The Lodge is registered to provide personal care and accommodation for up to 12 people who may have a learning disability, autistic spectrum disorder, mental health diagnoses accompanied by physical health needs. The service is made up of a large house offering accommodation for up to 10 people and two semi-independent flats in the grounds opposite the house for up to two people.

The home had a registered 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 a 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 previous inspection of this service on 6 August 2014 where we found it was meeting the requirements in the areas we looked at.

This inspection took place on 12 December 2016 and was unannounced. At the time of our inspection there were 11 people being supported at The Lodge. People had a range of needs, with some people having highly complex needs. Some people were living with learning disabilities, autistic spectrum disorders, mental health diagnoses and physical health conditions.

People and their relatives spoke highly of the staff at the service and the quality of care provided. Comments from people included “It’s very nice” and “I like all the staff. It’s good here, I like it.” Comments from a relative included “They meet (my relative)’s needs 1001%. It’s a beacon of light in terms of social care” and “It is exemplary by every single measurable parameter in the extreme.”

Staff treated people with kindness and respect. People enjoyed pleasant interactions with staff which demonstrated people felt comfortable in their presence. Staff knew people’s preferences and communicated with people using their preferred methods of communication. For example, staff used pictures in order to enable one person to better express their wishes and enable them to make choices.

The provider and the registered manager placed high importance on people receiving caring support from kind and caring staff. Staff were reminded of the importance and the value of being caring, supportive and kind in the form of various 'staff appreciation' awards.

Staff knew people well and engaged people in conversations about their interests and preferences. Staff skilfully distracted people when they became upset or anxious by talking to them about their favourite topics and encouraging them to focus on positive thinking. Staff found inventive and personalised ways to meet people’s needs.

People were protected from risks relating to their health, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to minimise these risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence.

Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

Staff knew how to recognise possible signs of abuse which helped protect people. Staff knew the correct procedures to follow should they need to report concerns. Safeguarding information and relevant contact numbers were accessible to staff and people who lived in the service. People and staff told us they felt comfortable raising concerns.

Recruitment procedures were in place to ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were vulnerable.

Staffing numbers at the service were sufficient to meet people’s complex care needs. Care was provided by skilled staff who had been trained in the competencies they required in order to meet people’s needs. Staff received ongoing tra

A single inspector carried out this 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 caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People living in the home were treated with dignity and respect by the staff that supported them. We received a number of positive comments, a care worker said "this is their home, we are here for them" and a person living in the home told us "I’m happy here". One visitor told us the staff were very supportive towards caring for their relative.

We saw that care workers were patient and gave encouragement when supporting people. We heard one staff saying "you can have more sugar but it might be healthier for you if you took a bit less, but it’s up to you."

Staff we spoke with were able to tell us what action they would take if they saw abuse taking place and where to find the correct contact information and procedures. One staff told us "we must always give the people here our best."

Staff carried out a range of health and safety checks to ensure people were kept safe. Records showed that fire drills were carried out and people had their personal emergency evacuation plans.

Where there were risks associated with people's health, these were assessed and appropriate support plans put in place. For example, we saw that people using the kitchen had been assessed as to whether people were at risk of harm and the actions to be taken to keep risk to a minimum.

Is the service effective?

People living in the home and their representatives were involved in the care planning and review process. This helped ensure that support was person centred and reflected the needs of each individual. One visitor had just attended a meeting with staff and a social worker to discuss an aspect of their relative's health, told us “the staff keep me informed of any changes”.

Staff told us that communication was good in the home, so that staff would be aware of any particular issues relating to individuals. This information was discussed at handovers.

Staff confirmed they had regular supervision and the records showed that the supervisor held meaningful discussions to ensure staff understood their role and responsibilities.

Is the service caring?

People that we spoke with during our inspection gave positive feedback about the home and the staff. One person told us “I want to be independent and the staff help me to do that”. Another person told us “staff are good”.

We observed staff knocking on people's doors before entering and this practice of respecting a person’s privacy was confirmed by a person living in the home and their relative who said “yes, staff always knock”.

