The inspection took place on 21 September 2016 and was unannounced. This was a comprehensive inspection.

Seeability - Derby Lodge is a care home providing support to up to eight people with a visual impairment who may also have a learning disability, physical disability, acquired brain injuries or degenerative conditions.

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.

Staff understood their role in safeguarding people. They had received training and demonstrated a good understanding of how they would protect people from abuse of potential harm. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence.

We found that policies and procedures were in place to keep people safe in the event of emergencies. People had individual plans to keep them safe in the event of an emergency and there were contingency plans in place.

People received their medicines safely. Medicines were stored safely and systems were in place to ensure medicine stock could be monitored and audited.

Staff training was tailored to the individual needs of people who lived at the home. Staff told us that they had good access to training and people and relatives told us that staff were effective in their roles.

Staff provided care in line with the Mental Capacity Act (2005) (MCA). Records demonstrated that people’s rights were protected as staff acted in accordance with the MCA when being supported to make specific decisions. Where people had restrictions placed upon them, these were applied for appropriately.

Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve positive outcomes for people.

People were supported to eat in line with their preferences and dietary requirements. We did note that people were not involved in writing menus but the registered manager was already in the process of making changes at the time of our inspection.

Staff treated people with dignity and respect. All caring interactions that we observed were positive and staff provided support to people in a way that promoted their dignity.

Information in care plans reflected the needs and personalities of people that we spoke to. People had choice about activities they wished to do and staff encouraged people to pursue new interests. People were supported to access advocacy services where appropriate and staff understood the role advocates played in promoting people’s rights.

Systems were in place to measure the quality of the care that people received. The registered manager had identified improvements and was in the process of making these at the time of our inspection. Improvements had been made to the way in which people provided feedback to improve the quality of their care.

Staff told us that they were well supported by management and were encouraged to make suggestions or raise concerns. People and relatives told us that they had a positive relationship with the registered manager.

On the day of the visit all the people using the service were present. Owing to their complex needs affecting communication, we were only able to speak with one person in a meaningful way. That person said, “Some of the staff are nice. They look after me alright”. We observed interactions between staff and people to be friendly, skilled and respectful.

Records showed a multi-disciplinary approach to meeting needs, involving others acting on people’s behalf. Consent to care and treatment had been obtained from those who knew and understood them well. The approach to care planning was person-centred, ensuring consistency and safe practice. Guidelines helped staff’s understanding of people’s individual communication methods. This enabled people to benefit from a service that respected their wishes and rights. The three relatives we spoke with were all pleased with the care provided by Derby Lodge. " I can't fault it" and " Fantastic" were some of their comments. However they had all experienced shortfalls in communication and felt this was an area for improvement.

The design and layout of the premises, maintenance and risk management activities ensured the safety and security of the environment. Procedures were in place to minimise risk of peoples’ care needs not being met in the event of emergencies, for example, a power failure or fire. A system was in place for responding to complaints from people and those acting on their behalf.

The residents we spoke with told us they liked living at the home and felt safe and well cared for. They told us that staff were polite and treated them with respect.

Relatives provided positive feedback about the care and support their family members received at the home. One relative told us “I cannot speak highly enough of the service and care [resident] receives from all the staff at Derby Lodge. Since being at Derby Lodge her world has opened up. She has been encouraged to experience so much more. All [resident’s] family are extremely happy with her care and progress.” Another relative said, “My family and I are very happy with [resident’s] care. The staff are very sensitive to her needs.”

The healthcare professional we spoke with told us that the home promoted people’s independence and developed their daily living skills. They said that staff followed guidelines relating to the delivery of people’s care appropriately.