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Beech Lodge DEAF-initely Independent Good

Reports


Inspection carried out on 10 January 2019

During a routine inspection

What life is like for people using this service:

•There were enough staff to meet people’s assessed needs and support their planned activities.

•Risks which affected people’s daily lives, both in the home and out in the community, were documented and known by staff.

•Staff had completed safeguarding training and knew what to do if they were concerned about people’s well-being.

•Staff provided support for people to take the medicines they needed to remain well.

•People's needs were assessed and staff received training which enabled them to provide care and support in line with best practice.

•People were supported to choose what they wanted to eat and to maintain good health. Staff were aware that people’s needs could change, and understood when to involve other health care professionals and services when this was required.

•People were supported by staff to make decisions about their care. Staff used their knowledge of people’s preferred ways of communicating, to assist people to make their own choices.

•Staff treated people with empathy and kindness. Staff took a genuine interest in people, knew them well and had a good understanding of their social and cultural diversity.

• Staff treated people with dignity and respect and overall, promoted their independence.

•Care plans contained sufficient detail, and work was being completed to ensure they were even more personalised and expressed what was important to people.

•People benefitted from engagement in meaningful occupation that supported their interests and hobbies.

• Since our last inspection in November 2017, the registered manager and staff had worked together to improve outcomes for people.

•However, some improvements were still required to ensure the quality of record keeping was consistently maintained and messages were communicated effectively.

•The provider was exploring relationships with another charitable organisation to ensure the future sustainability of the service.

•People, relatives and staff were being supported to make their views known about the future direction of the service.

•We found the service met the characteristics of a “Good” rating in four areas and “Requires Improvement” in one area; More information is available in the full report

Rating at last inspection: Requires Improvement. The last report for Beech Lodge DEAF-initely Independent was published on 9 January 2018.

About the service: Beech Lodge DEAF-initely Independent is a residential care home. The service is delivered from two adjacent houses, Beech Lodge and Chestnut Lodge. It provides accommodation and personal care for up to 19 deaf younger adults, who may have learning disabilities or autistic spectrum disorder, a physical disability or a sensory impairment. Fifteen people were living at the home on the day of our inspection.

Deaf-initely Independent is a charitable organisation who is the service provider. It is overseen by a board of trustees who meet monthly.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service has improved its rating from Requires Improvement to Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 8 November 2017

During a routine inspection

We inspected this service on 8 and 21 November 2017. The first day of our inspection visit was unannounced. We returned on 21 November 2017 to follow up on some issues we had discussed with the registered manager during our initial visit.

Beech Lodge Deaf-initely is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is delivered from two adjacent houses, Beech Lodge and Chestnut Lodge. It provides accommodation and personal care for up to 19 deaf younger adults across a wide age range all of whom have learning disabilities and who may also have other challenges. Those additional challenges may include, for example, autistic spectrum disorder, mobility issues, some other sensory impairment or a combination of such. Fifteen people were living at the home on the day of our inspection. Deaf-initely Independent is a charitable organisation. It is overseen by a board of trustees who meet monthly and who is the service provider.

There was a registered manager in post 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.

At the last inspection in May 2017, the service was rated as requires improvement. We found a breach of the regulations because risks to people's health and wellbeing were not always managed and the provider did not have a clear understanding of their safeguarding responsibilities. We found the provider was not acting in accordance with the Mental Capacity Act 2005 and did not have effective systems in place to assess, monitor and improve the quality of care and manage risks to people's health and wellbeing.

Following the last inspection visit, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led.

At this inspection we found some improvements had been made. Systems and processes had been introduced by the provider and registered manager to monitor the quality of the service. However, the improvements needed to become embedded in every day practice to be consistently effective. Whilst ratings under the key questions of responsive and well-led had improved, the overall rating remains as 'requires improvement'.

The provider and registered manager had a better understanding of mandatory requirements around adult safeguarding and the Mental Capacity Act 2005. However, greater depth of knowledge was required to ensure the rights and wellbeing of people who lived in the home were consistently protected. The provider had submitted applications when people had restrictions placed on their liberty to ensure their safety. Management of risks had improved, but risk management plans were not always sufficiently detailed to provide staff with guidance about managing risks in a person centred way.

