This inspection took place on 20 September and 21 September 2017 and was unannounced. We last inspected the service in August 2016 when we rated the service as requires improvement. At that time we found the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these related to safeguarding and governance. This inspection was to check improvements had been made following the last inspection and to review the ratings. At this inspection we found improvements had been made and the two breaches previously identified had been satisfactorily addressed.

Pearce Lodge is part of the Together Trust which is a registered charity. The home provides support for up to five people who have a physical and/or a learning disability. All bedrooms are located on the ground floor with the first floor providing staff sleeping facilities and office space. The property is situated in a quiet residential area off Hazel Grove, Stockport and is close to local amenities. On the day of this inspection four people were living at the service.

Since the last inspection a manager had been appointed and had successfully registered 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.

At our previous inspection we issued a requirement notice because the service had not applied for Deprivation of Liberty Safeguards (DoLS) authorisations; therefore the Mental Capacity Act 2005 (MCA) guidelines were not being fully followed. At this inspection the registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

At our previous inspection we issued a requirement notice because the service did not have effective governance and checks in place for staff supervisions and managing (DoLs.) At this inspection the registered manager and registered provider used a variety of methods to assess and monitor the ongoing quality of the service. The registered manager had developed a methodical auditing system that covered all aspects of the service. They had improved the way the service was reviewed including how they audited staff supervision. Since the last inspection staff had received on-going supervision and an annual appraisal. This meant that staff were being appropriately guided and supported to fulfil their job role effectively.

Procedures were in place to minimise the risk of harm to people using the service. Support workers were trained in how to report any issues of concern regarding people’s safety and welfare. We found that staff had a good knowledge of how to keep people safe from harm. People living at Pearce Lodge, their relatives and multidisciplinary staff that visited the home were all positive about how the home was managed in regard to ensuring people were supported to stay safe. Relatives told us, “Yes I believe (my relative) is safe, staff seem trained enough with hoist etc.” and “Yes we are very confident (our relative) is safe here.” One person who lives at the service told us, “Yes I feel safe here, I feel ok.”

People’s health needs were monitored and individual health action plans were in place. Support plans were individualised to include individual preferences, likes and dislikes and contained detailed information about how each person would like to be supported. People were offered a variety of different activities to be involved in and were supported to go out in to the local community on a daily basis.

We observed staff providing support to people throughout our inspect

This unannounced inspection was carried out on 12 August 2016. The service was last inspected in September 2014 and the service was found to be compliant in all the regulations in force at that time.

Pearce Lodge is part of the Together Trust which is a registered charity. The home provides support for up to five people who have a physical and/or a learning disability. All bedrooms are located on the ground floor with the first floor providing staff sleeping facilities and office space. The property is situated in a quiet residential area off Hazel Grove, Stockport and is close to local amenities. On the day of this inspection four people were using the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who was registered with the Care Quality Commission (CQC). 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.

One person using the service required significant levels of one to one supervision and the registered manager had not applied for a Deprivation of Liberty Safeguards (DoLS) authorisation, therefore the Mental Capacity Act 2005 (MCA) guidelines were not being fully followed. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found the registered provider had audits in place to check that the systems at the home were being followed and people were receiving appropriate care and support. However, we found that the systems failed to identify that staff did not receive regular supervision and appraisal and that one person using the service had not been referred for a DoLS asessment. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the service deemed essential. This included the Positive Range of Options to Avoid Crisis and use Therapy – Strategies for Crisis Intervention and prevention UK (PROACT-SCIPr-UK) programme. However, staff did not receive regular supervision and appraisal. We made a recommendation about supervision in the report.

We found there were sufficient numbers of staff on duty to meet the needs of people living at the home. However, the service currently had four full-time vacancies for care staff and were reliant on agency staff to ensure that sufficient staff were on duty.

We found that staff had a good knowledge of how to keep people safe from harm and we found that the recording and administration of medicines was being managed appropriately in the service. Staff had been employed following appropriate recruitment and selection processes.

Assessments of risk had been completed for each person and plans had been put in place to minimise risk. The service was clean, tidy and free from odour and effective cleaning schedules were in place.

People's nutritional needs were met. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day. One person told us they were well cared for and we found people were supported to maintain good health and had access to services from healthcare professionals.

Staff were knowledgeable about the people they cared for and they interacted positively with people living in the home. People were supported to make choices and decisions regarding their care.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detail

During our visit, we spoke with one of the four people who used the service. They shared some of their experiences at the home. Due to medical conditions, some others were not able to describe their experiences in detail. Some people were on holiday at the time of our visit. We spoke with two members of care staff and the manager.

One inspector carried out the inspection. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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?

We saw people were being cared for in an environment which was clean and safe. Processes for the prevention and control of infection were in place. For health, safety and security reasons, visitors were asked to sign on entering and leaving the home. There were enough staff on duty to meet the needs of the people living at the home at the time of our visit.

