Wallace Lodge

At the last inspection the service was rated 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.

There was a registered manager in post who had been registered with the Care Quality Commission (CQC) since September 2017. 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.

The registered manager was aware of their responsibilities and had a clear strategy and vision for the service in partnership with the provider's organisational vision. This was to enhance the lives of people regardless of their disability and to enable people to have a fulfilling and purposeful life. The care service had 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 were supported to live as ordinary a life as any citizen.

There were regular checks of the premises, equipment and utilities which were documented to ensure the safety for people living at the service, visitors and staff. People's care plans reflected their individual needs and personal risks were assessed. We found there were policies and procedures in place to help keep people safe. Staff were safely recruited and they were provided with all the necessary induction and training required for their role. 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. Staffing levels matched the dependency needs for people living at the service.

There were infection control policies in place and staff adhered to these. Medicines were safely managed and there were medication policies and procedures in place. There was a business continuity plan in place for use in emergency situations.

There was a robust governance framework in place to continually monitor and improve the service. We saw evidence of involvement from the provider's senior management team and documented audits carried out during their visits to the service. The registered manager submitted notifications to the Commission appropriately.

During the inspection we observed people carrying out activities with staff and attending sessions in the local community. We saw records of activities undertaken by people and they were supported to carry out their own choices for activities. 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.

There was training provided for staff in delivering end of life care. Staff treated people with dignity and respect. We saw kind, warm and caring attitudes between people in receipt of care from the service and staff. We observed people enjoying positive relationships with staff and it was apparent they knew each other well. Staff understood each person, how to support them and knew what they liked and disliked. We observed people liked staff and had friendly relationships with them.

The service had a comprehensive complaints and compliments policy in place. Any complaints received were logged, responded to within the stated time frames and analysed. Action plans were created and lessons learned were documented. The service promoted advocacy and there was accessible information available detailing what support people could access to help make choices about their individual lives. There was information available about safeguarding, complaints and advocacy displayed in communal areas and available in easy read formats for people.

Further information is in the detailed finding below.

We last inspected the service in June 2014. At that inspection we found the service was meeting all the regulations that we inspected.

At the time of our inspection the service did not have 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 had recently left the service following a number of years' service at the home. An acting manager had been appointed to provide interim management support for the home.

The home had a homely feel, communal areas were light and bright, people’s rooms were decorated and personalised to their choice.

The registered provider carried out regular health and safety checks included checks of gas safety, electrical safety, electrical appliances and fire safety. Each person had a detailed personal emergency evacuation procedure in place which outlined how to support the person in the event of an emergency.

During our inspection we observed sufficient staff on duty to meet people’s needs.

Identified risks were assessed and managed to minimise the risk to people who used the service and others.

Staff had a good understanding of safeguarding and described confidently what action they would take if required.

The registered provider had a robust recruitment procedure in place which included ensuring appropriate checks were undertaken before staff started work.

Medicines records we viewed were up to date and accurate. People were supported to take their medicines in their preferred way.

Staff understood and applied the principles of the Mental Capacity Act 2005 (MCA), and were aware of people’s rights when they could not consent themselves. We saw staff supported people to make choices and decisions.

People were supported to maintain a balanced diet. We saw that each individual’s preference was catered for and people were supported to manage their weight.

Staff had completed mandatory training required to perform their role. We noted all training was up to date.

People were treated with dignity and respect. Staff had a sound knowledge of the people they supported. Staff encouraged people to be as independent as possible.

The home ensured people received care and support from healthcare professionals including social workers, community psychiatric nurses, opticians and GPs.

People were involved in a wide range of activities including attending church, an art group, going to the pub and shopping. Staff supported people to maintain family relationships and links with the local community.

Care plans were detailed and reflected people’s individual needs. Reviews of people’s care were regularly completed and included input from the person.

Staff told us they enjoyed working at the home and they felt supported by the acting manager.

The registered provider had a comprehensive system to audit the running of the service. These included checks of the medication systems, care plans and training.

Feedback was sought from people, relatives and staff in order to monitor and improve standards.

Team meetings were held monthly to discuss issues within the service.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Where staff had identified a potential risk, either during the initial assessment or after admission, we found that a risk assessment had been completed to ensure people were safe. We saw that the risk assessment clearly identified the potential hazards and the control measures in place to manage the risk. The provider had developed policies and procedures in relation to safeguarding adults. We viewed these policies and saw that they contained information for staff to refer to about safeguarding, such as what constituted abuse, key responsibilities and how to report concerns. The provider had a system for

logging and investigating safeguarding concerns.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that DoLS had been submitted appropriately and relevant staff had been trained to understand when an application should be made.

Is the service effective?

Each person had individual support plans which set out their specific care needs and people had been involved in the assessment and planning of their care. Relatives we spoke with told us they were also involved in the planning of care. We saw that support plans and risk assessments were up to date and reflected people's individual needs and we observed staff supporting people in a caring and sensitive way. A family member told us, "They let me know what is happening on a regular basis."

There was an advocacy service available if people needed it, this meant that when required people could access additional support. We found that care records had been written using a person-centred approach. This meant that they described the person's abilities and how they preferred their care needs to be met. Staff we spoke with told us the managers were approachable and accessible at all times. The provider had systems in place to ensure that staff training was kept up to date.

Is the service caring?

People were supported by calm, kind and attentive staff. We saw that care workers showed patience and gave encouragement when assisting people. We saw people were supported to enjoy their meals at their own pace. Staff spent time chatting with people about their interests in a warm and engaging manner. We saw staff were skilled at understanding people's individual communication methods. They guided people in a way that supported them to retain their dignity. Staff told us they knew what interested people by reading what was written in the persons care plan and also spending time with them. Staff gave us examples of preferences of people watching DVD films and one person enjoyed bingo. Our observations of the care provided and discussions with people showed us that individual wishes for care and support were taken into account.

Is the service responsive?

People were given the chance to make decisions for themselves. Records showed that people's preferences, interests and needs had been taken into account and care and support had been provided in accordance with people's wishes.

We saw that where necessary people had been referred to other professionals. For example, we saw one person had been referred to the Speech and Language Therapy Team. Family members we spoke with were aware of how to make a complaint but they did not raise any complaints or concerns with us about their relative's care. A family member told us, "I know how to make a complaint. I have not needed to raise one though."

Is the service well led?

The provider had a system to assure the quality of the service they provided. The way the service was operated had been regularly reviewed. A range of checks were carried out including care records, medication and the environment for people who lived there. The area manager carried out at least monthly visits to audit the systems and procedures at the home.

The manager held regular team meetings with staff. Regular checks of the premises took place to ensure it was safe and suitable for the people who lived there. Staff were properly supported by the manager and received training relevant to their role.

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people's care needs.

We saw that staff provided care in a way that demonstrated they had a good knowledge of each individual person. Where appropriate, we saw staff providing support and encouragement to the people to do things as independently as possible.

We looked at how the service recruited staff by checking five staff files.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We looked at the activities for people who use the service and found that people attended community placements, had visits to and from relatives, went shopping, watched television and visited a church.