We carried out a review of the data available to us about Hill Lodge 1 on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hill Lodge 1, you can give feedback on this service.
Hill Lodge 1 is a residential care home providing accommodation and personal care to nine people with a learning disability and or autism at the time of the inspection.
People’s experience of using this service and what we found.
There were safeguarding policies and procedures in place and people and staff were encouraged and empowered to raise concerns. People were supported by staff who were trained to protect people from harm and abuse.
People’s risks were assessed and planned for and records were in place to ensure staff knew how to support people safely and appropriately. The management team carried out the necessary health and safety checks of the premises.
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.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and or autistic people.
This was a targeted inspection that considered safeguarding and risk management. Based on our inspection of these areas, the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. The model of care and the setting maximised people's choice, control and independence. Care was person-centred and promoted people’s dignity, privacy and human rights and the ethos, values, attitudes and behaviours of leaders and care staff ensured people using the services lead confident, inclusive and empowered lives.
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 28 February 2020).
Why we inspected
We undertook this targeted inspection to check the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met around specific safeguarding concerns, and concerns we had about risk monitoring and management. The overall rating for the service has not changed following this targeted inspection and remains good.
CQC have introduced targeted inspections to follow up on warning notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
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.
Hill Lodge 1 is a residential care home providing accommodation and personal care to nine people with a learning disability and or autism at the time of the inspection.
The provider also supports people in a registered care home next door; Hill Lodge 2. The properties are interconnected by the second floor and people living at Hill Lodge 1 and its neighbouring property can spend time in either of the homes. The management and staffing arrangements are shared across both services
The service was bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance detailed in Registering the Right Support. 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.
However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. The provider had been made aware of the best practice guidance and people were encouraged to increase their independence.
People’s experience of using this service and what we found
Without exception, people received care that was particularly responsive to meet individual needs and staff demonstrated a commitment to ensuring people were able to live fulfilling and happy lives. There was a genuine family feel to the environment in which people lived and it was clear people saw one another as family and had special relationships with staff. People were proud to live at Hill Lodge and relatives were extremely positive about experiences their loved ones had received.
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.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. 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.
People were kept safe from harm as staff knew people well and were able to offer tailored and specific support in order to keep people safe. There were sufficient numbers of staff to meet people’s needs and staff worked well with other agencies to ensure people received consistent and timely support.
People accessed healthcare as required and were supported to maintain healthy lifestyles. Medicines were managed in a safe way.
The registered manager and the senior management team were pro-active continually looking at ways to improve people’s lives and make the home a safe and comfortable place to live.
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 (report published 29 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
People continued to be supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in people’s daily life were assessed and planned to protect them from harm. People were supported by enough staff to ensure they received care and support when they needed it. Staff had been suitably recruited to ensure they were able to work with people who used the service. Medicines were managed safely and people received their medicines as prescribed.
The care that people received continued to be effective. People were supported by staff who had the knowledge and skills to provide their care and support. People chose what they wanted to do and staff knew how to act if people did not have the capacity to make decisions.
The care people received remained good. People’s independence was promoted and they could choose how to spend their time and what activities to be involved with. People could develop close personal relationships and kept in touch with family and friends who were important to them.
The service continued to be responsive to people. People completed voluntary work, went to college and time with friends doing what interested them. People were involved in the planning and review of their care and family members continued to play an important role. Where people had any concerns they were able to make a complaint and this was responded to.
The service continued to be well-led. Systems were in place to assess and monitor the quality of the service. People felt the staff listened to them and were able to comment on the quality of the service. The registered manager promoted an open culture which put people at the heart of the service.
We inspected this service on 19 October 2015. This was an unannounced inspection. Our last inspection took place in August 2013 and at that time we found the home was meeting the regulations we looked at.
The service provides support to nine people with a learning disability and five people who receive personal care support in their own shared home. Care Worldwide also provides a service to nine people in a registered home next door to this service; Hill Lodge 2. The management arrangements and staffing provided are shared across the two services. People are able to spend time in either service and there are interconnecting doors between the two properties.
There was a registered manager in the service. 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 supported with their independence and knew how to keep safe. Staff supported people to understand any risks to prevent avoidable harm. Where people were concerned about their safety they knew who to speak with. Staff supported people to raise any concerns and assisted with any investigation to ensure people were protected from harm.
People kept their medicines in the bedroom and were helped to understand what their medicines were for and to take responsibility for keeping their medicines. Staff knew why people needed medicines and when these should be taken.
People were confident that there were sufficient numbers of staff to meet their needs and keep them safe. Staff received regular training that provided them with the knowledge and skills to meet people’s needs.
People had access to food and drink that they liked and specialist diets were catered for. People’s health and wellbeing needs were monitored and they were supported to organise and attend health appointments as required.
People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and support and where people were not able to make decisions for themselves, they were supported to make decisions that were in their best interests with the help of people who were important to them.
People were treated with kindness, compassion and respect and staff promoted people’s independence. People liked the staff who supported them and had developed good relationships with them.
People maintained relationships with their families and friends who were invited to join in activities with them. People chose how to spend their time and participated in community activities alone, with friends or with staff support. People felt they could do the activities they wanted to at a time that suited them.
Staff listened to people’s views about their care and people were able to influence the development of the service. People knew how to complain about their care and concerns were responded to. People were involved with any investigation and knew about any changes that were made.
