Richmond Lodge is a residential home that provides care for up to five people who are living with a learning disability. At the time of our inspection there were five people living in the home. At the last inspection, in June 2015, the service was rated Good. At this inspection we found that the service remained Good.

People were safe and continued to receive safe care. The risks to people’s safety were regularly reviewed and processes were in place to protect people from avoidable harm. Sufficient numbers of staff were in place to keep people safe and safe recruitment procedures ensured people were protected from the risks of unsuitable staff. People’s medicines were managed safely and people received their prescribed medicines when needed.

People’s right to make their own decisions about their care and support needs, where able, was respected by staff. Where decisions were made for people, they were made in line with the principles of the Mental Capacity Act 2005 (MCA). People were encouraged to eat and drink healthily. Staff were well trained and felt supported to carry out their role effectively. People’s day to day health needs were monitored and referrals to external professionals were made where needed and in a timely manner.

People were treated with kindness, dignity and respect by the staff. People had developed positive relationships with staff which contributed to a positive atmosphere within the home. People’s support records were person centred and focused on what was important to them. Support was provided for people in line with their personal preferences. People were provided with an ‘easy read’ complaints process that supported people living with a learning disability. Effective systems were in place to manage any complaints that the provider may receive.

The service was well-led. The current registered manager split their time between two services, but this did not impact on the quality of the service provided. People, relatives, staff and professionals commented positively about the registered manager. There was a calm, open and friendly atmosphere at the home which resulted in a high quality of service for people. Effective auditing processes were in place, with regular input from representatives of the provider.

We carried out an unannounced inspection of the service on 12 June 2015. Richmond Lodge is registered to accommodate up to five people and specialises in providing care and support for people who live with a learning disability.

On the day of our inspection there was not a registered manager in place, however prior to the inspection taking place an application had been received from the current manager.

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.

Staff could identify the different types of abuse and knew the procedure for reporting concerns. Staff had attended safeguarding of vulnerable adults training and could explain how they incorporated that training into their work. People had the risks and implications of decisions they may take explained to them. Where appropriate people’s relatives and other healthcare professionals were involved in discussions about the care and support provided.

Regular assessments of the impact decisions could have on people’s freedom were carried out by the manager, and assessments of people’s ability to access the local community alone had also been conducted. Accidents and incidents were investigated and used to reduce the risk to people’s safety. Regular assessments of the environment people lived in and the equipment used to support them was carried out and there were personal emergency evacuation plans (PEEPs) in place for each person who used the service.

People were supported by an appropriate number of staff because the manager regularly assessed people’s needs to ensure there were enough staff to reduce the risk to people’s safety. Appropriate checks of staff suitability to work at the service had been conducted prior to them commencing their role. People were supported by staff who understood the risks associated with medicines. People’s medicines were stored, handled and administered safely.

People were supported by staff who completed an induction prior to commencing their role and had the skills needed to support them effectively. Regular reviews of the quality of staff member’s’ work were conducted and staff felt supported in carrying out their role effectively.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager was aware of the principles of DoLS and how these were implemented to maintain people’s safety.

People told us they liked the food and drink at the home and records showed people were supported to follow a healthy and balanced diet. People were provided with the information they needed to maintain a healthy weight. People’s day to day health needs were met by the staff and external professionals. Referrals to relevant health services were made where needed.

People were supported by staff who understood their needs and were kind and caring in their approach. Staff used a variety of techniques to communicate with people in a way that showed their views mattered to them and they were interested in what they were saying. Staff responded quickly to people who had become distressed.

People were provided with the information they needed that enabled them to contribute to decisions about their support. People were provided with information about how they could access independent advocates to support them with decisions about their care. People were supported to carry out their lives as independently as they wanted to and people’s ability to be independent was continually reviewed.

People were treated with dignity and respect and staff spoke respectfully to each other about the people they supported. People’s rights were explained to them and how they could raise concerns if their rights were not respected.

People were involved with planning the support they wanted to receive from staff and people’s wishes were continually reviewed to ensure they met their current needs.

People’s support plan records were written in a way that focussed on their wishes and preferences. Staff understood people’s personal histories and preferences and used that information when supporting people. People were able to do the things and follow the hobbies and interests that were important to them. They were also encouraged to contribute to the upkeep of the service by carrying out domestic activities.

People were provided with the information they needed if they wished to make a complaint.

There was a visible management presence at the service. The manager led the service well and understood their responsibilities. Staff understood their roles, were accountable for them and understood how they could contribute to reducing the risks to people’s health and safety. People were encouraged to provide feedback and this information was used to improve the service. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided.

