We inspected all three of Paradise Lodge Care Home Limited services, known as Willow Tree Lodge, Paradise Lodge and Chignal House and, over a period of three days, 07, 08 and 12 March 2018 as these services are all in close proximity.

The inspection of Willow Tree Lodge took place on 12 March 2018 and was announced.

Willow Tree Lodge is a ‘care 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. Willow Tree Lodge accommodates five people in one adapted building.

Although the provider spent a lot time working across all three services, we found a lack of consistency in outcomes for people. The provider and manager had not always understood their responsibilities concerning regulatory requirements in relation to health and safety, mental capacity and deprivation of liberty. The provider had worked well with health professionals in relation to peoples care needs, however they had not always worked well in partnership with stakeholders, such as the local authority and CQC to share information.

Although, the provider had identified risks to people’s safety, and taken action to address them, they had not always assessed the ongoing risk of harm. The manager and staff had not understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who use the service by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who consider whether the restriction is appropriate and needed. The lack of governance and poor understanding of the appropriate decision making process and establishing people’s capacity to make decisions had placed people at risk of harm.

The provider and manager told us they kept up to date with current guidelines and best practice in care services through a variety of networks, including CQC web site, Essex Association of Independent Care Providers who do forums, conferences and workshops. However, none of these forums related to most recent guidance and ways of supporting the specific client group using the service.

Although care plans were in place to guide staff on how to support people’s health; welfare and safety, we found one exception where there was no care plan in place in relation to a person’s epilepsy, or how this should be managed in the event of a seizure.

We recommend that the service seek appropriate professional advice regarding the management of epilepsy.

There was a manager in post. Following an interview with CQC they have been approved as the registered manager as of 16 March 2018. 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 care service has been developed and designed 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.” Registering the Right Support CQC policy.

Safeguarding matters and people's finances were well managed. Staff managed the complex needs of the people well and understood the support they needed to keep them safe. Staff understood what people could do for themselves, where they needed help and encouragement and how they communicated. Staff talked passionately about the people they supported and knew their care needs well. Different communication methods had been used to support people to understand information about their care an

Willow Tree Lodge provides accommodation and personal care for up to three people who have a learning disability and may also have mental health needs. On the day of our inspection there were 3 people living in the service.

When we last visited the service it was rated good.

At this inspection we found the service remained good.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were sufficient numbers of care staff on shift with the correct skills and knowledge to keep people safe. There were appropriate arrangements in place for medicines to be stored and administered safely.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. Management and staff understood their responsibility in this area. Staff were committed to ensuring all decisions were made in people’s best interest.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times. People and their relatives were involved in making decisions about their care and support.

Care plans were individual and contained information about how people preferred to communicate and their ability to make decisions.

People were encouraged to take part in activities that they enjoyed, and were supported to keep in contact with family members. When needed, they were supported to see health professionals and referrals were put through to ensure they had the appropriate care and treatment.

Relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service.

The management team had systems in place to monitor the quality and safety of the service provided.

Willow Tree Lodge provides accommodation and personal care for 3 people who have a learning disability and require 24 hour support and care.

This was an unannounced inspection which meant the service and staff did not know we were visiting.

A registered manager was 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.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS) and to report on what we find. We found the location was meeting the requirements of the DOLs.

People who used the service told us that the service was a safe place to live. There were procedures in place which advised staff about how to safeguard the people who used the service from abuse. Staff understood the various types of abuse and knew who to and how to report any concerns.

There were procedures and processes in place to guide staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

There were sufficient numbers of staff who were trained and supported to meet the needs of the people who used the service.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. The service was up to date with recent changes to the law regarding DOLs.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People spoke highly about the quality of the food and the choices available.

A complaints procedure was in place. Everyone we asked said they would be comfortable to raise any concerns with the staff, manager or provider.

People, relatives and staff were complimentary about the management of the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service identified shortfalls in the service provision and took actions to address them.

At the time of this inspection there were three people living at Willow Tree Lodge.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

This was an unannounced inspection. We spoke with all three people who lived at the home. We also spoke with the manager and another member of staff. We looked at written records, which included copies of people's care record, medication systems, staff personnel files and quality assurance documentation.

Is the service safe?

We found the home to be warm and clean. The accommodation was adapted to meet the needs of the people living there. The provider had a suitable plan in place to enhance the facilities further.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. People were protected by safe recruitment practices. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We saw that care plans and risk assessments were informative and up to date. Staff we spoke with were familiar with their contents, which enabled them to deliver appropriate and safe care. People were cared for by staff who were properly trained and supported to develop professionally.

People we spoke with were satisfied with the care and support they received. This was consistent with positive feedback reported in the provider's own annual quality assurance survey. People were given information and support to help them understand the care and support available to them and were encouraged to increase their independence.

Is the service caring?

We spoke with three people who used the service. One person said to us, "I like living here. It's a really nice place." Another person said to us, "Everyone's very kind to me. I have no trouble. I'm looking forward to going out tonight."

There was a calm and respectful rapport between staff and the people who lived at the home. We witnessed the care and attention people received from staff. Staff were attentive to people's needs and people were treated with dignity and respect.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Care plans and risk assessments were regularly reviewed.

One staff member and two people who lived at the home told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns.

Is the service well led?

One staff member said that they felt well supported by the manager and they were able do their jobs safely. The manager had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving.

It was not possible to speak to the people using the service at this unannounced inspection as they were not in the home at the time.

We found that the provider had systems in place to ensure that people living in the home were able to comment on their care and voice their opinions on a regular basis. People also had person centred care plans in place that helped staff to provide an individual approach to their care management.

People living at the home had the care and support in place that they needed and this was supported by an individual care plan that was kept up to date.

We found that the provider had systems in place to ensure that their staff team were appropriately trained and supervised. The provider also had systems in place to enable them to monitor and assess the quality of the service they provided.

At our inspection in October 2012, we found that the provider was not taking proper steps to ensure that people using the service were protected against the risks of receiving inappropriate or unsafe care through the means of assessing needs fully and planning the delivery of care effectively, to ensure the welfare and safety of people living in the home.

We visited the home again in February 2013 to review compliance against this regulation.

We found that the provider remained non-compliant in that people still did not have accurate or full assessments of their needs in place, the planning and delivery of care was not robust and did not always ensure the welfare and safety of the people using the service.

We also found that the provider remained non-compliant with regard to the full development and implementation of quality assurance systems that would allow the provider to regularly assess and monitor the quality of the services provided.

Whilst people living in the home were happy and felt safe and well looked after, they were not fully consulted about their care management or asked for their feedback on the day to day life in the home. One person told us "The staff are nice and they spend time with me."

People cannot be fully assured that their care needs would be properly assessed or planned for and this may include risks related to their care management.

The provider had the appropriate safeguarding measures in place and medicines were managed correctly. There were gaps in the staff training and not all staff had received training in core subject areas relevant to their role. Staff had not received regular supervision to support them in their role. The provider did not have effective quality assurance systems in place that assessed and monitored the quality of the care and services provided.