The provider assessed and monitored the quality of care to ensure standards were met and maintained. The provider and registered manager understood the requirements of their registration with us and informed us of information that we needed to know.
We saw that people received their care in a positive and caring manner. We observed care being provided by staff who had the knowledge and skills to deliver the support that each person needed.
We saw that the provider had an effective system in place to assess and monitor the service, which focussed on improvement. People told us they were happy with their care and the staff were responsive to their needs. We were told they were consulted about the service being provided and felt their views were listened to.
Medication systems were in place and monitored to ensure people received their medicines as prescribed.
Since that inspection, the registered person has produced an action plan as required. They have provided us with evidence that medication training has been updated to ensure the staff carry out safe administration practices. The medication administration records are now signed by two staff members where possible, to record medicines have been administered as prescribed.
The registered person has reviewed the security of medicines and one staff member on each shift is now the responsible person for the medication key. The medication key is handed over at the end of each shift to the next designated person. The responsible person for medication is highlighted in the main office. The registered person told us this system will be reviewed to ensure its continued effectiveness.
Some people using the service were visiting London with staff and there were two people in the home for us to talk to. People told us they knew what medicines they took and when they should have them. This meant people were informed about their medicines to maintain their well being.
Medication storage systems had improved although medication administration practices were observed as being unsafe, because medicines had been recorded as being given before they had been administered.
There were duplicate keys for the medication cabinet held by each member of staff which meant the security of the medication could be compromised.
Staff supported people to go out and do the things they enjoyed, including social activities, voluntary work and day care provision. People said they enjoyed playing crown bowls, going shopping, going out for a drink and to concerts and were looking forward to going on holiday. People told us, 'If we need help the staff are always there. I like to go out with my friends and they always know where I am. I know how to keep safe.'
People were encouraged to be independent and they told us they were responsible for looking after and tidying their rooms and they shared domestic duties including cooking. We saw people being supported to make two different types of curry for the evening meal. One person told us, 'We've made two curries, as some people don't eat meat, but we all like curry.'
The medicines that were to be kept at a low temperature, where not kept securely. The systems in place for monitoring and acting upon concerns with medication storage and temperature was not robust. This meant we saw medicines stored incorrectly, which could place people at risk, as the integrity of some medicines may have been compromised.
During our visit in April 2011 people told us before moving into the home people were able to spend time with people and have over night stays and weekend visits. People told us 'We are able to meet with people before we move in' and 'We could say if we didn't like someone'. People were confident staff took their views into account as it was important that they were happy in their home.
Each person had a plan of care which were reviewed with them and any changes were recorded. Where people needed health support, this was discussed with them and the care people needed was recorded. People told us they could decide if they wanted to be seen in private when receiving health care.
The routines and daily activities were flexible and staff responded to people's needs and the staffing was provided to ensure people were able to carry out planned activities. People told us they were able to have a job, attend college courses, go out with friends and were involved in many activities. People told us that during the last month they had been going to weekly football training sessions and watched Burton Albion play and some people had been to see a rock band and the Abba experience. Other people told us they enjoyed going shopping with friends and family and liked to have a drink and meal out.
People told us they were involved in making decisions about their care and their views were taken into account. People knew about their rights and if they needed help making decision they would involve others including an advocate. One person commented, 'It's up to us to sort out our life, we have to make our own decisions.'
The home supported people to develop skills needed to live independently and people took responsibility for looking after their home and their bedroom. People told us, 'We look after the house ourselves, we do the carpets, chairs and look after our own rooms, and I love it' and 'I like to help out in the kitchen.'
People knew how to keep safe in the home and the community and told us they would talk to the staff if they were worried. People knew how to make a complaint, and told us they would be comfortable talking to staff about any concern. People said they could talk openly with staff and be honest about what they wanted to do and how they felt and said 'I'd talk to my key worker' and 'I'd speak to the staff here, they'd sort it out.'
All the information we received from people was positive and therefore we did not need to revisit this during the follow up review undertaken in April 2011.
Each person had a plan of care which were reviewed with them and any changes were recorded. Where people needed health support, this was discussed with them and the care people needed was recorded. People told us they could decide if they wanted to be seen in private when receiving health care.
The routines and daily activities were flexible and staff responded to people's needs and the staffing was provided to ensure people were able to carry out planned activities. People told us they were able to have a job, attend college courses, go out with friends and were involved in many activities. People told us that during the last month they had been going to weekly football training sessions and watched Burton Albion play and some people had been to see a rock band and the Abba experience. Other people told us they enjoyed going shopping with friends and family and liked to have a drink and meal out.
People told us they were involved in making decisions about their care and their views were taken into account. People knew about their rights and if they needed help making decision they would involve others including an advocate. One person commented, 'It's up to us to sort out our life, we have to make our own decisions.'
The home supported people to develop skills needed to live independently and people took responsibility for looking after their home and their bedroom. People told us, 'We look after the house ourselves, we do the carpets, chairs and look after our own rooms, and I love it' and 'I like to help out in the kitchen.'
People knew how to keep safe in the home and the community and told us they would talk to the staff if they were worried. People knew how to make a complaint, and told us they would be comfortable talking to staff about any concern. People said they could talk openly with staff and be honest about what they wanted to do and how they felt and said 'I'd talk to my key worker' and 'I'd speak to the staff here, they'd sort it out.'