Lowena

The service was a purpose-built single storey building in its own grounds. The service is a large, bigger than most domestic style properties and larger than current best practice guidance. However, this had been responded to by reducing the living areas. This meant the environment was more inclusive for people using the respite service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

The Right support:

The model of care and setting maximised people's choice, control and independence. The service was close to the centre of town and there was good access to the local community and amenities.

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.

People were supported by enough staff on duty who had been trained to do their jobs properly. People received their medicines in a safe way. People were protected from abuse and neglect. People's care plans and risk assessments were clear and up to date.

Right Care

There was a strong person-centred culture within the staff team. Support plans had been developed for people, to understand the reasons for their behaviour, and provide guidance for staff to ensure consistent approaches were used when supporting people.

Staff knew people well and demonstrated an understanding of people's individual care, behavioural and communication needs. This helped ensure people people's views were heard and their diverse needs met.

People could communicate with staff. Staff understood their individual communication needs and were consistent in their approach and response. Care plans informed staff of any specific ways to best communicate with people.

The staff team had the appropriate levels of knowledge and skills to support people and responded to their individual needs and choices.

Right culture

People were supported by staff where the ethos, values, and attitudes of management and care staff ensured people led confident, inclusive and empowered lives. Staff created an environment that inspired people to understand and achieve their goals and ambitions.

People led lives that reflected their personalities and preferences because of the ethos, values, attitudes and behaviours of the management and staff.

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

At the previous inspection in January 2020 records did not demonstrate the service had information in a format which would support people with a learning disability or autism, to understand and enable them to communicate effectively. At this inspection we found action had been taken.

People had care plans in a format which supported their understanding of information. There were hospital passports to support people if a hospital admission was required.

At the previous inspection care plans were disorganised and information was difficult to follow. At this inspection, care plans had been reviewed. Information was in order and easily accessible. Staff told us the care plans were much clearer and easy to follow.

Care and behaviour support plans were accurate and kept under regular review, with the involvement of the person their family and external professionals if necessary. They provided staff with comprehensive guidance to ensure people's needs were met.

Risks were identified and staff had clear instructions to help them support people to reduce the risk of avoidable harm.

At the previous inspection we found the systems in place to demonstrate quality and safety was managed effectively, were not being carried out robustly to provide an accurate oversight of the service. At this inspection we found improvement in all areas. Senior staff had delegated tasks and responsibilities to carry out auditing and follow up on any issues. There was good oversight by the area manager.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Government guidance about COVID-19 testing for people, staff and visitors was being followed.

People's relatives and staff told us management were approachable and they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements to the service. They told us, “ We have always felt that [person’s name] is well monitored in the safe keeping of Lowena staff” and “As parents of a severely disabled child, we consider ourselves incredibly fortunate to have the support of Lowena both for [person’s name] and ourselves”.

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

Why we inspected

We undertook this inspection to review previous breaches of regulations found at the last inspection.

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.

Lowena is a short break service run by Cornwall Council for adults with learning disabilities. The service provides single room accommodation for up to 25 adults with a learning disability, physical disability and people living on the autistic spectrum, who need assistance with personal care.

The service is a large, bigger than most domestic style properties and larger than current best practice guidance. However, the size of the service having a negative impact on people has been reduced by the provider's focus on ensuring that people receive person-centred support which promotes choice, inclusion, control and independence. The service has been developed 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.

The service was a purpose-built single storey building in its own grounds. Occupancy levels vary on a day to day basis due to it being a respite service.

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

The service’s governance systems had generally improved and supported people using the service. The manager had only recently been registered with the commission. They were working hard to bring about the improvements required at Lowena. They were open, visible and committed to further improving the service. They were supported by a senior management team. However, governance systems were not always responding to required changes in a timely way. We have made a breach of regulation about this requiring the provider to take action. This is a continuing breach of regulation 17, At the previous inspection the service was in breach of this regulation because auditing system were not effective.

People took part in a range of activities which they enjoyed and were supported to maintain the relationships that were important to them. There were limitations in accessing community facilities since the providers transport was no longer available since September 2019. People were being supported to access the community, but this was limited due to the need for taxies or public transport. Staff were supporting people to use these forms of transport but told us it had significantly reduced choice in the community. This meant not everyone had an equal opportunity to use the community based on mobility needs.