A single inspector carried out this inspection. Five people were using the service at the time of the inspection, however due to their complex needs and limited verbal communication it was only possible to speak with two people. We observed the care being provided and people’s reactions to the staff and the care they received. We looked at two people’s care records. We talked with two staff and the manager and examined training records and documentation of quality audits.

This helped us to answer the questions below.

Is the service safe?

The environment was clean and hygienic and appropriate steps were in place to reduce the risk of cross infection. Environmental risk assessments had been completed and actions taken to reduce the risk where possible. Regular checks were made of key factors such as legionella prevention.

The Home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards to protect the rights of people using the service. It was clear from talking with staff that they had an in-depth understanding of mental capacity issues and capacity assessments for the people who used the service were sometimes complex. Steps were taken to maximise people’s participation in decision making and a multi-disciplinary approach was taken to ensure best interest decisions were made.

Individual risk assessments had been carried out and care was planned in response to these. This meant care and support was planned in a way that was intended to ensure people’s safety and welfare.

Is the service effective?

Full assessments of each person’s care and support needs were undertaken. Care plans were reviewed regularly and updated as necessary to ensure the support provided was appropriate to each person’s individual needs.

We saw there was involvement from a range of professionals in each person’s care, ensuring care was effective and specialist input obtained where necessary.

There was a structured approach to training and appraisal of staff to ensure staff were supported to function effectively in their job roles.

Is the service caring?

The staff knew the people who used the service well and had positive relationships with them. They were attentive to people’s needs and gave them encouragement and support. Staff were able to recognise non verbal cues to indicate people’s wishes.

People’s preferences, interests, and diverse needs were recorded and care and support was provided in accordance with their wishes.

People were encouraged to participate in activities they enjoyed thus promoting their well-being. People were able to choose whether or not to participate in activities and if a person indicated they would prefer to do something else this was listened to and acted on.

Is the service responsive?

We saw the service responded to the needs of individual people and tailored the service to take account of their changing needs and skills.

A number of methods were used to obtain feedback from people who used the service and we saw examples of improvements which had been implemented as a result of this feedback.

People told us they had not had any need to complain but they knew how to make a complaint if necessary and who to contact if they were not satisfied with the response. However, they told us they were confident their concerns would be dealt with by the staff and manager.

Is the service well led?

Policies and guidelines were in place to ensure safe services were delivered. These included policies covering health and safety, the Mental Capacity Act, whistle blowing and Adult Safeguarding.

Quality review systems were in place to assess the quality of the service and identify the need for improvement. Staff told us the results of audits and reviews were shared with them and discussions took place about actions being taken to improve. This meant that information gained from audits was used to improve the service.

There was a planned approach to education and training and staff had received the training they required to deliver safe and effective care. Staff received regular supervision and appraisal. They told us they felt well supported by the manager and encouraged to undertake further development.

Due to the complex needs of the people who used the service we used a number of different methods to help us understand their experiences when we undertook our visit. Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with one person who used the service and asked them for their views. We also spoke with two care workers and the registered manager. We also looked at some of the records held in the service including the care files for three people.

We found people gave consent to their care and received care and support that met their needs. A person who used the service told us told us they were asked for their consent. The person also told us, “I do the things I want to.”

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A person told us, “They have never run out of my medication.”

We found there were sufficient staff to meet people’s needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, “There are always enough staff around.”

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We spoke with one person who used the service and this person told us that they were able to express their views and were involved in making decisions about their care and treatment.

The care records we looked at showed that care was centred on the person as an individual and considered all aspects of their individual circumstances, and their immediate and longer-term needs, reflecting their preferences and diversity.

We saw examples of positive risk taking to support people to be as independent as possible.

We observed how staff were actively working towards maximising people’s choice, control and inclusion in order to reduce the potential for abuse because they were respecting people’s wishes, using appropriate forms of communication, maintaining privacy and dignity and were aware of their responsibilities under the Mental Capacity Act 2005 and the associated Deprivation of Liberty safeguards.

The people who lived at Richmond Lodge when we visited on 18 and 19 August 2011 were either unable to, or chose not to tell us about their experiences of life at the home. We therefore spent time observing their experience of care and evaluating the quality of support they received. We also spoke with other groups who have regular contact with the service to ask for their comments and observations. We checked some of the provider’s records, and looked at records of two people who were living at the service when we visited and one person who had recently left the service.