This unannounced inspection took place on 18 December 2018.

The Lodge is a care home for up to 7 adults with a learning disability and who can, at times, display behaviour that challenge others. At the time of this inspection, there were 7 people living at the 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. The Lodge consists of one building with two floors; one floor for three men and the other for four women. Bathroom and toilet facilities on each floor are shared.

We previously inspected the service on 11 and 18 October 2017 and we found one breach in regulation in relation to staff not receiving regular supervision and appraisals. At this inspection, we found improvements had been made and the provider was no longer in breach of any regulations.

At the time of this inspection the service was being managed by the deputy manager, who was not registered with CQC to manage the service. The previous registered manager had not been managing the service since August 2018, however we saw evidence that appropriate management arrangements had been put in place to manage the service since and satisfactory steps had been taken to select a manager. We spoke with the locality manager about the future management arrangements; they told us a person had been appointed to manage the service and they will be applying to become the registered manager. It is a legal requirement that the service has a registered manager in post. 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.

People told us they were safe living at The Lodge. Where risks to people's health and wellbeing had been identified, the risk assessments and guidance around these were detailed and contained sufficient information for staff to support people to minimise risk. Staff we spoke with told us how they supported people to reduce risks and prevent them from avoidable harm.

People’s medicines were managed safely and people were supported to take their medicines as prescribed however some improvements were required to the level of detail of some information recorded. We recommend the service always makes sure that records evidence the care provided.

There were sufficient staffing levels to meet people’s needs and provide a flexible service.

The provider had systems in place to manage, record and learn from incidents and accidents. These was regularly analysed, discussed during staff meetings and when required, changes were made to reduce the likelihood of future incidents occurring.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People’s needs in relation to the protected characteristics under the Equalities Act 2010, were taken into account in the planning of their care. People's communication needs were assessed and staff adapted their communication methods to better meet people’s needs, for example using simple questions or pictures.

People were supported to prepare and eat a balanced diet that met their individual dietary needs. They were supported to access healthcare services in order to maintain their health.

Staff were supported through a comprehensive induction, regular supervision and annual appraisals. People were supported by staff who had attended regular and relevant training.

Staff had a good understanding of infection control procedures and used personal protective clothing when required to prevent the spread of infection.

People and their relatives told us staff were kind and caring and their

This inspection of The Lodge took place on 11 and 18 October 2017. The inspection was unannounced on the first day and announced on the second day. We previously inspected the service on 20 July 2016 and at that time we found the provider was not meeting the regulations relating to safe care and treatment, premises and equipment, and good governance. On this inspection we checked and found improvements had been made, however we found one new breach of the regulations.

The Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The Lodge provides a service for up to seven adults who have a learning disability and behaviour that may challenge others. The home provides accommodation and support over two floors; one floor for three men and the other for four women. Bathroom and toilet facilities on each floor are shared. The home is close to community facilities including, shops, cafes, a bank, post office and garden centre.

There was a registered manager in post who had been registered since January 2016. 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 had a good understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse.

Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence. Detailed individual behaviour support plans gave staff the direction they needed to provide safe care.

Building maintenance and hygiene had improved and some areas of the home had been refurbished.

Safe recruitment and selection processes were in place. We reviewed the systems for the management of medicines and found that people received their medicines safely.

Sufficient staff were deployed to provide a good level of interaction. The required number of staff was provided to meet people’s assessed needs, although one person, whose support needs had changed, was unable to access the community on occasion while they were awaiting a re-assessment of their support needs.

Staff told us they felt supported, however we found they were not always supported with regular management supervision. Staff had received an induction and role specific training, which ensured they had the knowledge and skills to support the people who lived at the home.

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 supported this practice, although some best interest processes had not been evidenced.

People were supported to eat a balanced diet, and meals were planned around their tastes and preferences.

People were supported to maintain good health and had access to healthcare professionals and services. They were supported and encouraged to have regular health checks and were accompanied by staff to health appointments.

Positive relationships between staff and people who lived at The Lodge were evident. Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs.

People were involved in arranging their support and staff facilitated this on a daily basis. People were supported to be as independent as possible throughout their daily lives.

Care records contained detailed information on how to support people and included measures to protect them from social isolation. People engaged in social activities which were person-centred.

Systems were in place to ensure complaints were encouraged, explored

We inspected The Lodge on 20 July 2016. This is a small service so we checked the night before that people would be at home.

