treatment was not always planned and delivered in a way that was intended to ensure peoples safety and welfare. Staff had not received all the training they needed or professional development, supervision and appraisal.

The provider submitted a report detailing the actions they planned to take to meet the legal requirements.

We completed a fully comprehensive inspection of the service on the 29 June 2015. This day was unannounced which meant the provider did not know we would be visiting. A second day of inspection took place on 30 June 2015 and was announced.

We found improvements in relation to staff receiving training in autism, appraisals had been completed and relative surveys had been completed.

We found risk assessments had been completed but they did not always contain sufficient control measures to keep people and their staff safe. Some people diagnosed with epilepsy enjoyed going swimming but we saw no evidence of risk assessments in relation to this activity.

People had a care record titled ‘My Plan’ which included area’s of the person’s life where they needed care and support. We found that this did not always detail specific strategies for staff to follow in relation to specialised equipment and it had not been kept up to date with people’s communication needs or medicine administration.

The review and evaluation of documents had been completed on a monthly basis but the comments stated ‘no change’ or ‘reviewed’ therefore it was unclear whether the plan was still effective and appropriate.

Staff were supporting some people to take medicine in food as it had been recognised that they could not tolerate the taste or texture of specific medicines. Best practice would be for a doctor to authorise this as a best interest decision and for the process to be recorded in a care plan and risk assessment. We saw no evidence that this had been completed.

Health and safety checks were being completed by maintenance staff but they were out of date due to the person’s absence from work. The registered manager thought they were being completed by another person from the maintenance team but had not checked so the fire log book and scheduled maintenance checklists were not up to date.

Deprivation of Liberty Safeguards (DoLS) had been authorised although some had now expired and we saw no evidence that further applications had been made although the registered manager confirmed they had done so. Care staff knew DoLS were in place but weren’t able to explain what it meant for people’s care.

Some best interest decisions were in place but they had not been reviewed. Although staff were seen to act in people’s best interest the process for decision making had not always been followed in line with MCA code of practice.

Staff training was not up to date in relation to the provider’s refresher time periods. This related to mental capacity and deprivation of liberty safeguards. Non-abusive psychological and physical intervention (NAPPI) training was not current. We also saw that staff training in relation to medicine administration was out of date and we saw no evidence of competency based assessments. Makaton training, which some of the people use to communicate, had been mentioned in the provider action plan following the September 2014 inspection but not all staff had received this training.

The provider was not meeting its own aim in relation to supervision as they were not on track to complete six supervisions a year with each staff member. This meant there was no formal process, by way of training and supervision to assess staff competency in relation to meeting the specific needs of the people they supported.

People’s ‘my plan’ was not always kept up to date with changes in people’s care needs. One person’s care manager explained that the person was able to understand verbal communication and they confirmed that staff understood them even though their ‘my plan’ stated their preferred communication method was to use makaton and PECS.

Staff interaction with people was, at times, limited to functional task driven communication. Staff were observed to be having conversations amongst themselves over lunch rather than engaging with the people they were supporting. We also observed staff speaking about people rather than to them.

We saw audit tools were in place but these had not been completed. The registered manager told us they had not had a chance to complete any audits yet. This meant there was no effective and robust system in place to monitor and assess the quality of the service provision.

Safeguarding policies and procedures were in place and staff understood what their responsibility was in relation to reporting concerns. Accidents and incidents were recorded manually and electronically and one person had a behaviour chart which was being used to analyse the impact of a medicine change.

A range of health and safety risk assessments were in place and a fire risk assessment and emergency evacuation plan had recently been updated. Each person had a personal emergency evacuation plan and people were involved in fire drills so they knew what the fire alarm meant.

There were enough staff to meet people’s needs and the registered manager said staffing levels were calculated based on people’s activities. No dependency tool was used and they said there were no contracts in place specifying commissioned hours. One care manager told us one person was funded for five hours of two to one support each day if needed for community activities.

Recruitment was effective with the appropriate level of pre-employment checks in place. The registered manager explained they included people in the recruitment process as prospective staff would come to the service for a meet and greet opportunity and to go out on an activity with people so staff could assess their level of engagement and interaction. This information was then used in the staff selection process.

The staff team were long standing and had a good understanding of behaviour which may challenge. Documentation was in place which described potential triggers for behaviour; a description of the behaviour and how the staff should respond.

Medicines were stored safely and records were completed with double signatures and a senior administration check was completed for each administration. Records were kept when medicine was taken away from the service when people went home for a day or an overnight stay.

Freshly prepared food was on the menu every day and people were supported to have a well-balanced diet.

Health records were in place and seizure monitoring was used to inform meetings with one person’s neurologist.

Activities plans were in place and staff completed a daily record of activities people had engaged in, although we did not see evidence of any analysis of people’s enjoyment of these activities.

A complaints policy and procedure was in place. We could not see an audit trail of how one recent complaint had been managed in relation to the acknowledgement of how the complaint would be addressed and who by.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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 registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.