The inspection took place on 8 March 2018 and was an announced inspection. The service was last inspected on 29 July 2015, where we found the provider to be in breach of one regulation in relation to not protecting people who were unable to make decisions for themselves.

Wortley Lodge accommodates up to three adults with a learning disability and autistic spectrum disorder. The service is set in an adapted house providing accommodation to people over two floors. The ground floor communal areas comprise of an open plan kitchen and dining room and a living room. At the time of our inspection, three people were living at the service.

Wortley 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 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.

The service had a registered manager in post. A registered manager is a person who has registered with the 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.

At the inspection on 8 March 2018, we found that the provider had made sufficient improvements and were no longer in breach of a legal requirement.

The provider maintained systems to safeguard people from harm and abuse. People told us they felt safe living at the service. Staff knew types and signs of abuse and how to report abuse and poor care. People’s risk assessments were specific to their needs. They provided sufficient information to staff on the risks associated to people’s health and care, and measures on how to reduce those risks. The provider had sufficient numbers of staff to meet people’s needs and recruited suitable staff to support people at risk. Staff followed appropriate infection control practices to avoid the spread of infection.

People told us their needs were met. Staff were appropriately inducted and received regular training and supervision to deliver effective care. People’s nutrition and hydration needs were met and told us they were happy with the food. Staff supported people in accessing healthcare services and followed up on healthcare professionals recommendations. People liked their bedrooms and the premise's adaptations met their individual needs. 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. People told us staff gave them choices and asked their permission before supporting them.

Staff were trained in equality and diversity and knew the importance of treating people equally, with dignity and respect. People told us staff were caring, friendly and listened to them. Staff supported people to remain independent by encouraging and assisting them to do things that they could.

People’s care plans, health action plans and hospital passports were regularly reviewed and gave information to staff on how to provide personalised care. Staff worked with people to plan their weekly activities and the weekly activity plan showed people participated in a range of activities. People told us they knew who to speak to if they were not happy about something but had never made a complaint. Staff recorded people’s end of life care wishes and preferences in their care plans.

The management conducted regular audits and monitoring checks to ensure people’s

The inspection took place on 29 July 2014 and was announced. The service was last inspected in February 2014. At that time it was found to be fully compliant with all regulations inspected. The service is registered to provide accommodation and support with personal care for up to three adults with learning disabilities. Three people were using the service at the time of our inspection.

The service had a registered manager in place. 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 service did not always operate in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS is legislation that protects people who are unable to make decisions for themselves or whom the state has decided their liberty needs to be deprived.

Risk assessments were in place which provided guidance on how to support people safely. However, some of these required more detailed information.

The service had appropriate systems in place for safeguarding people. There were enough staff to meet people’s needs. Medicines were managed in a safe manner.

Staff were well supported and received training and one to one supervision. People were able to make choices about most aspects of their daily lives. People were provided with a choice of food and drink and supported to eat healthily. People had access to health care professionals and were supported to lead healthy lifestyles.

People told us they liked the staff. We saw staff interacting with people in a caring way and staff had a good understanding of how to promote people’s dignity.

Care plans were in place and people were involved in planning the care and support the received. People had access to a wide variety of educational and leisure activities within the community. The provider had appropriate complaints procedures in place.

Staff told us they found the registered manager to be approachable and helpful and that there was a good working atmosphere at the service. The provider had various quality assurance and monitoring systems in place. Some of these included seeking the views of people that used the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of this report.

People who use the service understood the care and treatment choices available to them. One person who used the service told us that they made decisions about when and how care was delivered. They told us “I decide what I eat”.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw records of the referral forms from the organisations that had referred people to the service.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw staff training records which confirmed that staff had completed safeguarding training.

There were effective recruitment and selection processes in place. We saw that staff who worked at the service had completed applications forms. We saw that people were shortlisted for interviews based on the information in their forms.

We saw a range of monitoring systems in the form of audits. This included audits of peoples' care records and infection control. The staff we spoke with confirmed that results from audits of care plans were discussed at supervisions and areas of improvement were identified.

On the day of the inspection two people had gone out to do activities and the other person in the home was non verbal.

We spoke to the manager and the deputy manager and they showed us that they were supporting people maintain contact with their families and were supporting them in their activities.

We reviewed three care plans and saw that people's welfare was fully considered. Staff were ensuring that people at the home were being taken to see relevant health professionals to ensure their overall health.

We reviewed the home's system for recording medication and saw that there was an effective system to ensure medications were given to people at the correct time and that the right medication was administered. The deputy manager audited the medication administration record on a monthly basis to ensure that staff responsible for administering medication were doing so in line with their medication policy.

People looked relaxed in their home and at ease with the staff. Care plans were person centred and holistic. We were told that people chose their daily activities and there was evidence that people were supported with these choices.

Whilst staff appeared confident and knowledgeable, the management of people's medicines was unsafe and the auditing process was inadequate.

The provider was unable to demonstrate that an ongoing healthcare issue for one individual had been discussed with an appropriate healthcare professional. Staff were offering support but there was no evidence to suggest this was the correct support for this individual.

Staff said they felt supported and were confident they had been given the right training to do their job.

Most records we checked were relevant to the management of the service and were accurate and fit for purpose.

We met the three people living at the service during this visit. All of the people were able to clearly express their views, through their verbal and non-verbal communication. The three people living at Wortley Lodge were female.

One person told us “I went to a party and ate lots of cake. I like watching Eastenders. X (staff member) is here tonight. I like X”.

People told us that they had formed good friendships with each other and they enjoyed meeting up again in the afternoons if they had attended different day centres, groups or community activities.

People were looking forward to visiting a professional nail salon the next day, followed by a trip to the theatre for a pantomime. People were keen to show us how their nails had been manicured on a previous visit and they wanted us to look at the theatre tickets. People choose a take-away meal every Friday and were eagerly awaiting the arrival of a Chinese meal on the day of our visit.