We made observations of people receiving the support they needed, in line with their care plan. For example, we saw one person being supported with their breakfast meal and holding a discussion with staff about their dietary needs. Another person who had injured his finger was being dealt with by staff in a caring, supportive way.

Is the service responsive?

We saw that the service worked well with other healthcare professionals. For example, one person had recently had a visit from an occupational therapist and a social worker visited the home on the day of our inspection. We saw from the care records that a GP and a dentist were contacted because staff had concerns about a person's health.

The ways people expressed their likes and dislikes had been recorded so that staff could understand people's wishes. Relatives told us that staff contacted them on a regular basis to discuss any changes to care and support.

Relatives were involved in contributing towards people's annual care review and their views were taken into consideration. One relative said "I feel very involved."

People could make choices. We regularly heard staff asking people to make a choice. One staff asked a person "I know you want to smoke your cigarette first so if we can’t do it before, we can we do it afterwards?" The staff then waited until they got a response from the person who wanted a cigarette.

We also saw minutes of health and safety committee meetings where any accidents and incidents were discussed. This provided opportunity to identify any learning points and put any required action plans in to place. On the day of inspection we identified a potential hazard and the registered manager responded by investigating the issue.

Is the service well led?

We saw that there were systems in place to monitor the quality and safety of the service. This included gathering the views of people living in the home and their relatives. People had opportunity to attend a monthly home meeting called ‘your voice’ and the minutes showed that all the people at the meetings were asked for their view and their responses recorded. One person told us "at the meeting I told them what I want but another person disagreed".

The home received regular visits from the representatives of the registered provider. One of the external manager's reports which we viewed provided an overview of their visit, an evaluation and recommendations. On the day of our inspection an internal compliance and quality manager arrived unannounced to the home to monitor the service. We saw monitoring visit reports assessing the premises, service records and care records.

Any accidents and incidents that occurred in the home were recorded and analysed on a monthly basis. We saw evidence of where action was taken to reduce the risk.

The registered manager explained how the service worked hard on selecting staff which were suitable for meeting the needs of people using the service. The recruitment records showed the detailed interview questions used to select the right staff and other records showed several people had left.

During our visit we observed people who used the service appeared very comfortable around the home and were very welcoming towards us. We saw there were interactions between people and staff, often sharing banter and jokes. We observed that staff were skilled in recognising and responding to people's needs whilst maintaining peoples’ dignity.

The atmosphere in the home was relaxed and inclusive; we saw that people were making choices about their daily activity. Staff explained and discussed with people their choices and any actions needed to support activity, for example, wearing suitable clothing when going out.

We read that each person had a plan which described the support they required; in this we read people's choices were recorded and implemented. We saw there were risk assessments in place for some people which promoted well-being and prevented crisis. Staff we spoke with were positive about working in the home and the contribution they made to people having fulfilling lives.

The environment was comfortably furnished and the communal areas were well maintained.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. The acting manager who was present during our visit was Rachel Wharton-Stone.

This visit was carried out to follow up a compliance action made at the last inspection. We also looked at consent to care and treatment, care and welfare, safeguarding people who use services, management of medicines and complaints.

During this visit we followed up a compliance action made at the last inspection, which took place on 28 November 2011.The compliance action had been made against Outcome 10 Safety and Suitability of Premises. It had been noted that people were not provided with a homely environment to live in. We also followed up two improvement actions; one against Outcome 4 Care and welfare of people who use services and one against Outcome 7 Safeguarding people who use services from abuse.

People living in the home were unable to communicate verbally. We spent time observing staff interacting and communicating with people. People responded well to them. Staff demonstrated a good knowledge and understanding of people’s needs.

We observed people moving around the home and preparing their lunch. The atmosphere was relaxed and people were given choices of what they wanted to eat and drink.

During the inspection we spoke to six of the nine people who lived at the home. One person told us, they had lived in the home for quite a while and felt it was time to move on. They told us “I have raised this with the manager and they are helping me.” Another person told us, “I am really happy living here, I have a lovely bedroom.”

