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Inspection carried out on 31 January 2018

During a routine inspection

Lomack Healthcare is a service that provides care and support to people living in two ‘supported living’ settings so that they can live in their own home as independently as possible. It provides a service to younger adults. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. This inspection looked at people’s personal care and support.

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.

At our last inspection we rated the service 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 on-going 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.

Why the service is rated Good

There was a registered manager at the service. 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.

Staff knew how to respond to possible harm and how to reduce risks to people. Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made to staff practise or the environment, to reduce further occurrences. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Medicines were stored and administered safely. Regular cleaning made sure that infection control was maintained.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. People received a choice of meals, which they liked, and staff supported them to eat and drink. They were referred to health care professionals as needed and staff followed the advice professionals gave them. Adaptations were made to ensure people were safe and able to move around their home as independently as possible. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members.

People’s personal and health care needs were met and care records provided staff with clear, detailed guidance in how to do this. There were activities for people to do and take part in and people were able to spend time with their peers. A complaints system was in place and there was information in alternative formats so people knew who to speak with if they had concerns. An end of life policy was being developed to support people and staff.

Staff worked well together and felt supported by the management team, which promoted a culture for staff to provide person centred care. The provider’s monitoring process looked at systems throughout the service, identified issues and staff took the appropriate action to resolve these. People’s views were sought and changes made if this was needed.

Further information is in the detailed findings below

Inspection carried out on 7,8 and 9 September 2015

During a routine inspection

Lomack Healthcare provides personal care to people who have a learning disability, in their own homes. At the time of our inspection, care was provided to three people who lived together in one house and another two people who lived together in another house.

The inspection took place on 7, 8 and 9 September 2015.

The service had a registered manager. 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.

During our previous inspection in June 2013, we found the provider was meeting all the standards that were assessed.

People were protected from abuse. Staff were knowledgeable about the risks of abuse and knew how to respond appropriately to any concerns to keep people safe.

Systems were in place to ensure that people’s safety was effectively managed. Risks had been assessed and were detailed clearly within people’s care plans. Staff used these to assist people to remain as independent as possible

There were sufficient numbers of staff employed to meet people’s assessed needs and provide a flexible service. Staff were only employed after the provider carried out robust pre- employment checks.

Systems were in place to ensure that medicines were administered and handled safely.

Staff received an appropriate induction and on-going training. They were knowledgeable about their roles and responsibilities and had the skills and experience required to support people with their care needs.

We found people’s rights to make decisions about their care were respected. Where people did not have the mental capacity to make decisions, processes were in place to protect them from unlawful restriction and decision making.

People’s nutritional needs had been assessed and they were supported to make choices about their food and drink.

People were supported to attend health appointments when required and to see health and social care professionals as and when required.

Staff treated people with kindness, respect and compassion and cared for them according to their individual needs. People received care from staff that respected their views and maintained their privacy and dignity.

Care plans were detailed and provided staff with sufficient guidance to provide consistent care. People and their relatives were involved in making decisions about their care. Staff had a good understanding of people’s needs and preferences

Staff supported and encouraged people to develop and maintain hobbies, interests and relationships.

People and their relatives were encouraged to express their views on the service and provide feedback both formally and informally.

People knew how to make a complaint if they needed to, and were confident that the service would listen to them. The registered manager investigated and responded to people’s complaints in accordance with the provider’s complaints procedure.

We found that a system of audits, and reviews were used to good effect in monitoring performance and managing risks.

The service benefitted from good leadership and staff were positive in their desire to provide good quality care for people. The registered manager demonstrated a clear vision and set of values based on person centred care and independence.

Inspection carried out on 26 June 2013

During a routine inspection

When we visited Lomack Healthcare on 26 June 2013, we observed that people were offered support at a level which encouraged independence and ensured individual needs were met. There was a relaxed and calm atmosphere in the service we visited and people were at ease in the company of the staff supporting them. The staff were polite and respectful in their approach and interacted appropriately with people.

We noted that people were involved in planning their care and making decisions about their support and how they spent their time. Some people were at day centres at the time of our visit, and others were involved in carrying out tasks to support their personal development. One person confirmed the different activities and entertainment they participated in.

Within the care files we saw care documentation had been signed by the individual or their representative to confirm their involvement and agreement with their provision of care. We found evidence of mental capacity assessments being completed for people and full involvement of appropriate professionals in the decision making process leading up to such assessments.

We spoke with staff about their understanding of safeguarding, to ensure they had an effective working knowledge and could use this to protect people.

During our visit, we found written records, including staff files and people's individual care documentation were stored securely, maintaining confidentiality and protecting dignity and respect.

Inspection carried out on 28 January 2013

During a routine inspection

When we visited Lomack Healthcare on 28 January 2013, we observed that people were offered support that ensured their individual needs were met. Staff were friendly in their approach to people and engaged confidently with them, respecting their dignity and communicating effectively with people.

We observed that people were happy and relaxed in the home environment and noted that the atmosphere was calm and homely. We spoke with two of the five people receiving support from the service provider and they told us they were happy with both their home and the staff supporting them. This was also evident in their gestures and expressions which showed them to be at ease.

We spoke with three relatives who told us that they were very happy with the level of support that was provided. One person said, "The staff are caring, I have no concerns and am really pleased with how things are." Another person told us, "The staff are stars, I can't rate them highly enough."

We reviewed three people's care records and saw that they included comprehensive information to show how people should be supported and cared for. One person told us, "Staff look after me and I get to do what I want."

Inspection carried out on 9 March 2012

During a routine inspection

When we carried out this review on 09 March 2012, there were only two people receiving support from this service provider. Both of these people had very limited verbal communication, however when we visited them, we observed from their facial expressions, gestures and behaviours that they were happy and at ease with the staff that supported them. We also spoke with their family, who told us that the staff and the support was superb. They said �We could not wish for anything more�.

We observed the staff interacting with people in a caring and respectful way, and offering them choices using sign language to support their verbal communication.

People had Health Action Plans in place, which indicated that appointments with other health professionals such as opticians, dentists and chiropodists were made for them at regular intervals or when required.