People's needs were assessed before they used the respite service for short breaks. Support plans were not always updated in a timely way. This had been recognised by the management team and was being addressed. Some support plans, risk assessments had been reviewed and updated and this was ongoing. However, there was no evidence that it was being written in a format which could be understood by people with limited capacity. Staff were aware of the details of people's care plans and supported them accordingly. We have made a breach of regulation about this requiring the provider to take action.

The services environment continued to improve. Improvements found at the July 2019 inspection had been sustained and developed. All rooms were furnished in a domestic nature. Wall art and wall mounted televisions enhanced the homely environment. Further work was being undertaken to add shower facilities.

People were unable to provide us with verbal feedback because they had complex needs. Two of them however, nodded and smiled when we asked them if they were happy in the home. Three relatives and a care professional informed us that staff treated people with respect and dignity and people were safe using Lowena. We observed that staff interacted well with people and were attentive towards them. Staff made effort to ensure that people's individual needs and preferences were responded to.

People were cared for by staff who worked together to meet people's needs. Staff felt well supported and happy in their roles. This helped to create a relaxed and happy atmosphere for people to spend time in.

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. People were supported by staff who knew them well and were able to communicate with them in their chosen way. This ensured people could make choices about their day to day routines.

The review of medicines and implementation of a new system for the management of medicines was robust.

People were supported by experienced staff to keep them safe and meet their needs. However, there were some current vacancies which were being recruited for.

The provider had a robust recruitment process which helped to minimise the risks of abuse to people. People were very comfortable and relaxed with the staff who supported them.

The provider worked with health, social care professionals and families to make sure people received the care and treatment they required.

The provider had a complaints procedure in place and people confirmed they knew how to make a complaint.

Rating at last inspection and update:

At the last comprehensive inspection in January 2019, the service was rated as requires improvement overall with an .inadequate rating in the well led key question. We took enforcement action where a condition was placed upon the provider’s registration. The condition related to the environment and required the provider to send regular reports to CQC to show what they would do and by when, to improve. CQC had received reports as required.

We carried out a focused inspection in July 2019 only checking the action the provider had taken in the effective section rated requires improvement and well-led section previously rated as inadequate. There was enough evidence to demonstrate the service had improved enough in the well led section to rate it as requires improvement. Requirement actions had also been met in the effective and responsive sections. The provider had met the conditions applied to their registration and can now apply to CQC to have these removed. However, at this inspection we found the provider was not fully meeting requirements in the Responsive and Well Led and have therefore continued with a rating of requires improvement. .

Why we inspected: This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Lowena is a short break service run by Cornwall Council for adults with learning disabilities. The service provides single room accommodation for up to 25 adults with a learning disability, physical disability and people living on the autistic spectrum, who need assistance with personal care.

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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a purpose-built single storey building in its own grounds. Occupancy levels vary on a day to day basis due to it being a respite service.

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

Governance systems had improved. Quality audits were now reflecting a true account of the environment and the impact on people using the service. However, more time was needed to ensure these systems were embedded in the governance of the service.

The environment had improved. The heating system had been reviewed so that heating was regulated throughout the service. This inspection was undertaken during the summer period therefore no heating was being used. Records showed daily audit checks of people’s room temperatures were being taken so they were being monitored.

Maintenance of the premises had improved. This included decoration in people’s rooms and the standard of mattresses and bedding. These had been replaced and more appropriate bedding to ensure comfort for people using the service.

All rooms including lounge areas had been decorated. Additional furniture, wall art, soft furnishings and decorative items were in place meaning rooms were more homely and inviting.

Where damage to a bathroom wall had been identified action had been taken to repair and decorate.

A recommendation made by the fire service in July 2018 had been addressed.

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.

Communication between staff at night had been improved by providing 'walkie talkie' radio sets.

Senior management oversight was more effective. The operational manager was ensuring audits were accurate. Service records were visually checked as well as observing the environment. Any issues were reported on and fed back to senior managers for action.

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.

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 14 February 2019) and there were breaches of regulation. During the inspection of the service in January 2019 we found the service had not addressed a previous breach of regulation regarding maintenance of the premises. This meant there were repeat breaches demonstrating ineffective management systems.

We imposed a condition on the registration of Lowena which required the provider service to provide CQC with a monthly audit reports on how they were addressing the failings highlighted in previous inspections .The provider sent the commission monthly actions taking place to show what they were doing and by when. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This report only covers our findings in relation to the Key Questions Effective and Well-led which contain those requirements.