The atmosphere in both houses was homely and calm, and the relationship between people and staff was friendly. People were very comfortable with staff and enjoyed spending time talking and engaging in activities with them. Staffing levels were planned around people's needs and their daily activities. Since our last inspection staff had received further training to ensure they had the skills to meet people’s specific needs. Staff felt valued and supported in their roles, but felt reasons for some changes were not always effectively communicated to them.

People’s health and dietary needs were assessed and monitored. People were involved in managing their health needs and had a health passport to share vital information with other

Inspection carried out on 16 May 2017

During a routine inspection

We inspected this service on 16 May 2017. The inspection was unannounced. At our previous inspection in February 2015, the provider met the legal requirements.

The service is delivered from two adjacent houses, Beech Lodge and Chestnut Lodge. It provides accommodation and personal care for up to 19 deaf younger adults, who may have learning disabilities or autistic spectrum disorder, a physical disability or a sensory impairment. Fifteen people were living at the home on the day of our inspection.

There was no registered manager in post 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. A manager had been appointed in October 2016 but had not submitted their application to be registered with us.

Deaf-initely Independent is a charitable organisation. It is overseen by a board of trustees who meet monthly and who is the service provider.

There were enough staff to care for people effectively and safely. Staff were aware of the safeguarding procedures and knew what action to take to protect people should they have any concerns. However, the provider and manager had not always followed appropriate procedures to ensure people were kept safe from abuse and avoidable harm. Some incidents had not been referred to the local authority safeguarding team as required by the regulations. Where people’s care and support plans indicated a risk of self harm or a risk of harm to others, there were not always risk assessments to inform staff how to support people in a way that minimised those risks.

The provider and manager were not working in accordance with their responsibilities under the Mental Capacity Act 2016 and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments had not always been conducted in order to determine capacity levels prior to important decisions being made. People’s involvement in decision making had not been recorded, although we were told people were involved in making decisions about their care. Where care plans contained some restrictions on people’s liberty, the provider had not considered whether an application should be submitted to the authorising authority.

The provider checked staff were suitable to support people before they began working in the home and completed an induction to ensure they understood their role and responsibilities. There was a training programme in place to refresh staff knowledge and ensure they continued to work in accordance with best practice. However, staff required further training specific to the needs of people who lived in the home, particularly when people could display behaviours that could be challenging to themselves or others.

People had access to specialist services for their physical and learning disabilities and staff made sure they took their medicines safely and as prescribed.

There were friendly relationships between the people and the staff who provided their care and support. Staff communicated with people effectively using different techniques and took time to understand people’s individual needs. Staff tried to work in a person centred way and encouraged people to maintain and develop life skills. However, some of the procedures within the home did not always support person centred care.

Care plans reflected how people would like to receive their care, and included personal information, health needs, preferences, and daily living tasks. However, some care plans had not consistently been updated.

Staff were responsive to people’s social needs and encouraged them to participate in social events and activities that were meaningful to them.

Systems to monitor the quality of care to people were not consistently effective. The provider had not alwa

Inspection carried out on To Be Confirmed

During a routine inspection

We inspected this service on 16 and 18 February 2015. The inspection was unannounced. At our previous inspection in January 2014, the service was meeting the legal requirements.

There was a registered manager in post 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.

At the time of our inspection, Mr Timothy Wood was no longer the manager at this home, and an application for him to deregister was in progress. The person Marie Mason was no longer the responsible individual and an application to remove their name was in progress.

The service is delivered from two adjacent houses, Beech Lodge and Chestnut Lodge. It provides accommodation and personal care for up to 19 deaf younger adults, who may have learning disabilities or autistic spectrum disorder, a physical disability or a sensory impairment. Sixteen people were living at the home on the day of our inspection.

People who lived at the home told us they felt safe at the home and with the staff. People were safe because the manager and staff understood their responsibilities to protect people from harm. Staff were trained in safeguarding and risk assessment and knew how to maintain a balance between encouraging people’s independence and keeping them safe.