The Lodge provides a service for up to seven adults who have learning disabilities. The home is divided into two units across two floors; one floor for three people and the other for four people. The floors are connected by a central office area. The home is close to community facilities including shops, cafes, and a garden centre.

At the time of the inspection there were six people who used the service (three females in the lower lodge and three males in the upper lodge). Most of the people had lived at the service for many years dating back to the late 1990s with the last admission to the service in 2010.

A registered manager had been in place since June 2016. 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. Prior to the registered manager coming in post the other registered manager had been in place since June 2011.

We found the building was in need of a complete refurbishment as all the rooms, fixtures and fittings were showing wear and tear. The carpets and vinyl were heavily marked and some were ill-fitting. We found no carpets had been replaced since the previous owner of Valeo Limited had sold the company to Caretech over six years ago and some had not been replaced for 11 years.

There had not been any domestic staff in post for three months and this had a marked impact on the cleanliness of the home. We saw that the sides of settees were heavily soiled with split coffee, the vinyl floors were dirty, woodwork needed cleaning and carpets were in need of hovering.

We observed were sufficient staff on duty to meet people’s needs during the day. We saw a senior carer and five staff were on duty. However, overnight there was one waking staff and one staff member who slept at the home. We found that the sleep-in staff members were woken in the early hours of the morning as at least three of the people often got up and needed to be supported.

We found care records were comprehensive, however they needed to be reviewed and updated. Also staff needed to ensure all incidents were recorded and reviewed.

Staff had received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The staff we spoke with understood some of the requirements of this Act but needed to ensure capacity assessments and best interest decisions were accurately recorded and in place where needed.

All of the documentation within the home refers to Caretech and we were unclear as to whether this was a different provider to the registered provider Valeo Limited. Following the visit we confirmed that the home was registered correctly and established Caretech operate Valeo Limited as a subsidiary of their portfolio so the registration was valid.

Caretech had developed a range of systems to monitor and improve the quality of the service provided. However, we found the internal systems for monitoring these services were ineffective as they did not identify the gaps in care records, the potential infection control issues, the impact of sleep-in staff being woken in the early hours of most mornings or that incidents were not always recorded. Thus information fed to the operational manager did not cover all the issues.

We met with five of the six people who used the service and we were able to speak with three people and spent time observing staff practices. We saw the people were comfortable with each other and staff and there was lots of laughter.

Staff were aware of how to respect people’s privacy and dignity. We saw staff supported people to make choices and decisions.

People were offere

We spoke to two of the people who lived at The Lodge at the time of our inspection. The people we spoke with told us they were well looked after and liked living at the home. They told us they were involved in making decisions about their care and treatment. One person told us, "I tell the (staff) what I want them to do to help me. I like it here."

People's care and support was planned and delivered in line with their individual care plan. People received care and support that met their needs in a safe and person centred way.

People had the opportunity to get involved in a variety of activities and trips out of the home.

People were protected against the risks associated with medicines because the provider

had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place.

There was an effective complaints system available. Comments and complaints people

made were responded to appropriately.

We spoke with three people who lived at The Lodge. They told us staff supported them and they were involved in making care decisions. They were aware of potential risks and why risk assessments were in place. They were also aware why certain restrictions were in place such as access to knives. One person told us, “That’s what I want, staff to help me.”

We saw evidence of monthly meetings where people could contribute to decisions about what happened in the home. People were consulted on an individual basis about their personal preferences. For example, they could choose how they wanted their bedrooms decorated.

We saw people's needs were assessed and care and support was developed from an assessment of their needs.

Staff had received appropriate training for their role and understood the importance of reporting suspected abuse. The three staff members we spoke with told us they felt supported. They told us they were always doing training

We spoke to two people who use the service. They didn't make any negative comments about the service. Both said that they had opportunities to participate in activities they enjoy and they were involved in making choices and decisions about the support they receive.

We were unable to get views from most of the people who use the services due to the nature of their disabilities. We therefore spent time observing care practice and peoples’ responses and interactions.

One male resident, who has learning difficulties, said there was no choice of food; they are made to eat what the staff eat. He said he does not like living with the other two residents, as they do not talk to him at all. He said, “I get bored a lot as I don’t get to go out as often as I would like, only two times a week for short times. Not a lot happens in the home either”.