Archived: Denmark Lodge

Denmark Lodge had been developed and designed in line with the values that underpin the Registering the Right Support, Building 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 lived as ordinary a life as any citizen.

This inspection took place on 2 January 2019. At the last comprehensive inspection in April 2016 the service was rated as Good overall. The key question Effective was rated as requires improvement with a recommendation for improving recording systems for the supervision of staff. Improvements had been made in relation to this. At this inspection we found the evidence continued to support the rating of good overall 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.

At this inspection we found the service remained Good.

A registered manager was in post who had been registered with the Care Quality Commission (CQC) in 2010. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

People’s care and support was individualised and reflected their needs and wishes. They had lived together for some time and had been supported by a core group of staff providing them with consistency and continuity of care. People made choices about their day to day lives. 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 were involved in the planning and review of their care and support. They chose the activities they wished to take part in. They went bowling, swimming, to the cinema and attended a fitness class. They went on holidays, day trips, to social clubs and attended local places of worship when they wished to. People kept in touch with those important to them

People’s preferred forms of communication were highlighted in their care records. Staff were observed spending time chatting and socialising with people. Good use was made of easy to read information which used photographs and pictures to illustrate the text. People had access to easy to read guides about advocacy and complaints.

People’s health and wellbeing was promoted. A weekly menu encouraged people to have vegetables and fruit in their diet. They helped to prepare and cook their meals. People had access to a range of health care professionals. They had annual health checks. People’s medicines were safely managed. People were supported at the end of their live and others were helped with their bereavement. A relative commented, “Thank you for giving so much help and care, with so much love and patience.”

People had positive relationships with staff, who understood them well, anticipating what would make them anxious or uncertain. Staff treated them with kindness and compassion. They understood and respected people’s diverse needs. Staff knew how to keep people safe and how to raise safeguarding concerns. Risks were well managed encouraging people’s independence. There were enough staff to meet their needs. This was kept under review as new people moved into the home. Staff recruitment and selection procedures were in place to ensure all necessary checks had been completed prior to employment.

People, their relatives and staff were invited to give feedback through quality assurance surveys, meetings, complaints and compliments. They had information about how to raise a complaint. The registered manager and provider completed a range of quality assurance audits to monitor and assess people’s experience of the service. Any actions identified for improvement were monitored to ensure they had been carried out. The registered manager worked closely with local organisations and agencies and national organisations to keep up to date with current best practice and guidance. Comments about Denmark Lodge included, “An excellent well run facility” and “Excellent care and support for each individual.”

Further information is in the detailed findings below.

We last inspected the service on the 9 September 2014. At this inspection we found the provider was meeting all of the requirements we inspected.

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.

Support workers had not always received access to supervisions and appraisals. Support workers were supported by a committed registered manger and had access to training and professional development. There were enough staff with appropriate skills, deployed to meet the needs of people living at the home. People, their relatives and support workers spoke positively about the home and the continuity of care staff.

People and their relatives were positive about the home, the support workers and registered manager. People were safe and looked after well at the home. Support workers managed the risks of people’s care. They ensured people had the medicine they needed to meet their needs and their on-going healthcare needs were met. People received a healthy and balanced diet.

People enjoyed living at the home and were supported to live active social lives, which included attending activities and events in the community. People were supported to be involved in day to day activities, such as baking and cleaning.

The registered manager ensured people, their relatives and external healthcare professional’s views were listened to and acted upon. The registered manager ensured support workers were involved in day to day decisions and promoted support workers to take on responsibilities such as key worker duties. Relatives and healthcare professionals spoke positively about the registered manager and the home.

During our inspection we spoke with the registered manager and three other members of staff. We also reviewed records relating to the management of the home which included seven support plans and staff training records.

The focus of this inspection was to answer one of the five questions we always ask; is the service safe? Below is a summary of what we found. The summary describes what staff told us, what we observed and the records we looked at.

Is the service safe?

The staff had received training to help them assess whether someone had the capacity to make a decision and what to do if they lacked capacity. Staff demonstrated they understood the principles of the Mental Capacity Act 2005 (MCA) and were acting on them.

Records were being kept of capacity assessments and best interests decisions. The most important information was being recorded but some relevant detail was lacking. The registered manager told us they would review the records and add the missing information.

No applications to deprive someone of their liberty had been submitted under the Deprivation of Liberty Safeguards to date. The registered manager was in the process of submitting applications to the local authority and understood when an application should be made and how to submit one.

People appeared relaxed and those people we asked told us it was 'alright' living at the home.

We observed staff seeking people's consent whilst providing care in all interactions with people with the exception of one instance. Clear guidance was not in place in relation to assessing people's capacity to make decisions.

We observed care being delivered in line with people's individual care plans. People we spoke to told us about a range of activities they were supported to do. One person told us 'I go to my club every Wednesday, I cook. I like fish and I have it every Friday'.

There were systems in place to ensure medicines were kept and administered safely. We observed staff administering medicines in a competent manner. People confirmed that staff gave them the support they needed with their medicines.

There were enough staff on duty with sufficient training to meet people's needs. One person told us 'I have (staff) as my keyworker. They take me out, talk to me'.

There was a complaints system in place and one person told us that if they had a problem 'I would talk to someone. I talk to everyone here'.

We spent time in the communal areas and staff interacted positively with the people living in the home. People told us that they were happy. Everyone appeared calm and happy during our visit.

We spent time observing the care provided and saw positive interactions between staff and people using the service. People were supported to be as independent as possible. People were encouraged to take part in general tasks around the home such as making drinks and emptying the dish washer. We could see that people felt comfortable with staff.

The environment in the home was pleasant and well planned. This enabled effective cleaning and also ensured people could move around safely and easily.

A range of activities was open to people, including voluntary work at a garden centre, swimming and craft sessions. There were planned activities and these varied depending on how well people felt. One person told us that 'there are lots of activities to do'.

Staff told us that they felt well supported by the service manager. They felt confident about their skills and training. Most staff felt that they worked together as an effective team.

One person was shouting at other people living in the home. There was not enough evidence of actions taken by the home to minimise the risk of this behaviour upsetting other people living in the home.