Cheddle Lodge

We found the following examples of good practice.

¿ National guidance was followed on the use of personal protective equipment (PPE). Staff had received appropriate infection prevention and control training.

¿ Restrictions on visiting were in place at the time of the inspection. Arrangements had been made to enable people's relatives to visit safely, when guidance allowed.

¿ Procedures ensured social distancing could be maintained, whilst also enabling people to use communal areas of the home.

¿ The home was clean and well organised. The provider had purchased a number of sanitising fogging machines and had a regular programme of fogging and cleaning of bedrooms and communal areas. Additional cleaning was taking place throughout the home, including of frequently touched surfaces.

¿ There were procedures, policies and risk assessments to manage and minimise the risks Covid 19 presented to people who used the service, staff and visitors.

¿ Managers and staff worked closely with a range of external health and social care professionals.

We were assured that this service met good infection prevention and control guidelines.

Further information is in the detailed findings below.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 13 people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by how the service was organised and how people were supported. People using the service received planned and co-ordinated person-centred support which was appropriate and inclusive for them.

People’s experience of using this service and what we found

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The home was clean and free from malodours. Risks were well managed and health and safety checks in the home had been carried out. There was a programme of regular maintenance to the building and servicing of equipment. Staff were aware of their responsibilities in safeguarding people from abuse. Medicines were managed safely. Safe systems of recruitment were in place.

There were sufficient staff to meet people’s needs and staff received the induction, training and support they needed to carry out their roles. People's nutritional and health needs were met.

Staff knew people well and took a pride in providing kind and caring support. People’s individual communication styles were valued by staff. People had access to independent advocates. People’s preferences and routines were respected. Records gave detailed descriptions of how people liked their support provided.

Care records were person centred, reviewed regularly and updated when people’s needs changed. People took part in a wide range of activities that were based on their interests and hobbies.

There were good systems of quality assurance checks and audits. Everyone was positive about the registered manager and the way the service was run. The provider had notified the Care Quality Commission (CQC) of significant events such as safeguarding concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 16 October 2018) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of those regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection we found the provider was in breach of four regulations of the Health and Social Care Act 2014. You can see the action we have told the provider to take at the end of this report.

Cheddle Lodge is a ‘care home’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Cheddle Lodge is registered with CQC to provide accommodation for 13 people who require support and care with their daily living. The home is a single storey building situated in Cheadle, Cheshire.

The service had a registered manager in post. 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.

On our inspection we found some shortcomings in the safety within the home. Some hot surfaces posed a scalding risk to people, the electrical Portable Appliance Testing (PAT) had expired and we observed a fire door in the home being propped open which could have allowed unauthorised people into the home. When these were raised with the registered manager they were immediately addressed and measures put in place.

We also found some support workers had not received update training meaning their practices may not be in line with current best practice.

People’s consent was sought before any care or support was given. The authorisation for some people’s Depravation of Liberty Safeguarding (DoLS) had expired and new applications were submitted when this was raised with the registered manager.

People told us they felt safe. Support staff were able to explain the process for reporting any suspected abuse. Support staff told us they felt happy to raise any concerns they had.

We found staffing levels to be appropriate and staff had time to spend with people and the care given was unhurried. Appropriate checks were made on applicants before they started work.

People’s medicines were managed safely and in line with national guidelines. The home worked well with the local pharmacy and had procedures in place to prevent the over-ordering of medicines that the home had sufficient stocks of.

During the inspection we saw people being offered choices in all aspects of their daily living and their choices were respected.

Meals were freshly prepared in the home. At weekends the chef baked cakes and decorated them as the people living in the home requested. We saw people being supported patiently to ensure they ate and drank enough.

Bedrooms in the home were individually decorated according to the person’s choices. A senior support worker explained the rooms were decorated before people moved in but the person moving in, their family and their key worker were encouraged to make it look and feel as homely as possible.

We saw people being treated with care and compassion throughout our inspection. It was evident that the staff in the home knew the people living there very well. Staff were able to understand people’s non-verbal communication to ensure their needs were being met. People were encouraged to be as independent as possible.

People’s care records were detailed and contained a lot of information about the person’s background and preferences. Staff told us these were very useful either when new staff started or new people moved in for people to get to know each other.

Staff spoke highly of the registered manager in the home and the culture they promoted. Staff told us they felt happy speaking to the registered manager if they had any concerns either with individuals or the service generally and they felt they would be listened to.

This was an unannounced inspection of Cheddle Lodge on 29 April 2016. We last inspected the home in November 2013. At that inspection, we found the service was meeting all the regulations that we reviewed.

