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Inspection carried out on 18 September 2018

During a routine inspection

The inspection took place on 18 and 25 September and was unannounced.

Hunter’s Lodge is a 'care home' which provides accommodation and personal care for up to ten people with a learning disability, mental health needs, an acquired brain injury or multiple complex needs. At the time of our inspection visit, ten people were living at the 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 required to have a registered manager and there was 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.

At the last inspection on 17 February 2016, the service was rated Good. At this inspection, we found the service remained Good.

Staff received training in, and understood, their responsibility to protect people from abuse and neglect. The risks associated with people’s care and support needs had been assessed, kept under review and plans were in place to manage these. The provider’s staffing arrangements meant people’s needs could be met safely, and in a person-centred way. People received their medicines safely and as prescribed. Steps had been taken to protect people, visitors and staff from the risk of infection.

People's individual needs and requirements were assessed prior to them moving into the home. Staff received an effective induction, further training and ongoing management support to enable them to succeed in their roles. People had support to eat and drink safely and comfortably, and any associated risks or complex needs were assessed and managed. Staff played a positive role in helping people maintain their health and attend routine medical appointments. People's rights under the Mental Capacity Act 2005 were understood and promoted by staff and management.

Staff approached their work with kindness and compassion. People had support to express their views and opinions, and participate in decision-making that affected them. People's privacy, dignity and independence were promoted by staff and management.

People received person-centred care and support, which reflected their individual needs and requirements. They received support from staff to participate in a range of recreational and social activities, based upon their known interests and preferences. The provider had procedures in place to promote good complaints handling.

The management team promoted an open and inclusive culture within the service. People, their relatives and staff felt able to approach the management team at any time. Staff benefitted from effective leadership, and felt valued and well-supported in their work. The provider carried out audits and checks to assess and improve the quality of the care and support people received.

Further information is in the detailed findings below.

Inspection carried out on 17 February 2016

During a routine inspection

This inspection took place on 17 February 2016 and was unannounced.

Hunter’s Lodge is registered to provide accommodation for personal care for a maximum of 10 people with learning disabilities or autistic spectrum disorder. There were six people living at the home on the day of our visit. At the time of our inspection, there was 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.

People told us they felt safe and supported by the care staff and were protected from the risk of abuse. All care knew each person which helped them to understand and reduced their risk of harm or abuse. Care staff were consistent in helping people with any anxiety or distress by providing reassurance and guidance. Care staff told us that helping people to live in a calm and relaxed environment reduced the risk of abuse to people living at the home. All staff felt confident in recognised the potential signs of abuse and would report these through the senior staff or management at the home.

People had care staff that were available and there were sufficient numbers of staff to provide care to all people living at the home. Where people had risks identified as part of their daily living, care staff provided support to reduce those risks. People told us they received their medicines as prescribed and at the correct time.

People were cared for by care staff who told us their training reflected the needs of people who lived at the home. Where people had not been able to consent to certain aspects or decisions about their care, records of decisions had been completed.

People had access to snacks and meals throughout the day and night. Where people required support to prepare their meals care staff helped them. People had accessed other healthcare professionals to support them.

People told us they like the care staff and had developed positive and respectful relationships and care staff were very kind and caring in their approach. People’s privacy and dignity were respected and were supported and empowered to be independent in all aspects of their lives.

People were involved in the planning of their care and told us they were regularly involved in updating these. People’s care plans recorded their care needs in an individual way that reflected their preferences and life histories.

People were happy to raise any concerns or worries directly with the care staff who were able to provide solutions or answers at that time. The registered manager was keen to answer people’s concerns and we saw this happing when people raised concerns with them.

People were seen to approach and make request through the day with all staff, including the registered manager. The registered manager told us it was important that they were approachable and visible within the home which helped them monitor and maintain a home which people liked.

Inspection carried out on 15 April 2014

During a routine inspection

We carried out an inspection on 15th April 2014. We talked with the manager, the operational manager, the staff and we reviewed information given to us by the provider. We met and spent time with five of the eight people living at Hunters Lodge. They were able to express their views about the service and we saw they all appeared to be happy and relaxed.

Below is a summary of what we found. The summary is based on our observations during the inspection, observations of people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

From our observations and from the information we saw set out in care plans, policies, procedures and audits the provider�s safety monitoring systems were robust. The staff showed that they had a clear understanding of their role in providing care and safeguarding the people they supported. The staff demonstrated that they knew the people well and had read and understood the instructions set out in individual care plans.

We saw evidence that people were supported to make decisions for themselves and develop their independence. The care plans set out detailed instructions for staff as to how each person could give consent. When people lacked the capacity to make important decisions, meetings were held to make decisions for them that were in their best interests.

We saw that everyone was encouraged to eat a healthy balance diet. The staff received regular training in nutrition and food hygiene.

From our observations and from the information we saw set out in policies, procedures and audits the provider�s hygiene monitoring systems were robust.

The staff we spoke with understood about the risk management plans that had been written for all the people and how these met with their particular needs. Staff demonstrated that they understood how to show people respect and maintain people�s dignity at all times.