Why we inspected: We carried out an announced comprehensive inspection of this service on 9 January 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the inadequate maintenance of the premises and quality assurance processes.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement as there needs to be more evidence of sustainability in governance. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lowena on our website at www.cqc.org.uk.

Follow up: We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lowena is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as 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.

The registered manager had recently left their post and de registered with the CQC. There was an interim manager in post. The manager and two team leaders were responsible for the day-to-day running of the service. 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 2008 and associated Regulations about how the service is run.

As part of this comprehensive inspection we checked to see if the provider had made the required improvements identified at the inspection of 4 December 2017. At that inspection we found the service environment was not being maintained to a satisfactory level which had the potential to have a negative impact on people using Lowena. The heating system was not providing consistent heat throughout the service. There were six rooms which were not occupied at the time of inspection where radiators were not working. Some parts of the large lounges were cool to sit in. One room had a carpet which had a malodorous odour. Two specialist baths were not working, one had been de commissioned and required replacement, another was waiting for parts. There were two adapted showers which were being used by people until the baths were replaced and repaired. The general decoration of the service was not satisfactory. Walls were damaged and marked as was some woodwork surrounding peoples sinks in some rooms.

In addition, at the previous inspection in December 2017 survey feedback had highlighted some mattresses were hard and needed replacing. This was also highlighted by staff during the inspection. No action had been taken to address this. The quality of towels being used was poor. White towels were grey and coarse, two were frayed and not fit for purpose.

External areas of the service were not being maintained. A rear garden area could not be used due to the grass not being cut and therefore was too long to play ball games, which people had always enjoyed in good weather.

Governance systems were not effective. Oversight of the services environment had not identified and acted upon defects in a timely way. The decoration and overall general maintenance of the service was not being managed or reviewed effectively.

The views of people were not regularly formally sought and acted upon. A recent negative comment about mattresses had not been investigated and acted upon.

At this inspection we found governance systems were inadequate. There was an organisational lack of leadership and oversight to improve the services environment. The organisation had not acted upon defects in a timely way. The decoration and overall general maintenance of the service was not being managed or reviewed effectively.

From our findings during this inspection we noted quality audits had not identified the impact on people in respect of the temperature in the building. People using the service had complex needs. Many people were not mobile and most were unable to verbally communicate. This meant they were vulnerable and this had not been acknowledged or respected in any of the audits that had taken place.

Health and safety auditing had not identified the benefits of an alarm system for service users or staff. During this inspection we identified two rooms where overhead lighting above the sink was not operating effectively. These issues had been reported however the organisation had not responded. This demonstrated the providers response was ineffective. We have made a recommendation about this.

Senior manager checks to make sure mattresses had been replaced as reported on would have shown that what was in the records had not been carried out. This meant the oversight systems were ineffective and what had been reported on were not accurate or true records.

Environmental issues had not been actioned in respect of the maintenance of temperature, decoration and external maintenance. During this inspection we found the provider had not acted to improve the way the service was heated and to ensure all areas of the service was consistently warm enough for people to be comfortable in.

Limited decoration had taken place since the previous inspection. However, all rooms remained sparse. There were no pictures, lamps or items which would make rooms homely and inviting. Paintwork remained generally poor and scratched. Two rooms, including a bathroom, had not been decorated following repairs to the walls and looked unsightly.

The care service was established before the development of the CQC policy, 'Registering the Right Support' and other current best practice guidance. This guidance includes the promotion of values including choice, independence and inclusion. Action had not been taken to ensure the provider was working within the guidelines.

Medicine administration systems had been reviewed and were being monitored by managers. Auditing processes meant any omissions and stock control issues were being identified and managed more effectively.

The service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during their daily routines and delivery of their care. These had been kept under review and were relevant to the care provided.

The service worked with other health professionals and supported people to access healthcare professionals if required.

We found continuing breaches of the Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 17 of the Health and Social Care Act 2008.Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Lowena is a ‘care home’. People in care homes receive accommodation and nursing care as single under one contractual agreement. CQC regulates both the premises and care provided. We looked at both during this inspection. Lowena provides respite personal care and support to younger adults and older people for up to 25 people. At the time of our inspection seven people were receiving respite care at Lowena. People used the service for various short term periods to provide respite for them and their families who were their main carers. However, one person had been resident at Lowena for several months due to an emergency situation and a suitable permanent placement was currently being arranged as the service was not designed for long term placements.