Care plans included risk assessments for people’s health and welfare and described the actions staff needed to take to minimise the identified risks. Staff understood people’s needs and abilities because they read the care plans and shadowed experienced staff until they knew people well.

There were enough staff on duty to meet people’s physical and social needs. The manager checked staff’s suitability to deliver personal care and to support people to live independent lives during the recruitment process.

The manager checked that the premises and equipment were well maintained and serviced to minimise risks to people’s safety. People’s medicines were managed, stored and administered safely.

Staff received training and support to enable them to meet people’s needs effectively. Staff had opportunities to reflect on their practice and consider their personal career development.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). No one was under a DoLS at the time of our inspection. Records showed that people, their families and other health professionals were involved in making decisions in people’s best interests.

People chose what they would like to eat and staff supported them to cook their preferred meals, according to their individual abilities in the kitchen. Staff referred people to other health professionals for advice and support when their health needs changed and supported people to follow the health professionals’ advice.

A relative told us they could visit at any time and always felt welcome. We saw staff understood people and treated them with kindness and compassion. Staff reassured and encouraged people in a way that respected their dignity and promoted their independence.

People decided how they were cared for and supported. Care was planned to meet people’s individual needs, abilities and preferences and to encourage their independence. People knew their complaints would be listened to and action taken to resolve any issues.

People who lived at the home were supported and encouraged to share their opinions about the quality of the service with a person they knew well. The staff, manager and trustees shared a common vision and values, including the aims and objectives of the service. People were supported and encouraged to live as independently as possible.

The provider’s quality monitoring system included regular checks of people’s care plans and staff’s practice. When issues were identified the provider took action to improve the quality of the service people received.

Inspection carried out on 23 January 2014

During a routine inspection

We spoke with six people who used the service and asked them their views in relation to the care they received. All the people indicated that they were very satisfied with the quality of care and support given.

We spoke with the parent of one person who told us that, “The care received is excellent. All the staff are caring and compassionate.”

We saw that people received their care in a positive and caring manner. We observed interactions between the people who used the service and staff during the day and found there was a relaxed and friendly atmosphere between them.

People were supported to take part in activities that were interesting and stimulating so that they had a meaningful lifestyle. People were able to choose what recreational activities to be involved in. This included gardening, college courses, eating out, going on holiday and swimming.

On the day of our inspection we found the home was clean. Housekeeping staff and support workers understood their responsibilities to prevent and control the spread of infection.

Medication systems were in place and monitored to ensure people received their medicines as prescribed.

Effective recruitment processes were followed when new staff were appointed and appropriate checks carried out before they commenced their new roles. All new staff completed a period of induction and training for their job role.

During a check to make sure that the improvements required had been made

We followed up on one area of non-compliance identified in a previous inspection on 11 October 2012. We reviewed evidence that demonstrated the provider's compliance in this area.

Inspection carried out on 11 October 2012

During a routine inspection

The home consists of two houses, Beech Lodge and Chestnut Lodge, which are situated next door to each other. We met and spoke with six people, from both houses, to ask for their views about living in the home. We used the services of an independent interpreter so that people could speak with us in their first language of British Sign Language. People told us they were well cared for and supported to maintain and develop their independence. We were told, "The staff are always there if I need help."

We asked to look at care plans and care records for four people, however the records were not available for us to see. We asked people to comment on the standard of care and support they received. We were told, "I don't want to live anywhere else" and "I am very happy with everything here."

The people we spoke with told us they led busy, active lives and had support from staff to go out and do things in their local community.

We looked at training records which showed that care and senior staff were provided with regular opportunities to update and develop their knowledge in order to meet people's needs. We were told, "The staff know to help me."

We saw that there were procedures in place to respond to suspected or disclosed abuse, so that people were not placed at risk of potential harm.

Inspection carried out on 8 April and 3 May 2011

During an inspection in response to concerns

People told us that they were happy living in their home and felt safe there. One person said that staff were “good”. Due to the complex communication needs of some people who live in the home it was not possible to receive their views, however observation of their interaction with staff showed that they were relaxed and comfortable in their presence.

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