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Inspection carried out on 4 October 2018

During a routine inspection

Links Lodge is a detached house situated in a residential area of North Shore, Blackpool. The home is registered to accommodate up to 10 adults, with a learning disability who require assistance with personal care. The home specialises in supporting people with learning disabilities who are living with dementia. Most rooms were single occupancy, with one double room available for those wishing to share facilities. Some rooms had en-suite bathrooms, and communal bathing facilities and toilets were available throughout the home. There were gardens to the front, side and rear of the house.

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 inspection visit took place on 04 October 2018 and was unannounced. At the time of the inspection 10 people lived at the home.

At our last inspection we rated the service Outstanding. On this inspection, we found the service had remained Outstanding. We found the evidence continued to support the rating of Outstanding 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.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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.

Most people had complex needs and were unable to tell us their experiences at Links Lodge. People able to speak with us and their relatives were very praising of the staff team. They told us they felt exceptionally safe and looked after by staff. We observed interactions between staff and people. These were frequent and friendly. It was clear from these interactions, people who lived at Links Lodge were the central focus of the staff team and were supported to have an excellent quality of life.

The service had built on their previous success and sustained the outstanding model of care and support provided to people living in the home. The registered provider and staff team continued to find ways to improve the service and remained focused and enthusiastic in the way they provided innovative care to the people they supported.

Staff had an excellent appreciation of people's individual needs and continued to be inventive in the ways they provided care and interaction. These included introducing a Danish concept for creating happiness and well-being called Hygge and ‘The Night Owl’ club. The systems used identified how to deliver an activity in a meaningful way. This information encouraged positive responses and created ‘golden moments’ which preserved and promoted continued well-being.

Social and leisure activities were many and varied and met people’s individual preferences. People were encouraged to be part of their local community and integrate into community groups in the area.

The exceptionally well managed and flexible staffing levels and skills met people’s needs and wishes. Recruitment was thorough and effective in appointing staff with the right qualities to give exceptional care. Staff support and supervision was frequent and training was in-depth, interactive and inventive.

People were actively involved in the decoration of their rooms which were geared around their needs and preferences. The house was clean, well maintained and homely. Many dementia friendly design features, such as sensory lights, projectors and themed wall art were incorporated into the décor. Specialist equipment was in place such as pressure

Inspection carried out on 23 December 2015

During a routine inspection

This inspection took place on 23 December 2015 and was an announced inspection. This meant the staff and provider knew 24 hours before the inspection we would be visiting. This was because we wanted to be sure that people would be at home.

Links Lodge is a detached building situated in a residential area of North Shore, Blackpool. The home is registered to accommodate up to 10 adults, with a learning disability who require assistance with personal care. The home specialises in supporting people with learning disabilities who are living with dementia. At the time of our visit nine people lived at the home.

Most rooms were of single occupancy, although one double room was available for those wishing to share facilities. Some rooms had en-suite bathrooms, but communal bathing facilities and toilets were available throughout the home. There were garden areas to the front and rear of the building and people were assisted to grow flowers, fruit and vegetables.

The service was last inspected in November 2014. They met the requirements of the regulations during that inspection and were rated overall as good.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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.

People indicated that they were very happy with the care they received and that they enjoyed the care and companionship of staff very much. People’s relatives told us the registered provider, management and staff team were superb. They said they were extremely approachable, available and willing to listen. They said staff involved them in their family member’s lives at every opportunity and they felt part of an extended family.

The service provided excellent and innovative care and support to people to enable them to live fulfilled and meaningful lives in a way they wanted. Staff were skilled at ensuring people were safe whilst encouraging those who wanted to enjoy adventurous activities to have as much independence as possible. Relatives were extremely positive about the care their relative received. One relative said, “The staff are fantastic, couldn’t be better.” Another relative told us, “I wouldn’t want [family member] to live anywhere else. The care is excellent and the activities are amazing.”

Risks to people were minimised because the registered provider had procedures in place to protect them from abuse and unsafe care. People who were able to communicate verbally, told us they felt safe and happy in Links Lodge. One person said, “I enjoy living here. The staff look after me and make sure I am happy.” Relatives told us that staff gave their family member’s the best possible care and it was ‘second to none’. They said that they knew their family members were safe. One relative said, “The staff care for the residents as if they were their own family. They are so careful with them and do everything possible and more.”

Staff demonstrated affection and warmth in their relationships with people. We saw people were delighted when they saw staff arrive in the home and were relaxed and contented when with them. Staff were patient and supportive, encouraging people to trust and communicate with them. One person used a helmet most of the time to protect their head when they moved into the home, as they caused themselves injury when they became agitated. Soon after they had started living at Links Lodge they no longer needed to wear this. Staff and the person’s relatives felt this was because they had other more positive ways of gaining staff attention and support and enjoyed a fulfilling lifestyle.

