Stokelodge

At the time of the inspection nine people were living at the home. The service is a residential home that has been developed and adapted in line with the values that underpin the Care Quality Commission's 'Registering the Right Support' and other best guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can lead as ordinary life as any citizen.

The home had a registered manager. A registered manager is a person who has registered with the 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.

This comprehensive inspection took place on 18 December 2018. The inspection was unannounced, which meant the staff and provider did not know we would be visiting.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. 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 our last inspection in March 2016 we found the provider required to improve their provision of staff training in relation to supporting people living with autism. At this inspection we found the provider had made the required improvements and now ensured staff had completed the necessary training.

During this inspection we identified the service had improved and now delivered outstanding personalised care that was responsive to people's needs. People experienced exceptional care that was extremely flexible, to their individual changing needs and preferences. People and relatives regularly reported that the dedicated staff team consistently went the extra mile to make people’s dreams come true. The care provided to people, achieved exceptional outcomes, enriching the quality of their lives and improving their physical and mental wellbeing.

Staff were particularly skilled at helping people and their families to explore and record their wishes about care at the end of their life, which made them feel empowered, valued and listened to.

The registered manager sought the views of people and their relatives and reviewed complaints to drive improvements in the home.

People were protected from avoidable harm by staff who received the required training and understood their responsibilities to safeguard people. Risks to people had been identified and were managed safely. The provider had enabled staff to develop and maintain the necessary skills and knowledge to deliver effective care to meet people’s needs. The registered manager ensured there were always sufficient suitable staff deployed to support people safely.

Staff knew people well and delivered their care in accordance with detailed assessments, which were reviewed regularly. People were protected from the risks associated with malnutrition and supported to eat a healthy balanced diet. 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. Staff quickly referred people to external services, when required to maintain their health.

Staff supported people to maintain required standards of cleanliness and hygiene in the home, which reduced the risk of infection. Staff followed required standards of food safety and hygiene, when preparing or handling food.

Staff promoted people’s independence, self-esteem and confidence, whilst treating them with dignity and respect. Staff consistently considered people’s needs regarding equality and diversity.

People were supported to take part in stimulating activities of their choice and to maintain relationships with their families and those that mattered to them.

The service was well led by the registered manager, who inspired staff to deliver care and support in line with the provider’s core values, which promoted people’s dignity, independence and choice.

The provider operated effective performance management processes to monitor the quality of service being delivered, which were reviewed regularly, and reflected best practice.

The registered manager had developed good links to local community, that reflected the needs and preferences of the people who used the service.

Further information is in the detailed findings below.

Stoke Lodge is a care home which provides residential care for up to nine adults with mild to moderate learning disabilities. People receiving the service also live with complex emotional and behavioural needs including Autism. Some people living at the service also had additional health conditions such as epilepsy and cerebral palsy. The care home comprises of two floors with its own secure garden and is situated on the outskirts of Basingstoke town centre. At the time of the inspection nine people were using the service.

Care was provided by support workers who will be referred to as staff throughout the duration of this report.

Stoke Lodge has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

Relatives of people using the service told us they felt their family members were kept safe. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues to ensure they had the skills and confidence required to support people safely. There were sufficient staff employed to ensure that people’s individual needs were met.

People were not always supported by staff who had the most up to date training available to enable them to proactively meet people’s individual needs. Staff were able to demonstrate that they were able to meet people’s basic individual needs. However the provider had not ensured that staff had received appropriate formalised training to ensure they could develop people’s communication skills.

Contingency plans were in place to ensure the safe delivery of people’s care in the event of adverse situations such as large scale staff sickness or accommodation loss due to fire or floods.

People were protected from the unsafe administration of medicines. Staff responsible for administering medicines had received training to ensure people’s medicines were administered, stored and disposed of correctly. Staff skills in medicines management were regularly reviewed by the registered manager to ensure they remained competent to administer people’s medicines safely.

People, where possible, were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. The home promoted the use of advocates where people were unable to make key decisions in their life. This is a legal right for people who lack mental capacity and who do not have an appropriate family member of friend to represent their views.

Staff sought people’s consent before delivering their care and support. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

People were supported to eat and drink enough to maintain a balanced diet. People were involved in developing the home’s menus and were able to choose their meal preferences. We saw that people enjoyed what was provided. People were supported to participate in meal times with the guidance provided by health care professionals being followed. Records showed people’s food and drink preferences were documented in their care plans and were understood by staff.

People’s health needs were met as the staff and the registered manager had detailed knowledge of the people they were supporting. Staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. Personal external relationships were supported and a range of activities sought to enrich people’s daily lives. The registered manager and staff were motivated to ensure that people were provided with the opportunity to experience holidays and participate in a range of external activities.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager showed a comprehensive understanding of what constituted a deprivation of person’s liberty. Appropriate authorisations had been granted by the relevant supervisory body to ensure people were not being unlawfully restricted.

Staff had taken time to develop close relationships with the people they were assisting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These were practically demonstrated by the registered manager and staff.

People received personalised and respectful care from staff who understood their care needs. People had care and support which was delivered by staff using the guidance provided in individualised care plans. Care plans contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. People were encouraged and supported by staff to make choices about their care including how they spent their day within the home or in the community.

Relatives knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way although none had been received since the last inspection. Relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager. Information was made available in alternative formats to allow people receiving the service to provide their feedback or complaints, thereby enabling them to feel valued.

The registered manager and staff promoted a culture which focused on providing individuals with the opportunities to live their lives as members of the community promoting their independence. People were assisted by staff who encouraged them to raise concerns with them and the registered manager. The provider routinely and regularly monitored the quality of the service being provided.