The manager told us that there were no deprivations of liberty safeguards in place for the people living at Hunters Lodge. They said that in the light of new guidance they were in the process of making applications for several people who required supervision to leave the grounds on their own.

The staff rotas showed that the manager had taken people�s care needs into account when making decisions about the number of staff required, the skills mix and experience staff would need. The rotas showed where necessary additional staff had been used with bank workers and overtime to ensure safe staffing levels were maintained. The night time staffing levels and on call system showed that out of main hours the staffing provision was safe.

There were systems in place to make sure that management and staff learned from events such as accidents and incidents, complaints, concerns and investigations. This meant that people were benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People�s health and care needs had been assessed and care plans were in place. There was evidence of people and their representatives being involved in assessments of their needs and planning their care.

Specialist health care needs were always assessed and included in care plans and health action plans. Specialist health and social care professionals regularly gave input to the service. All care, activity and risk assessment plans were being reviewed regularly. Every person had a representative and advocacy services were available if required.

We saw that the people living at Hunters Lodge were being supported to develop their learning and independence. We were told about the activities they enjoyed and what they wanted to do in the future. The staff we spoke with told us how they worked with each person to support them to undertake the things they wanted to do.

Is the service caring?

We observed during our visit and saw in people�s care plans that people were supported and encouraged to live full and active lives. People took part in a wide range of leisure and social activities. We were told by the manager that future activities were being organised to include families and promote friendships. We saw that everyone was supported to access the activities they enjoyed.

The staff we spoke with demonstrated to us that they were committed to providing the best levels of care and to facilitate activities for the people who used the service. They demonstrated to they were aware of potential risks, people's rights and their responsibilities.

Is the service responsive?

We found that care plans were person centred and contained lots of information about people's choice and preferences. We saw that everyone�s care plans contained detailed information about each person�s support preferences.

We found that people's health and care needs were being regularly assessed. There was regular input from external social care and health professionals when needed.

We were told that the service satisfaction questionnaire was being developed to allow families and representatives to comment on the service provided at Hunters Lodge. The survey was to be sent out in the next couple of months.

We saw when we reviewed the complaints log that there had been no complaints or concerns made in the last twelve months. We were told by the operational manager that any complaints or concerns which were received by the provider organisation were always taken very seriously and action taken to resolve the issue.

We were told about and we saw that staff received regular training to meet the support needs of the people who used the service. Training had been provided about the care and support of people with epilepsy and autism.

We were told by the registered manager how people were supported when a hospital admission was required. This support was provided by the provision of additional staffing from Hunters Lodge and support from the hospital liaison nurses. When a person went into hospital they took with them a hospital passport with information about the person and their care needs.

Is the service well-led?

The provider has had stable staff team for some years. There have been changes in the management of the home and a new manager has recently taken up the post. There is a clear management structure within the service and the provider organisation. From the discussions with the manager, they were knowledgeable about the service, the people and staff. They met with their managers and peers regularly to maintain up to date knowledge. The operational manager told us that other senior staff from the provider organisation regularly visited the premises to speak to the staff and the people who lived there.

The provider had a quality assurance system in place. Records seen by us showed that any shortfalls identified had been addressed. There were systems in place to provide feedback to staff about changes and developments at team meetings, the communications book.

The staff we spoke with had a good understanding of the provider�s policies and procedures. Information was readily available on the provider�s computer system which all the staff were able to access. Information was available around the building on �easy read� posters about safeguarding and speaking out. All the staff we spoke with said that if they witnessed poor practice they would report their concerns.

Staff we spoke with told us that they had worked with the people who lived at the home for some time and really enjoyed their work. They told us that there was a good team spirit and everyone stepped up to take on responsibly while they were without a manager. They said that they now felt they were supported by the manager and involved in the development of the service.

Inspection carried out on 5 September 2013

During a routine inspection

When we visited Hunters Lodge we met seven of the eight people who lived there. We spoke with some in private about their views and experiences. We met the manager and some of the staff.

People told us they were very satisfied with the support they received which helped them be as independent as possible. They felt safe in the home and could raise any concerns to the staff who they liked and trusted.

We found that people were encouraged to be independent, get involved in activities of their choice and access the local community facilities.

People were supported to make decisions for themselves whenever possible. Their wellbeing and any concerns were taken seriously. The team sought input from external professionals when needed.

A full staff team was in place and a full staff compliment on most shifts had benefitted people in the home. Information was shared effectively between staff. The environment had been significantly improved and was clean and homely. The staff were suitably trained and felt well supported.

There were effective leadership arrangements in place to manage the care service and monitor health and safety risks.

Inspection carried out on 11 October 2012

During a routine inspection

When we visited Hunters Lodge we met six people who lived there and spoke with four about their experiences. We met the manager and five of the staff. People told us they were very satisfied with the support they received which helped them be as independent as possible.

We found that people were supported in promoting their independence and community involvement. Their diversity, values and human rights were respected. People told us they liked the staff and they provided good care and support. They felt safe and were able to raise any concern they had. Suitable systems were in place to support people with their medicines.

We looked at staff training records and spoke to two staff to get their views. They felt the staffing levels allowed them to spend time with people and they were well supported and trained.

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