We looked at how the home was staffed. Staffing levels were exceptionally good and were geared around individual’s needs. People had personalised one to one care at a time that suited their needs. This ensured people had frequent and individual activities in the home and in the community. The registered provider increased staffing when people were deteriorating in health or at the end of life. This allowed people to remain ‘at the home’ to be supported by skilled and well trained staff who knew and cared for the person. Recruitment was safe and robust and people who lived at the home were involved in this where possible.

People’s health needs were pro-actively met and any changes in health managed well. Medicines were managed appropriately. They were given as prescribed and stored and disposed of correctly.

Staff received relevant and up to date training. The management team worked in partnership with dementia and learning disability organisations. They also used innovative systems developed by these organisations to make sure they were training staff to follow best practice. Staff were encouraged by the registered provider to develop ideas to enrich the support provided to people. This helped people to experience a level of care and support that promoted their wellbeing and encouraged them to enjoy a stimulating and meaningful life.

The staff team were passionate about providing exceptional care and routinely treated people with kindness and respect. They had an in-depth appreciation of people’s individual needs around privacy and dignity.

A variety of home-made food and of specialist produced soft diets were provided to people. Mealtimes were flexible and were relaxed and enjoyable. Staff used a number of different methods to increase people’s appetite, where people were underweight or reluctant to eat. Where people were watching their weight staff provided appetising low calorie food.

The management team had policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We spoke with the management team to check their understanding of MCA and DoLS. Relevant staff had been trained to understand when an application should be made. Where people lacked capacity staff made sure best interests meetings were carried out and their views and those of relevant people sought.

The vision and values of the staff team were imaginative and person-centred and made sure people were at the heart of the service. They looked at innovative ways of including people in planning their care, gaining their views and in choosing activities. They used signs, photographs, DVD’s, smells and objects of reference to encourage involvement. Relatives said that staff were always welcoming and helped them to continue positive and supporting relationships with their family members.

The home had a clear management structure in place. The registered provider worked in the home on a day to day basis and routinely monitored the care provided. The registered provider and staff team were experienced, knowledgeable and familiar with the needs of the people who lived at Links Lodge. They demonstrated how they had sustained outstanding practice, and pioneering development in the home. The management team continually researched new and innovative information and systems to improve people’s well-being. There were formal procedures in place to monitor the quality of the service. Any issues highlighted in the audits were quickly acted upon and any lessons learnt. The care planning / recording system allowed the management team to check what was happening at any time from the home or elsewhere.

Inspection carried out on 26 November 2014

During a routine inspection

This inspection took place on 26 November 2014 and was an announced inspection. This meant the staff and provider knew 24 hours before the inspection we would be visiting. This was because as a small home for people with learning disabilities, people are often out during the day.

Links Lodge is a detached building situated in a residential area of North Shore, Blackpool. The home is registered to accommodate up to ten adults, with a learning disability who require assistance with personal care. The home specialises in supporting people with learning disabilities who are living with dementia. At the time of our visit ten people lived at the home. Eight people had both learning disabilities and dementia.

Most rooms were of single occupancy, with one double room available for those wishing to share facilities. Some rooms had en - suite bathrooms, but communal bathing facilities and toilets were available throughout the home. There were garden areas to the front and rear of the building.

The service was last inspected in August 2013. They met the requirements of the regulations during that inspection.

The registered provider was an individual who also managed the home on a day to day basis. Registered providers 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.

Risks to people were minimised because the registered provider had procedures in place to protect them from abuse and unsafe care. People who were able to communicate verbally, told us they felt safe in Links Lodge. One person said, “I like it here. All the staff are good to me. They look after me.” Relatives told us that their family members were well looked after and were safe. They said that they had no concerns about their safety at Links Lodge. A relative said.” We are so happy with the care [our family member] gets. We can trust the home and staff and can go on holiday without worrying.” Another relative said, “[Our family member] is even safer there than with me.”

The management team had policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We spoke with them to check their understanding of MCA and DoLS. Where people lacked capacity, best interests meetings involving the person, relevant professions and relatives were taken over any important decisions and the discussions, the options considered and the agreements made recorded.

We looked at how the home was staffed. There were enough staff to meet people’s needs in the home and local community. People had personalised care at a time that suited their needs. We saw that the staffing was structured to the needs of the people who lived at Links Lodge and not the organisation. One person told us “I love it here. The staff are great - the best”. A relative said, [The provider] only has the best staff. They are all excellent.” Another relative commented, “It is a happy family run home with fantastic staff.

Recruitment was safe and robust. People were protected from unsuitable people working in the home because the home’s recruitment procedure was followed and appropriate.

Relatives told us the needs of their family members were very well monitored. They said staff quickly responded to any changing needs. They added they were informed about any needs identified, asked their views and involved in any decisions. One relative told us. “I have the utmost confidence in the staff. They are really on the ball.” Medicines were managed appropriately. They were given as prescribed and stored and disposed of correctly.