The people we spoke with who used the service told us they felt safe. One person said “I feel safe. I’ve never seen anything which made me feel anxious.”

Discussion with staff and examination of records confirmed a programme of training was in place for all members of staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure people in care homes and hospitals are looked after in a way which does not restrict their freedom inappropriately. Staff had all received training about the Mental Capacity Act and Deprivation of Liberty Safeguards so they understood when an application should be made and how to submit one.

Is the service effective?

People’s health, social and care needs were assessed with them and they were involved in writing and reviewing their care plans. Specialist needs had been identified in care plans, for example, ways to communicate. Care plans were reviewed every three months and when people's needs changed.

The people we spoke with told us they were happy with the support they received and said their needs were met. They spoke positively about the staff who supported them. From what we saw and from speaking with staff it was clear they had a good understanding of the care and support needs of the people who used the service.

We saw a written statement of purpose was available for people, which also comprised a service user guide and contained comprehensive information about the care and services provided at the home. The provider may wish to consider providing this document in an easy read or pictorial format to help make it easy to understand for people who used the service.

Is the service caring?

People we spoke with told us they liked living at the home. Comments included “It’s nice, I like living here”.

We saw the staff showed patience and gave encouragement when they were supporting people. This meant people were able to do things at their own pace and were not rushed.

Is the service responsive?

The records we saw confirmed people’s preferences and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities which were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

We saw documentary evidence which showed the service worked well with other agencies and services to make sure people received their care in a joined up way.

From speaking with staff we found they had a good understanding of the home’s values. They told us about their roles and responsibilities and they were clear about these. We saw quality assurance processes were in place to make sure the provider monitored the care provided and made improvements where necessary. For example, people who used the service had the opportunity to express their opinions through individual service user meetings.

During our inspection we spoke to one person living in Pearce Lodge about their care. They told us they were always informed and consulted regarding their care. They said “I’m very happy” and told us they liked living in the home and said “I like being able to make my own decisions”.

The person told us what they liked to do during the day and what their plans were for their future and told us staff supported their decisions.

The person also told us they felt safe and when asked about making a complaint or comment regarding their care and treatment they told they felt comfortable doing this. They said “staff always sort out any problems for me, I know it will get sorted out”.

We spoke to a person visiting their relative and they told us they were always consulted regarding their relatives care and said the staff were “very caring”. They told us they were happy with their relative making their own decisions now. They said “I feel comfortable making comments regarding their care, staff are very helpful”.

Pearce Lodge is a residential care home for up to five young adults.

We were able to talk with one of the residential social workers and one of the four people who were living at Peace Lodge at the time of our visit.

We briefly spoke with two other residential social workers before they went out to pick up the other people who lived at Pearce Lodge from their day services.

We also spoke with two family members, the registered manager, Stockport Metropolitan Borough Council quality and monitoring team and the district nursing service by telephone.

Everyone said that they were happy with the care provided and had no complaints.

The comments we received from the family members were; “The transition from the previous placement to Pearce Lodge was very good”; “We were involved in the admission process and the support plan.” Both family members said that they felt the person’s privacy and dignity was respected.

The one person we spoke with who lived at Pearce Lodge told us that she was happy with her room and the staff.

The district nursing service said that the staff were extremely helpful and took on board what they were told.

Everyone had a support plan which provided staff and other health care professionals with information so that they could give the care the person needed. This included health and personal care together with activity plans to meet social care needs.

We were told that staff had training and support to help them in their day to day role as residential social workers.

A representative from the organisations head office in Cheadle visited the home regularly to make sure that the people who lived at Pearce Lodge were receiving appropriate care and were kept safe.

During our inspection we spoke with one person who used the service and we spoke with two family members by telephone. All of them told us that they were happy with the care and support provided. One person told us “I can tell people if I am not happy and I have no complaints“. “We are kept informed of any changes and have a good relationship with Pearce Lodge”. Another family member we spoke with told us “Any problems which have occurred have always been ironed out”.

We spoke with the manager and two of the four residential social workers who were on duty at the time of the inspection everyone said that they liked working at Pearce Lodge. They told us that they had regular training to keep them up to date.

We looked at the recruitment files for the last two people who were employed. We found that they contained application forms, references and police checks to ensure as far as possible only suitable people were employed.

The two monthly care records we looked at for one of the three people who were living at Pearce Lodge contained records which assisted the care workers to meet the person’s needs. The training staff received also ensured that the people who lived at Pearce Lodge were provided with safe and appropriate care.

During our visits we were able to observe that people were treated with respect.

We spoke with an officer of the Stockport Social Services Quality Assurance team who told us that they had received no concerns regarding this service.