The provider’s value of care was communicated to people and understood by staff. We saw these standards were evidenced in the way that care was delivered to people.

The registered manager provided strong positive leadership and fulfilled the legal requirements associated with their role. The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe. Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided.

Relatives told us and we saw that the home had a confident registered manager and staff told us they felt supported by the registered manager.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service well led?

' Is the service responsive?

This is a summary of what we found.

Is the service safe?

Representatives of people who used the service were complementary about people's safety being maintained by the provider. Parents of people told us that they trusted the manager and staff to keep their relatives safe and well. One relative told us, 'The staff really do care. He is definitely in the right place, which is why I can sleep at night.'

People were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We found that the provider had an effective process to manage medicines safely. During our inspection we observed two care workers administer medicines appropriately, in the way people preferred, detailed within their medication plan.

People were cared for by suitably qualified, skilled and experienced staff because the provider had an effective recruitment and selection process. The provider had completed all necessary checks to ensure that people received care and support from competent and trustworthy staff.

Where people did not have the capacity to consent the provider acted in accordance with legal requirements. We found that staff had received training in relation to the Mental Capacity Act 2005 and had a clear understanding of the main principles. We saw decisions effectively recorded using the local authority toolkit for mental capacity assessments. For example, one assessment dealt with a person's fluctuating capacity to make significant financial decisions. We saw that best interest decisions had been made involving the person, their parents, health professionals and staff from the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS )which applied to this service. The DoLS are a legal process supported by a code of practice to ensure that people who lacked mental capacity to make decisions were not deprived of their liberty, other than in accordance with the law. While no applications had needed to be submitted for the people who used the service, appropriate policies and procedures were in place. Staff had been trained to understand when an application had to be made, and how to submit one.

Is the service caring?

We observed that staff encouraged and supported people in a professional and caring manner throughout our inspection. Our observations confirmed that staff were patient and people were able to do things at their own pace and were not rushed.

Relatives of people who used the service told us that the staff treated people with respect and dignity. One relative told us, 'Care at Stoke Lodge has always been good but since the new key worker arrived it is simply wonderful. If you see them (key worker and relative) together you can see there is genuine warmth and friendship.'

Is the service effective?

Staff had received training to meet the specific needs of the people living at Stoke Lodge. Examples of such training included the management of special dietary requirements and appropriate intervention techniques.

The provider had sought expert guidance in relation to one person's care plan and had arranged for staff to be trained by a specialist dietician. Parents of one person told us, 'The food is excellent and all the staff know how much protein is in what. To be honest they know much more about what is good for him than we do.'

All staff had been taught a recognised system for supporting people to manage their behaviour where this was necessary. Positive behaviour management and sensitive physical interventions ensured people's human rights were protected.

Is the service responsive?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The support plans were detailed and had appropriate risk assessments in place. Care practices we observed demonstrated that staff knew the needs of people and care was delivered in accordance with their care plans.

We reviewed the transition plan of one person who hoped to move into Stoke Lodge in the near future. The service had arranged several familiarisation visits for the person and their representatives. This meant that the provider had allowed people time to decide whether or not they wished to use the service and to allay any fears or anxieties.

Where people had more complex health needs we saw there were specific plans which detailed the care required and how to deliver it. We saw that one person had an epilepsy care plan. We reviewed their daily records and found that care had been delivered in line with their epilepsy plan and that monitoring had been appropriately recorded. Staff we spoke with knew the immediate action required to ensure the person's safety if they had a seizure whilst engaged in activities within the community.

Is the service well-led?

The provider had systems in place to regularly assess and monitor the quality of service that people received. These included collecting feedback from people, their relatives and staff. The provider also completed quarterly compliance audits to monitor the quality of the service.

The provider had a satisfactory complaints process. We reviewed the complaints file and saw there had been one complaint since the last inspection. The manager had acknowledged this complaint and completed a brief investigation. The complainant had been satisfied with the provider's response.

We saw the provider's business improvement plan for the service. We noted that identified actions in relation to improving the communication aids within the service and people's living environment had been completed.

Family we spoke with made positive comments about the staff and quality of the health care being provided. One parent said, 'We're absolutely thrilled to bits. The manager and key worker are brilliant. He is really happy at Stokelodge and they have gone out of their way to keep him safe. We couldn't wish for a better home.'

We saw that people had effective plans in place to protect them from potential harm and abuse. All parents said that staff were skilled in managing challenging behaviour and that their sons were happy living at the home.

Since the last inspection there had been three incidents reported involving missed medication. We found an open culture at the home relating to these errors and saw that they had been reported, recorded and investigated effectively.

Parents told us that the staff provided excellent care, which gave them confidence in the quality of their training. Staff we spoke with gave examples about the sensitive handling of personal issues by the manager, which allowed them to produce their best for the people they supported.

We found a broad range of self auditing which ensured the manager could identify, assess and manage risks relating to the welfare and safety of people being supported.

People's needs were assessed and care was delivered in line with their individual care plans, which were person centred and detailed the support needs of people. Parents of people using the service told us they were very happy with the variety and suitability of activities available. One parent told us, 'I know he is really happy there because he always has a smile on his face'. Another said, "He loves it there".

People who use the service were protected because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One parent said, 'I am really, really happy. They have gone out of their way to ensure my son's safety.

Medicines were kept safely and administration was accurately recorded. We saw one person being given their medicines in a safe and respectful way.

We found that all staff received a comprehensive induction relevant to their workplace and role. This meant they were able to deliver care and treatment to service users safely and to an appropriate standard.

We saw an effective system of monitoring which ensured the manager could identify and manage risks relating to the health welfare and safety of service users.