One person commented on the staff who worked in the home, “They help me get through problems.” Another person said “I get asked about being involved in my support plan.” One person told us they had not received a copy of their support plan.

People told us that they were supported to choose how to spend their time. We were told by one of the people using the service “It’s quite nice here, relaxing, and peaceful and quiet.”

Another person told us “I am going to college one of the courses will help me with my cooking”.

People told us that they felt staff always asked and informed them before they did anything. One person told us “they always knock on my door before they come in”. Another person told us “I know about care plans, I have signed mine to say I agree with it”.

We were told by people who used the service how they received support to take medication. One person told us “The staff help me take my tablets.” Another person said “When I need to take my tablets the staff come to my flat to give them to me”.

We found the home was well decorated, clean and comfortable. People’s bedrooms were personalised to their own tastes and preferences. We found furniture and fittings to be of a good standard.

People told us that they had to move to alternative premises when the home was refurbished. One person told us “I am happy the building work is finished and I am back in my home.”

During our visit we observed staff interactions with people. Staff engaged with people well and supported them sensitively. We observed staff provided reassurance and redirection with consideration and respect for people’s individual personalities.

We added Outcome 10 Complaints because during the inspection people told us they had made an informal verbal complaint. They told us they were unclear of the outcome and had not received a copy of the complaint procedure.

Other people told us that if they were unhappy they would talk to staff. People told us they had chosen keyworkers who they got on with and could discuss any concerns with them. One person told us “If I have a problem I go straight to the staff or the deputy manager if they are there.”

We spoke with all of the people who lived in the home and they told us that staff provided the care and support they needed. They said staff were nice to them and “easy to talk to”. We observed how staff interacted with people who lived in the home and all the interactions we saw were kind and respectful. One person we spoke with said “I’m alright as it’s very nice here. The staff are nice and friendly, that’s all the staff”.

There were regular meetings in the home where people expressed their views and asked questions. A meeting was held on the day we visited where people discussed the planned refurbishment of the home. One person said “we do have resident’s meetings and you can talk about anything, what you would like to do, where to go on holiday, what your plans are for Christmas. We all sit down and chat about it”.

A great deal of importance had been placed on people being able to participate in all aspects of home life to help them develop independent living skills. People helped with cleaning, were involved in cooking meals and recycling. One person said “I’m being more independent now. I go to the shop on my own, do my own cooking, go to college and do some shopping. I do interviews for new staff working here and do health and safety so talk about things which need replacing”.

Some people we spoke with wanted to move into their own home to live more independently and this was being supported. One person said “I would like to live on my own so I am moving on. Moving is a good thing for me”. Another person said “I would like to live on my own, there are too many residents here. The staff members are great though”.

When we asked people if staff helped them do the things they needed help with, people said that they did although they told us they did many things for themselves. One person said “I get on with everyone here. I do most things for myself but staff are always around and they help me if I need anything”. One person told us they kept their own medicines in their room and staff only needed to provide minimal support with them; “a member of staff opens the cabinet for me but I take my tablets out and I take them myself”.

Most people we spoke with said they were happy living at the home. People who were not happy at times were supported by staff. Those who wished to move because they now required less support were being supported to do so.

One person said “sometimes I feel unhappy, I don’t always get on with other people. I can talk about what I like and don’t like”. Another person said “there’s too may residents here, they are too noisy and they say the wrong things”. Both people told us staff always helped them when they felt unhappy and helped them to understand why they felt this way.

People understood how some of their behaviours may have a negative impact on themselves and others. People also understood how to keep themselves safe. One person said they did not watch certain types of films as “they can make me a bit violent”. Another person said they should not speak with people they did not know whilst out of the home as they knew this kept them safe.

People who lived in the home told us about the plans to refurbish the home. Each person knew this was going to be done and they understood that the use of certain rooms would be changed. One person told us “the changes to the home are a good idea. This lounge is going to be our new kitchen and the old kitchen is going to be a sensory room I think. The office will move as well”.