September Lodge

Updated 9 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This announced inspection took place on 23 September 2017. The inspection was announced 72 hours in advance as this allowed the registered manager to prepare the people they supported at September Lodge to know that an inspector would be visiting their home. With this knowledge they were then prepared and were able to choose if they wished to partake in the inspection process. The inspection was conducted by one adult social care inspector.

We reviewed the Provider Information Record (PIR) before the inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. We also reviewed other information we held about the service and notifications we had received. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with two people living at the service, the registered manager, managing director and five care staff. We looked around the premises and observed care practices on the day of our visit.

We looked at two records relating to people’s individual care. We also looked at three staff recruitment files, staff duty rotas, staff training records and records relating to the running of the service. We received feedback from four health and social care professionals about their experience of working with the service. After the inspection we spoke with one relative.

Updated 9 December 2017

September Lodge provides accommodation and personal care for five people who have autistic spectrum disorders. September Lodge is owned and operated by Greenlight PBS Ltd who run a number of services across Cornwall. On the day of our visit five people were living at September Lodge.

We carried out this announced inspection on 23 September 2017. The inspection was announced 72 hours in advance as this allowed the registered manager to prepare the people they supported at September Lodge to know that an inspector would be visiting their home. With this knowledge they were then prepared and were able to choose if they wished to be involved in the inspection process. At the last inspection, in October 2015, the service was rated Good. At this inspection we found the service remained Good.

People told us they felt safe living at September Lodge and with the staff who supported them. People told us, “Good staff, good home, that’s all you need to know, now you can leave”, “I like it here” and “The staff are as good as it gets.” Relatives told us they were, “Very happy” with the care provided and , “I know [relatives name[] is safe there, the placement suits what she needs.”

People received care which was extremely person centred and responsive to their needs. They were supported and fully engaged in activities that were meaningful to them.

Care and support was provided by a consistent staff team, who knew people well and understood their needs. The registered manager told us “The people we support are cared for, supported, they are loved. It’s not just a job, its loyalty, commitment.” In our discussions with staff we found that all had the same understanding and approach in how they cared for the people they supported. We also heard from staff how proud they were of people’s individual achievements.

Transition work that staff undertook with people who were coming to live at September Lodge was individualised. For example, we saw personalised videos were used to introduce one person to the service so that they could see and become accustomed to the accommodation and surroundings that they would be coming to live in. The registered manager had met with the person, family members and other health and social care professionals to discuss how the person would best be supported with the transition from their current placement to September Lodge. The person was also encouraged to take part in decorating their accommodation, choosing colours, furnishings and to bring personal items so that it so that their room was completely decorated as they wanted it.

There were sufficient numbers of suitably qualified staff on duty. Staffing levels were adjusted to meet people’s changing needs and wishes. For example, one person was admitted to hospital in an emergency situation and the provider ensured there were sufficient numbers of staff available to support the person throughout their hospital stay. This meant they responded to the person’s changing health needs.

The service recognised and identified when people needed additional psychological support. For example, when the person was admitted to hospital the registered manager was aware the person was in a vulnerable situation and needed emotional support from them. The registered manager told us “I told my family I need to be with [person name], I will see you in four days. The other staff did the same.” The management team arranged for two recently recruited care staff who supported the person prior to moving to September Lodge to be part of the current support team at the hospital. This meant the person had some familiarity with some staff to help ease anxiety levels. This showed that the provider responded in a person centred way by ensuring that they had sufficient, skilled staff to support them in a crisis situation.

We were also given other examples of how staff listened to people and responded to their individual needs to come to find a positive way forward. For example, a person had difficulty with using the bathing facilities at the service. The registered manager said “We had to think outside of the box and use facilities that the person trusted which are not on site.” This meant that they had to approach another venue that the person trusted to request their assistance. The person told us they were happy with the arrangement made and their aim was that they would be able to use the facilities in September Lodge in the near future.

A person said they wanted to have more direct contact with management. The person was allocated their own deputy manager to be responsible for overseeing their support plan and to ensure that it was adhered to each day. In addition following a request from the person, the registered manager downloaded a messenger application on their phone so that they had direct contact between them. The registered manager said this enabled the person to feel more confident that managers were available for them when needed.

People’s support plans were presented in a format that each person could understand. For example, a person videoed their support plan. On the video they explained their health issues and how they needed staff to support them to manage their health condition. This demonstrated that the person was aware of their health needs, and how they wanted staff to respond to them. Alongside the video support plan was a written support plan. Details of how people wished to be supported with their care needs were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. The support plan was also signed by the person which evidenced that they agreed with its contents and how staff should support them.

Care records were up to date, regularly reviewed and accurately reflected people’s care and support needs. People, who received care, or their advocates, were involved in decisions about their support and consented to the care provided. Risk assessment procedures were designed to enable people to take risks while providing appropriate protection.

People were supported to maintain good health, have access to healthcare services and receive on-going healthcare support. Staff supported people to arrange and attend appointments to see their GP and other necessary healthcare appointments.

People were supported to access the local community and take part in a range of activities of their choice. Staff supported people individually and in groups to attend work placements and activities of their choosing.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.

People were supported to eat and drink enough and maintain a balanced diet and were involved in meal planning. Menu planning was done in a way which combined healthy eating with the choices people made about their food.

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. A person had restrictions in place around accessing food. The approved Deprivation of Liberty Safeguards (DoLS) condition allowed the service to lock cupboards where food was stored. However the registered manager told us “It’s not about locking cupboards it’s about managing [the persons] condition. Locking cupboards would be a last resort.” We saw the person was supported to access the kitchen, and had access to food and drinks.

People and their families were given information about how to complain. The registered manager and operational manager were visible in the service, regularly working alongside staff to provide care and support for people. There was a positive culture within the staff team and staff said they were supported by the registered manager.

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. People and their families were involved in the running of the service and were regularly asked for their views through on-going conversations with staff and surveys.

Further information is in the detailed findings below