The staff team were very aware of the importance of eating and drinking well particularly as the people they supported had complex needs, learning disabilities and were living with dementia. Staff used innovative methods to enable people to have a varied, interesting and nutritious diet. They used a variety of ‘food smells’ and picture menu’s to enhance people’s appetites and choose food. Staff realised that one person used to thoroughly enjoy bacon sandwiches but now had a soft diet. They sought out a specialist food provider who made ‘pureed bacon sandwiches’. The person ate this ‘sandwich,’ smiling as they did so.

Staff had an in-depth appreciation of people’s individual needs around privacy and dignity. All staff routinely treated people with kindness and respect. A relative told us, “The staff are remarkable, they are always cheerful and caring. They are wonderful, they ‘go the extra mile’.”

Staff told us they had excellent access to training and were strongly encouraged to develop their skills and knowledge. One member of staff said, “You only have to ask for particular training and if it will benefit residents we get it, no problem.” The management team worked in partnership with dementia and learning disability organisations. They also used specific systems developed by these organisations to make sure they were training staff to follow best practice. This helped people to experience an exceptional level of care and support that promoted their wellbeing and encouraged them to enjoy a stimulating and meaningful life. A member of staff told us, “It is a privilege to work here. We make a real difference to people so they can still have a good life, going out and enjoying themselves as long as possible.”

The vision and values were imaginative and person-centred and made sure people were at the heart of the service. The staff team looked at innovative ways of including people in planning their care, gaining their views and in choosing activities. They used iPads and other technology to assist people in retaining skills and in activities. The service user guide, care plans and complaints procedures and newsletters were provided in easy read and DVD format. This meant more people could access them and to encourage people to be involved in making choices and understanding information about the home.

Staff were exceptionally focussed on people’s needs especially their individual communication needs. As several people did not have verbal or formal recognised communication staff observed and recorded their reactions to different events, situations and activities. We saw that people were showing evidence of great enjoyment and interest in the conversations with staff and despite their limited verbal communication these conversations were clearly not one sided. This showed the excellent communication skills members of staff had and their inspirational ability to encourage a high level of interaction with people.

Staff inspired people to try different and varied social and leisure activities so that despite their increasing dementia they were able to live life to the full. These included according to individual’s likes and dislikes, circus, shows, sports and music events and theatre. Staff used specialist equipment including light sensory equipment and music to assist relaxation. Staff had been on training to use iPad’s to their best effect and were enthusiastic about assisting people to use these. One member of staff told us, “It is amazing how these get people interested.”

The home had a clear management structure in place. The registered provider and management team were experienced, knowledgeable and familiar with the needs of the people who lived at Links Lodge. They frequently audited the quality of the service. Any issues highlighted in the audits were quickly acted upon and any lessons learnt.

Staff told us they were highly motivated and inspired by the registered provider and management team who researched new ideas on dementia care and learning disabilities and attended care shows in order to develop the service and improve care. People and their relatives told us the registered provider, management and staff team were approachable and available and willing to listen to people. One relative said, “This home is far superior to anywhere [our family member] has been before.”

Inspection carried out on 16 August 2013

During a routine inspection

The majority of people living at Links Lodge were unable to communicate with us verbally. However, during our inspection we were able to chat with one resident and a visiting relative. Both gave us positive feedback about what life was like at Links Lodge. They told us that the needs of people living at the home were being met by a kind and caring staff team and that the environment was always clean and tidy.

We found staff to be well supported and appropriately trained and those living at Links Lodge looked comfortable in their presence. Methods for monitoring the quality of service provided had been established and systems had been developed in order to protect the health and safety of those living at the home.

Comments from those we spoke with included:

“It is as near as you will get to home. They (the staff) always go that extra mile. They will come and give (name removed) a cuddle and a love, which he likes especially if he is distressed about something. There isn’t a staff member that wouldn’t give him a hug.”

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at the cleanliness of the environment and the control of infection. Standards relating to medications, staff training and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

Inspection carried out on 18 September 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care.

They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector and a practising professional.

We talked with five staff and several people who live at the home as well as family members.

We looked at the care plans for four out of the 9 people who lived at the home to see how their needs should be met.

We found that all the people who lived at the home were supported and encouraged to maintain their independence and family contacts. We also observed lunchtime. People living at the home told us in their own way that they were satisfied with the food provided by the home and if they didn't like something they would be offered an alternative and this would be provided.

On the day of our visit we saw that people were involved in pre planned individual activities. Staff also held some group activities during the inspection.

People living at the home told us that they felt safe at the home. They told us they had no concerns or complaints about their care. We observed that people living at the home were able to make their own decisions and indicate if they were dissatisfied with anything.

Records in relation to nutrition and health care needs were up to date, reviewed and were kept securely.

Reports under our old system of regulation (including those from before CQC was created)