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Inspection carried out on 6 November 2018

During a routine inspection

Shrub End Lodge provides accommodation and personal care for up to six people. It is a service for people who have a learning disability and/or autistic spectrum disorder. At the time of our inspection five people were using the service. The service is a single story building with communal areas and six bedrooms. The service is set in a residential area with easy access to the local community.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

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 ongoing 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 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.” Registering the Right Support CQC policy

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.

Staff knew people well and had some training to provide appropriate care and support to people in most situations. However, they had limited understanding and training in the mental capacity act and deprivation of liberty safeguards. Consequently, people were not always supported to have maximum choice and control of their lives in the least restrictive way possible. In addition some specific care need training had not been provided to staff supporting people with specific needs, such as Dysphasia Training, where a person is at risk of choking. Consequently we have made a recommendation around these learning needs.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risks to people were identified, assessed and where appropriate reduced or discussed with people. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. The management of medicines was safe and medication was administered by staff who were competent to do so.

People were supported to develop food choices, had their nutritional and hydration needs met and had a positive dining experience . Referrals were made to health professionals when required and health needs were being met on a day to day basis.

Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care that met their needs.

People and their relatives were involved in the planning of their care. Care plans were sufficiently detailed about a person’s care and support needs, and reviewed on a regular basis. People were supported to follow interests and participate in social activities of their choice and preference.

The service had quality assurance systems in place to monitor and support good care and these were reviewed on a regular basis. The registered manager had processes in place to deal with complaints

Further information is in the detailed findings below

Inspection carried out on 21 April 2016

During a routine inspection

Shrub End Lodge provides accommodation and personal care without nursing for up to six people. It is a service for people who have a learning disability and/or autistic spectrum disorder.

There were five people living in the service when we inspected on 28 April and 26 June 2016. This was an unannounced inspection.

There was a registered manager in post. The registered manager was also the provider. 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.

People received care that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner. They were knowledgeable about people’s choices, views and preferences and acted on what they said. The atmosphere in the service was friendly and welcoming.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care. Procedures and processes guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

People were supported to make decisions about how they led their lives and their views were central to how the service was provided. People were supported in accordance with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and met. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

There was an open and transparent culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. Audits and quality assurance questionnaires were used to identify shortfalls and drive improvement in the service.

Inspection carried out on 18 November 2013

During a routine inspection

We talked with four people who used the service to gain their views and experiences. They told us their needs were met and staff treated them well. One person told us, �I love it here, it�s great. It is my home, I like it. Everyone is like a family to me.�

People confirmed they were consulted about the care and support that they were provided with and understood the care and treatment choices available to them. One person told us, �They (staff) talk to me and make sure I am ok and look after me if I need it. If I am sick they take me to see the doctor.�

We looked at three people�s care records which provided information for staff on how to meet people�s individual health and care needs. We saw that people�s choices and preferences were reflected in the care records and written in a way that promoted their independence.

We spoke with four people about the quality of the food. Feedback was positive.

People we spoke with told us they felt safe at Shrub End Lodge and trusted the staff and provider. They confirmed they were looked after by staff and their needs were met.

We looked at staff records and spoke with two members of staff who told us they were being appropriately supervised and supported. Staff we spoke with were knowledgeable about the people they supported and how to meet their needs.

We saw that the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided.

Inspection carried out on 4 February 2013

During a routine inspection

We spoke with three of the four people living at the home.They said they were happy and were supported by the staff to take part in various activities outside of the home. One person told us that they organised, chaired and took minutes for a resident's meeting once a month.They also told us that they had just been involved in interviews for a new member of staff. One person said "I really like it here.They have helped me to improve myself. I go to college and I'm doing well."

The plan of care was detailed about the individual needs of the person living at the service. The care plan had been signed and dated by the person receiving the care. There were records of review of the plans and a record of the daily activities chosen by the person involved.

The provider had made arrangements with a pharmacy to supply medication to the home. Staff had received training in the safe administration of medication.

The provider had made arrangements for sufficient staff to work at the home to provide support to people. Staff had the appropriate qualifications and experience to care for the needs of the people who lived at the service.

We found that people were not directly aware of the complaints process but told us that if they had any concerns they would raise them with the staff or the manager. One person told us, "I would speak with staff and they would help me." Another said "I don't have any complaints. I am very happy here."

Inspection carried out on 18 August 2011

During a routine inspection

When we visited Shrub End Lodge on 18 August 2011 some of the people living there were not at home; one person was visiting relatives and others were out doing some planned activities. The two people who were at home were getting ready to go out shopping. We stayed for a short time talking to the two people living in the home and told them that we would return another day as we did not wish to interrupt their planned shopping trip. One person told us that they would be on holiday the following week and if we wanted to have a chat we should come back after that.

On the day of our second unannounced visit, three of the people living at Shrub End Lodge were out doing social activities. The two people who were at home spoke with us about general things and told that they liked living at Shrub End Lodge.

One person told us, �I�m happy dear.�

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