Lowena is situated close to the centre of the city of Truro with all amenities being a walk or short drive away. The service provides single room accommodation for up to 25 adults with a learning disability, physical disability and people living within the autistic spectrum, who need assistance with personal care. Occupancy levels vary each week due to the nature of the service. The service is a purpose built service on one site.

There were a range of aids and adaptations in place to support people with disabilities which impact on their mobility and movement. Each person had their own room. There are no en-suite facilities but there were two adapted baths and two walk in showers. There were additional toilets located at various points around the service. The service was divided into two wings, one for people who were mobile and one for people who required more equipment to support them. There was also a self-contained adapted flat for people to use who had a greater level of independence.

There was a registered manager in place. 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.

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.

The service environment was not being maintained to a satisfactory level which had the potential to have a negative impact on people using Lowena. The heating system was not providing consistent heat throughout the service. There were six rooms which were not occupied at the time of inspection where radiators were not working. Some parts of the large lounges were cool to sit in. One room had a carpet which had a malodorous odour. Two specialist baths were not working, one had been de commissioned and required replacement another was waiting for parts. There were two adapted showers which were being used by people until the baths were replaced and repaired. The general decoration of the service was not satisfactory. Walls were damaged and marked as was some woodwork surrounding peoples sinks in some rooms. Survey feedback had highlighted some mattresses were hard and needed replacing. This was also highlighted by staff during the inspection. No action had been taken to address this. The quality of towels being used was poor. White towels were grey and coarse. Two were frayed and not fit for purpose.

External areas of the service were not being maintained. A rear garden area could not be used due to the grass not being cut and therefore too long to play ball games, which people had always enjoyed in good weather.

Governance systems were not effective. Oversight of the services environment had not identified and acted upon malfunctions in a timely way. The decoration and overall general maintenance of the service was not being managed or reviewed effectively.

The views of people were not regularly formally sought and acted upon. A recent negative comment about mattresses had not been investigated and acted upon.

Staffing levels were based around the needs of people using the service. Due to fluctuating occupancy levels, staffing the service needed to be flexible. Staff were responding to this and proposed changes in staffing shift patterns were currently in consultation with the provider and unions.

Staff had been recruited safely, received on-going training relevant to their role and supported by the registered manager and team leaders. They had the skills, knowledge and experience required to support people in their care. Staffing levels were sufficient to meet the needs of people who used the respite service.

Care records were person centred and focused around the needs of the person. They were regularly updated and reviewed and where possible included information from people and their families. Some staff had recently received training to support people using easy read formats which were beginning to be adapted to peoples care plans. This supported people to have a better understanding of what their care plan meant to them.

Care and support plans included person centred daily observation records that identified the care and support interventions that had been provided around care and support for the person being supported.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

People’s rights were protected by staff who under stood the Mental Capacity Act and how this applied to their role. Nobody we spoke with said they felt they had been subject to any discriminatory practice for example on the grounds of their gender, race, sexuality, disability or age. There was a strong focus on protecting people’s human rights.

Accidents and incidents were being recorded and reported and any lessons learned were shared with staff. The service learned by any mistakes and used this as an opportunity to raise standards. There was a culture of openness and honesty and staff felt able to raise concerns or suggestions.

There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 regulations. You can see the action we have told the provider to take at the end of this report.

This report only covers our findings in relation to the question ‘is the service safe?’ You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lowena on our website at www.cqc.org.uk

Lowena is a respite service that provides care and support for people who have learning disabilities and other complex needs. Lowena can accommodate up to a maximum of 25 people, although due to the nature of the service this fluctuates on a daily basis. The service is owned and operated by Cornwall Council.

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.

The service had taken action to ensure all hot water outlets were operational and were discharging water at a safe temperature. We checked the room where we found the cold water tap had been turned off during the November 2015 inspection. This tap was now operational and the hot water temperature was being safely regulated by ‘mixer valves’.

Observation of the maintenance records showed there were monthly checks to ensure temperatures were safe and being maintained and that legionella testing was being carried out. This was to ensure there was no risk of legionella bacteria being present and met the approved code of practice and guidance on regulations for Legionnaires’ disease.

