The inspection took place on 31 October 2018. It was unannounced.

Throwleigh Lodge is a care home providing nursing care for people living with complex learning difficulties and physical disabilities. At the time of the inspection there were 13 people living at the home and up to 17 people could be accommodated.

This service was set up and registered prior to Building the Right Support and Registering the Right Support (2015) which sets out the values and standards for the size of a service for people living with a learning difficulty or autism. Although the size of this service was larger than our Registering the Right Support standards, people were being cared for in smaller group settings over two floors to enable more personalised care to be given. However, we found that more could be done to involve people, and their families and representatives, in the design of services.

People in residential care homes receive accommodation and 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.

On the day of the inspection the registered manager was not present due to ill health. 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.

At the inspection we had difficulty gathering all the information we required and the staffing records were difficult to locate. Some care and dietary records were confused and handwritten notes were not always clear. The registered manager assisted us with further information on their return to work but record keeping and organisation was an area that required improvement.

people and their relatives were not formally involved in the development of the service. Policies were a few years out of date and needed review. There was low reporting by the service to the CQC and some statutory notices had only been sent after a care professional had highlighted a concern.

The numbers of accidents and incidents were recorded but there was no evidence of any learning outcomes from these.

We discovered that some infection control measures and equipment were not at the required standard. Some aspects of the premises needed attention to ensure that a homely and uncluttered environment was provided for people.

Risks to people were being identified and staff showed awareness of the actions to take. Staff also had knowledge of safeguarding processes and an openness to report. Medicines practice and storage was safe. Staffing levels were good enough to achieve safe care. However, there had been a high turnover of staff and a reliance on bank or retired nurses.

People’s needs had been assessed. Good knowledge of people’s complex needs was demonstrated by the nurses. The care staff were competent and they received monthly supervision from the new registered manager. There was good daily communication between staff.

There was evidence of working with the multi-disciplinary community team for people with learning difficulties, and referrals were made to meet specific health needs. People’s special dietary needs were understood and met. Environmental checks were undertaken.

People’s consent was sought in line with the legal requirements of the Mental Capacity Act. Where people's liberty was restricted to keep them safe, the provider had followed the requirements of the Act, and the Deprivation of Liberty Safeguards (DoLS), to ensure the person's rights were protected.

The staff displayed a caring attitude towards people and showed patience and understanding. Care plans were person centred and demonstrated a good understanding of each person’s life. There was a personalised activity plan in place for each person.

The inspection took place on 21 March 2016 and was unannounced.

Throwleigh Lodge provides care, support and accommodation for a maximum of 17 adults with learning disabilities, some of whom have additional physical disabilities and complex needs. There were 17 people living at the service at the time of our inspection.

There was no registered manager in post at the time of our inspection. The service manager had applied for registration with the CQC and their application was under consideration. 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 and associated Regulations about how the service is run.

There were enough staff on duty to meet people’s needs safely and promptly. Staffing rotas were planned to ensure that staff with appropriate knowledge and skills were available in all areas of the service. People were protected by the provider’s recruitment procedures. Staff understood safeguarding procedures and were aware of their responsibilities should they suspect abuse was taking place.

Risks to people had been assessed and actions to minimise the likelihood of harm were recorded.

The service aimed to learn and improve from any incidents and accidents that occurred. There were plans in place to ensure that people’s care would not be interrupted in the event of an emergency.

Medicines were managed safely but we identified two areas in which the provider should improve their practice. Some medicines were stored in a warm environment in which the temperature was not recorded, which meant the provider could not be certain that all medicines were being stored appropriately. When staff gave people PRN (‘as required’) medicines, they had not always recorded the reason for doing so. We raised these issues with the service manager during the inspection, who agreed to implement measures to address them.

People were supported by staff that had the skills and experience needed to provide effective care. Staff had induction training when they started work and ongoing refresher training in core areas. They had access to regular supervision, which provided opportunities to discuss their performance and training needs.

Staff knew the needs of the people they supported and provided care in a consistent way. Staff shared information effectively, which meant that any changes in people’s needs were responded to appropriately. People were supported to stay healthy and to obtain medical treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell.

The acting manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s best interests had been considered when decisions that affected them were made and applications for DoLS authorisations had been submitted where restrictions were imposed upon people to keep them safe.

People were supported to have a balanced diet and could have alternatives to the menu if they wished. People’s nutritional needs had been assessed when they moved into the service and were kept under review. Risk assessments had been carried out to identify any risks to people in eating and drinking.

Staff were kind and sensitive to people’s needs. People had positive relationships with the staff who supported them. Relatives said that staff provided compassionate care and were kind and caring. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity.

The service manager provided good leadership for the service. People and their relatives had opportunities to give their views

We visited Throwleigh Lodge to look at the care and welfare of the people who used the service.

We spoke to six people who used the service and four members of staff. We observed the interactions between staff and the people who used the service. We did this for the people who we were unable to verbally communicate with.

All the people we spoke with said they were happy living there. One person said “Staff work really hard here, and they really help people. My medical condition has improved with their help.”

People told us that staff asked their permission before doing things for them. One person said “They have to have my permission to go into my room. They never do anything I don’t want them to.”

We saw that assessments of people’s needs had been carried out. Where people’s needs changed the plans had been reviewed. We saw that risks had been identified to protect the welfare and safety of people.

We looked around the house and saw that it was clean and tidy. People who used the service told us they were happy with the standards of cleanliness.

Staff told us that they felt supported to do their job. Staff received regular training and supervision to ensure they met the needs of people who lived there.

The complaints procedure was available to people who used the service in an easy read format. All the people we spoke with said they had never felt the need to complain, but if they did they thought the manager would listen to what they said.

We made an unannounced visit to Throwleigh Lodge and looked at the care and welfare of people who used the service.

During our visit we spoke with two people who use the service and four members of staff who were on duty (including the registered manager). We also spoke to two visiting activity workers and a pharmacist.

We saw written comments from relatives. Examples included “Everything we see and know about the home is excellent.’ And “I and my family greatly appreciate the welcome we receive when we visit and the friendliness of all the staff.” All the written comments we saw from relatives were positive.

We spent time observing people who we were unable to verbally communicate with to see how staff interacted and supported them. We saw staff treating people with respect and involving them in activities throughout the time we spent at the service.

Two people told us that “The staff here are lovely.” They also told us that “The food is good and I get a choice of what I want to eat.”

Two visiting activity workers told us that “Staff are always there to help and support people when we visit.” A pharmacist told us “I am more than happy with this service” and that they were “Impressed with the work the manager and staff did”.

We looked around the location and saw bedrooms, communal areas, bathrooms and toilets were clean and free from unpleasant odours.