Mar Lodge

Mar Lodge provides accommodation, care and support for up to 7 people with learning disabilities or autistic spectrum disorder. At this inspection they were providing care for 7 people.

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.

People's experience of using this service and what we found;

Right Support: The building and environment were residential and ‘homely’. The home was designed to enable people to socialise in communal spaces, but also have time alone, or see visitors in private The kitchen was accessible to all people living at the home. People had been supported to personalise their own rooms. There were a number of steps within the building which may present a trip or fall hazard, however, the provider had taken action to reduce risks with adaptations such as brighter lighting and working with individuals to manage the risks while maintaining their independence.

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.

Right Care : People received a structured lifestyle based on their choice and preferences. Staff were appropriately skilled and competent to meet people's needs and keep them safe. Staff knew and understood people’s communication needs, and this supported positive respectful relationships and interactions. People’s independence and abilities were promoted. People lived active lives and were supported to maintain relationships with friends and family.

Right Culture: People's wishes and needs were at the centre of everything. The provider, registered manager and staff were highly motivated to achieve good outcomes for people and were caring and compassionate. Systems and processes for monitoring and improving quality and safety were effective. The culture and values were based on people’s views and priorities and were shared by people, staff and managers.

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

Rating at last inspection

The last rating for this service was ‘good’ (published 12 December 2018).

Recommendations

We recommended the provider take action to improve temperature control in the conservatory so people can access this living space as required at all times of the year.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained as ‘good’ based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service was registered with the CQC prior to the CQC’s publication of ‘Registering the Right Support’ guidance for homes which accommodate people with learning disabilities and autism. Our guidance now says people with learning disabilities should not live in homes of more than six people. At the time of our visit, whilst registered for seven people, six people lived in the home.

At our last inspection we rated the service as ‘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.

Most areas of the service continued to be safe. However, the kitchen and laundry area posed some potential risks to people’s safety and infection; and the facilities in the communal bathroom meant people could not be as independent with personal care as they could potentially be. There were regular checks made on water, gas, electric and fire systems to support people’s safety. People received their medicines as prescribed. Staff understood the risks to people’s health and wellbeing and acted to lessen each risk. Checks had been made on staff before they started working for the service to make sure they were safe to work with people. There were enough staff on duty during a 24-hour period to meet people’s needs.

The service continued to be effective. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The principles of the Mental Capacity Act (MCA) were followed. People enjoyed the meals prepared at the home. People attended appointments when required, with different health and social care professionals. Staff received training to support them to work effectively with people who lived at the home.

The service continued to be caring. People were treated with dignity and staff respected their privacy. Staff were kind to people, and had developed positive relationships with the people they supported. They understood people’s needs and preferences, and what was important to them. The service supported people to maintain and develop relationships with their family.

The service continued to be responsive. People’s individual needs were catered for very well by staff who worked at the home. They had an excellent understanding of what mattered to people. People lived purposeful lives having opportunities to work in the community, as well as pursuing their interests and hobbies. Information was available throughout the home in formats which supported people's needs. There was a complaints procedure, although no complaints had been made to the service since our last inspection. Procedures were in place for planned end of life care.

The service continued to be well-led. The registered manager and deputy manager worked hard to ensure a good quality of service was maintained. Management was inclusive, and the opinions of people and staff mattered. The registered manager provided good support to the staff group, and to people who lived at the home. Checks were made to ensure the service met its obligations to provide safe accommodation to people and to deliver care and support which met people’s individual needs.

Mar Lodge is a care home registered to provide accommodation for up to seven people who have a learning disability or who are on the autistic spectrum. The home is located on two floors. Each person had their own room. The home had a communal lounge, kitchen and dining room where people could spend time together. At the time of inspection there were seven people using the service.

The service had a registered manager. 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 were protected from the risk of harm because staff had undertaken training to recognise and respond to safeguarding concerns. They had a good understanding about what safeguarding meant and how to report it.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where people displayed behaviour that may be deemed as challenging the training and guidance given to staff helped them to manage situations in a consistent and positive way that protected the person, other people using the service and staff.

The building was well maintained and kept in a safe condition. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. People’s GPs and other healthcare professionals were contacted for advice whenever necessary.

There were enough staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction and regular supervision. There was an on-going training programme to provide and update staff on safe ways of working.

People were supported to maintain a balanced diet and guidance from health professionals in relation to eating and drinking was followed. We saw that people were able to choose their meals and were involved in making them.

People were supported to make their own decisions. Staff and managers had an understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We found that appropriate assessments of capacity had and DoLS applications had been made. Staff told us that they sought people’s consent before delivering their support.

People were involved in decisions about their support. They told us that staff treated them with respect.

People received care and support that was responsive to their needs and preferences. Care plans provided detailed information about people so staff knew what people liked and what they enjoyed. People were encouraged to maintain and develop their independence. People took part in activities that they enjoyed. People participated in developing their support plans.

People and staff felt the service was well managed. The service was led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

The vision of the service was shared by the staff team and put into practice. The service promoted a positive and open culture.

Systems were in place which assessed and monitored the quality of the service. This included obtaining feedback from people who used the service and their relatives.

When we visited people were returning from various community activities for their evening meal. One person had been doing voluntary work and another had taken part in a creative arts workshop. Two were going to a party that evening and were getting ready to go out. Records showed that all the people who used the service were supported to lead full and active lives.

The evening meal was served during our inspection and all the people who used the service helped out in one way or another. We talked with two people who were washing up in the kitchen after the meal. They both said the food was good and they liked helping in the kitchen. One said 'The food is lovely and we get choices every day.'

All the people who used the service helped to keep the home clean and tidy. One person told us how they vacuumed their bedroom and set the table for meals. Another person told us, 'I've got my own room with my own key and I look after my room myself.'

Relationships between staff and the people who used the service were good. One person told us, 'I trust the staff and they are my friends.' Another person said, 'I like all the staff and all the residents.'

People said the care the home provided was good. One person told us, 'The staff help me with anything I want them to help me with.' Another person told us, 'The staff remind me if I need to have a bath and when I do I have staff there in case I fall.'

People told us they felt safe in the home and trusted the manager and the staff. One person said, 'If there were any problems Mark (the manager) and the staff would sort them out.' Another commented, 'I'd tell the staff if I wasn't happy.'

People got on well with the staff team. One person told us, 'I like all the staff. I pull their legs and make them laugh.' Another said, 'I have one to ones with staff when they talk to me or we go for a walk through the town.'

The people who used the service were consulted on all aspects of how the home was run. They contributed in one to one discussions with staff, group meetings, and through their advocates. Their relatives/representatives were also consulted.