The service had a new boiler fitted in March 2016 which the registered manager said had improved the continuity of hot water throughout the service.

Staff checked the water temperature before assisting a guest with a bath to ensure it was within safe limits.

At this focused inspection we found the registered provider had taken effective action to meet the requirements of the regulations and the breach had been met.

Lowena is a respite service that provides care and support for people who have a learning disabilities and other complex needs. Lowena can accommodate up to a maximum of 25 people, although due to the nature of the service this fluctuates on a daily basis. The service is owned and operated by Cornwall Council.

People using the service had a range of learning, sensory and physical disabilities and there were a range of aids and adaptations in place which met those needs. There was a sensory room as well as kitchens and dining areas which incorporated a range of seating and equipment to support people with physical disabilities.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were leaving the service after a week end break when we arrived. However nine people were arriving later in the day for an overnight stay. People using the service had limited verbal communication. We therefore observed peoples activities when they arrived at the service and saw people were relaxed and engaged in their own choice of activities. There were enough staff to support people in what they chose to do. One person was preparing to go swimming and another two people were being supported to prepare their evening meal.

We looked around the environment which was divided into three units including a self-contained flat. This was a bungalow set in its own grounds. Where possible people used the same rooms so they were familiar to them. People brought their own personal items to make the rooms homely during their stay. In some instances rooms were sparse due to the safety and needs of people using them.

A written communication entry highlighted concerns from the maintenance person that a cold water connector at a sink in a room had been switched off due to a risk of the person flooding the room. However, this resulted in hot water being discharged at an unsafe temperature. This meant there was a hazard when people ran the hot water tap in that room.

We saw many positive interactions and people enjoyed talking with and interacting with staff. One staff member said, “I have worked here for a long time, it’s a very rewarding place to work”. People told us that staff supported them to maintain their independence and we saw evidence of this within the care documentation we viewed.

Staff were trained and competent to provide the support people required. They were supported through a system of induction and training. Staff told us the training was thorough and gave them confidence to carry out their role effectively. The staff team were supportive of each other and worked together to support people. Staffing levels met the present care needs of people that used the respite service.

Staff were competent in how they were providing support to people. They were familiar with what support and care people needed. Staff supported people to make meaningful decisions about their lives and respected people’s decisions and wishes. People were supported to lead full and varied lives and staff supported them to engage in a wide variety of activities. A relative told us, “They (staff) are always doing something whether it’s in the home or outside”.

We found people and others who were important to them, were involved in the planning of their care and documentation was written ina way that was focused on the person. A relative told us the service consulted with them and responded to peoples’ needs promptly and with understanding and empathy.

Where people did not have the capacity to make certain decisions, the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People had a choice of meals, snacks and drinks chosen by them. A pictorial communication board was in place for people who were unable to verbalise their choice of foods. Some people were involved in meal preparation. One kitchen had been designed to accommodate people using wheelchairs, or those who required seating to prepare meals, by lowering a work surface.

There were systems in place to ensure people who used the service were protected from the risk of harm and abuse and the staff we spoke with were knowledgeable of the action to take if they had concerns in this area.

There were arrangements in place to ensure people received their medicines safely and staff were knowledgeable of these.

People knew how to complain and we saw people had the opportunity to discuss how they felt about the service. Each person had a key-worker who checked regularly if people were happy with the service they received. One relative told us, “[Persons name] has been going for a long time, they do a good job and If I wasn’t happy about something I would know who to go to”.

Lowena was well-led and people told us they were kept informed about any changes in the service. They told us they felt their comments were listened to and acted upon. The service had an open and positive culture with a clear focus on enabling and supporting people to become more independent.

We identified a breach of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.

Some people who used the service had a physical disability or were on the autistic spectrum. The service was primarily for people to have a break from their home environment. People stayed at Lowena for a weekend, overnight or for a few days/nights during the week.

The people who used the service, on the day of the inspection, had limited or no verbal communication skills. We were able to speak however to four people who all said they enjoyed their visits, liked the staff and enjoyed the food. We were able to speak with four staff members who all said they thought a good service was provided at Lowena.

On the day of the inspection the accommodation was furnished, decorated and maintained to a good standard. The home was very clean and there were no offensive odours. Satisfactory systems to minimise the risk of infection control were in place.

There were satisfactory numbers of staff on duty. The service had a suitable quality assurance system to ensure good standards of care were maintained.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.