Cheddle Lodge is registered to provide accommodation for thirteen residents who require support and care with their daily living. At the time of our inspection the home was fully occupied. The home is a single story building situated in a residential area of Cheadle in Stockport. Care staff are available twenty-four hours a day to provide support and ensure the safety and well-being of the residents. All the residents have physical needs and some have learning disabilities. Cheddle Lodge is situated in its own grounds with a garden and small car park to the rear of the building.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the inspection. A registered manager is a person who has registered with CQC 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.

We found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014, and we have made two additional recommendations.

The home had a supervision policy which recommended staff receive a formal supervision every two months, but we found that this policy had not been adhered to, and some staff had not had a formal supervision from their line manager for over three years. This meant that staff were not receiving the appropriate support to enable them to carry out their duties effectively.

The home did not formally seek feedback from residents or their relatives about the quality of service provision.

When we looked at the complaints procedure we saw that this was written in a format which many of the residents may not be able to understand. We made a recommendation that this is reviewed and a separate complaints leaflet be produced so residents would be able to better understand how to make a complaint.

You can see what action we have told the provider to take at the back of the full version of the report.

We saw that Cheddle Lodge was clean and well maintained, and all rooms were fitted with tracking rails to assist with safe transfers into and out of beds and seats. Access to the building was secure and staff understood how to protect the residents from different forms of abuse. The service had whistleblowing and safeguarding policies and staff was aware of their responsibilities to report any untoward behaviour they might witness.

Residents were supported by a stable staff team who had worked together for a number of years and knew the residents well. We saw that there were enough staff and people told us that the staffing ratio reflected the needs of the residents.

Care records gave a good indication of resident’s abilities and provided a good description of their likes and dislikes. Where risk had been identified, risk plans were in place to minimise the risk of harm occurring. The staff were trained to administer medicines and we saw residents were assisted to take their prescribed medicines in a way they were comfortable with by staff who understood their needs.

The visitors we spoke to told us they believed the staff were competent and knowledgeable. We saw from training records that all new starters received a thorough induction and ongoing refresher training to maintain their competence. The service also provided bespoke training to assist staff to meet the identified needs of residents who lived at Cheddle Lodge, such as epilepsy training or training in supporting residents with swallowing difficulties.

Staff communicated well with each other and we saw that information was exchanged between staff informally throughout the working day, and a detailed handover meeting took place at the start and finish of every shift. This ensured that care staff were aware of any change in need and of any tasks which might need to be completed.

The registered manager and the care staff we spoke to demonstrated a good understanding of capacity and consent. When residents were being deprived of their liberty the correct processes had been followed to ensure that this was done within the current legislation.

Attention was paid to resident’s diet and residents were supported to eat and drink in a way that met their needs. We were told that the food was good and that they had enough to eat and drink.

Care staff at Cheddle Lodge monitored residents’ general health, and where specific healthcare needs were identified the service was proactive in seeking the right level of support; liaising with health care professionals to provide an appropriate level of support.

We saw residents were comfortable and well cared for. Staff were vigilant to residents’ needs and were able to respond in a timely way to requests for assistance. All residents had difficulty with speech but staff had learnt to understand and interpret what they were saying without being presumptuous. They respected needs need for privacy, but understood the risk of social isolation and did not leave residents unattended. Staff spent time talking with residents on a one to one basis or in small groups so that residents felt like they were included. A volunteer who was visiting the service said to us: “Residents have a life here…all the staff are looking for ways to engage with them”. We saw, and residents indicated to us, that they were happy living at Cheddle Lodge.

We saw that residents were encouraged to maintain hobbies and interests, and were supported if they wanted to go on holiday.

Relatives informed us that they were listened to, and felt comfortable speaking to any of the staff if they had any concerns.

The home had a registered manager who was respected by staff, residents and their relatives, and had a visible presence throughout the home.

To help ensure that residents received safe and effective care, systems were in place to monitor the quality of the service provided and there were systems in place for receiving, handling and responding appropriately to complaints, but these were not available in a written format which residents could understand.

We did however, speak to family members visiting the home or via the telephone. They provided wholly positive comments about the home, care and staff.

These comments included: 'I think it's marvellous'; 'My relative has really come on since they have been there' and 'The staff are A1, they are so kind.'

Another person visiting the home said if they had any problems they felt they could always talk to staff and the staff were 'marvellous'.

One family member told us they knew their relative was very happy and could 'see the changes' and could see how happy they were.

One person told us they rang the home every night and it was never too much trouble for staff. Another person said 'I am always involved in the care'.

All the family members we spoke to told us they were happy with the care and treatment provided by the home.