This inspection took place on 10 January 2019 and was announced. We gave the service 24 hours’ notice of the inspection visit because the location was a small care home for younger adults who are often out during the day. We needed to be sure that they would be in.

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. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Lodge is situated near Langport in the grounds of Immacolata House, another care home run by the organisation. The home can accommodate up to three people living with a learning disability. People living in the Lodge can also access the facilities at Immacolata House.

The service has been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

.

Why the service is rated Good.

People received care and support that was safe. The provider had a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people. All staff had received training in safeguarding vulnerable people. People’s medicines were managed safely and within current guidelines.

Risk assessments were in place to identify any risk to people and staff understood the actions to take to ensure people were safe. There were sufficient staff to support people with their daily living and activities.

People received effective care and support. Staff had a clear understanding of people’s needs and received training relevant to their role and the needs of people living in the home. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs.

People received care from staff who were kind and caring. Staff respected people’s privacy and dignity always. People were supported to express an opinion about the care provided and contribute to any changes.

People received responsive care and support which was personalised to their individual needs and wishes. There was clear guidance for staff on how to communicate with people and how to know when a person was not happy or distressed. People were supported to access health care services and to see healthcare professionals when necessary.

People were supported by a team that was well led. The registered manager demonstrated an open and positive approach to learning and development.

There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from issues raised.

Further information is in the detailed findings below.

This inspection took place on 17 June 2016 and was announced. The provider was given 24 hours’ notice because the location was a small care home for a younger adult who was often out during the day and we needed to be sure they would be in.

The last inspection took place on 22 October 2013 and no concerns were identified.

The service provides specifically tailored accommodation and specialist support for a person with complex needs associated with their learning disability, autistic spectrum condition, sensory impairment and a chronic physical health condition. The person was able to carry out most of their own personal care but needed two to one staff support to keep them safe from avoidable harm. The Lodge is a stand-alone building set within the extensive grounds of Immacolata House, a large care home for older people owned by the same provider.

The service had 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.

The registered manager was on annual leave on the day of inspection. However, the provider’s operations manager agreed to meet us at the home in their absence. They told us the service philosophy was “To adapt our service to meet the person’s requirements. Everything has been adapted and tailored to meet their needs”. We observed this had been applied in practice.

The management and staff were clearly dedicated to ensuring the person experienced the best quality of life possible within the context of their complex care needs. A member of staff said “[Person’s name] is amazing. He surprises you all the time. I love working with him, he is so unique and such a personality”.

The service had a clear staffing structure, with clear lines of reporting and accountability; from the care staff, to the registered manager, to the provider’s senior management team. The registered manager participated fully in the shift rotas and therefore was visible around the home and able to provide clear leadership and guidance to staff. Staff understood their respective roles and responsibilities and they were highly motivated to provide the best quality of care possible for the person who lived in the home.

The person’s relative told us they felt confident the person was safe and well cared for. They said “[Person’s name] is being looked after and is calm most of the time. He seems pretty happy at The Lodge”. We found there were sufficient numbers of staff to meet the person’s needs and to keep them safe. The service employed a small consistent team of permanent staff who were all very knowledgeable about the person’s complex needs and personal preferences. Systems were also in place to ensure the person received their medicines safely and the correct medicines were administered at the right times.

The person was supported to maintain good health and wellbeing by the team of dedicated care staff and a range of local NHS and social care professionals. Specialist medical advice and support was also provided by the local hospital and mental health NHS Trusts.

The person’s care plan was comprehensive and provided clear guidance for staff on how to support the person’s individual needs. The person had contributed to the assessment and planning of their care. Care records included detailed risk assessments and guidelines for staff on how they should interact with the person to help keep them calm and safe. These had been developed with professional input from the local mental health NHS Trust. The guidelines were then reviewed by the local authority’s learning disabilities good practice panel.

The service promoted the person’s independence. The person carried out most of their own personal care and made their own de

During our inspection, we spent most of the time with the person who lived at the home and spoke with the two members of staff who helped to support him.

The home had a friendly, open and welcoming atmosphere. The person who lived at 'The Lodge' told us that they were happy at the home and comments included "I'm very happy" and "course they look after me well".

We saw that staff knew the person's needs very well and were respectful at all times.

There was a care file in place which contained all the information required to meet their care and treatment needs fully. The person's GP and care manager were involved when necessary. The home had a good relationship with the person's relative.

The person received nutritious meals based on their specialised diet and took part in choosing their meals and shopping for their food. Favourites included "I like chicken fricassee" and "I like lasagne".

Staff demonstrated that they understood the signs of abuse and how to report any concerns. The home had an up to date policy and guidance on the process to follow in cases of suspected abuse. The person at the home told us they knew how and who to make a complaint to if they needed to.

The person's private areas of the home were designed and personalised to meet their individual needs, choices and abilities.

The provider had a quality assurance system in place that regularly monitored the service provided.

During our inspection we spoke with the person living in the home and two members of staff who helped to support him. This included the manager of the home. We also read the person’s care plan to enable us to understand what support they needed.

The person who lived in the home who told us they were happy living there. We saw them laughing and joking with the staff and saw they were comfortable in their surroundings. They said “its nice living here, I like doing the things I like doing, I like seeing my relative”. The person knew what support they needed from staff and told us they would say if they were not happy with how they were cared for. The person had recently raised a concern about their care and we saw the manager had taken action to address this.

We saw the person had their care needs assessed, planned and delivered so that staff could meet their needs appropriately. Medication administration followed a clear process to ensure the person received their medicines safely.

Records that the home kept were stored securely and retained for an appropriate amount of time. Staff were recruited through thorough checks to ensure they were of good character and had the right skills and experience to carry out their role.

This visit was part of our routine schedule of planned inspections.

We spoke with the person who lived in The Lodge. They told us “I am very happy living here.” They told us that staff knew about their needs and helped them in the way they wanted to be helped. They confirmed they were involved in the running of the home and had been involved with their care plans. When asked if they knew how to raise a concern or complaint they said “I can talk to any one but I would go to Tracey” (the registered manager).