We carried out a review of the data available to us about September Lodge 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 September Lodge, you can give feedback on this service.
We carried out this announced inspection on 23 September 2017. The inspection was announced 72 hours in advance as this allowed the registered manager to prepare the people they supported at September Lodge to know that an inspector would be visiting their home. With this knowledge they were then prepared and were able to choose if they wished to be involved in the inspection process. At the last inspection, in October 2015, the service was rated Good. At this inspection we found the service remained Good.
People told us they felt safe living at September Lodge and with the staff who supported them. People told us, “Good staff, good home, that’s all you need to know, now you can leave”, “I like it here” and “The staff are as good as it gets.” Relatives told us they were, “Very happy” with the care provided and , “I know [relatives name[] is safe there, the placement suits what she needs.”
People received care which was extremely person centred and responsive to their needs. They were supported and fully engaged in activities that were meaningful to them.
Care and support was provided by a consistent staff team, who knew people well and understood their needs. The registered manager told us “The people we support are cared for, supported, they are loved. It’s not just a job, its loyalty, commitment.” In our discussions with staff we found that all had the same understanding and approach in how they cared for the people they supported. We also heard from staff how proud they were of people’s individual achievements.
Transition work that staff undertook with people who were coming to live at September Lodge was individualised. For example, we saw personalised videos were used to introduce one person to the service so that they could see and become accustomed to the accommodation and surroundings that they would be coming to live in. The registered manager had met with the person, family members and other health and social care professionals to discuss how the person would best be supported with the transition from their current placement to September Lodge. The person was also encouraged to take part in decorating their accommodation, choosing colours, furnishings and to bring personal items so that it so that their room was completely decorated as they wanted it.
There were sufficient numbers of suitably qualified staff on duty. Staffing levels were adjusted to meet people’s changing needs and wishes. For example, one person was admitted to hospital in an emergency situation and the provider ensured there were sufficient numbers of staff available to support the person throughout their hospital stay. This meant they responded to the person’s changing health needs.
The service recognised and identified when people needed additional psychological support. For example, when the person was admitted to hospital the registered manager was aware the person was in a vulnerable situation and needed emotional support from them. The registered manager told us “I told my family I need to be with [person name], I will see you in four days. The other staff did the same.” The management team arranged for two recently recruited care staff who supported the person prior to moving to September Lodge to be part of the current support team at the hospital. This meant the person had some familiarity with some staff to help ease anxiety levels. This showed that the provider responded in a person centred way by ensuring that they had sufficient, skilled staff to support them in a crisis situation.
We were also given other examples of how staff listened to people and responded to their individual needs to come to find a positive way forward. For example, a person had difficulty with using the bathing facilities at the service. The registered manager said “We had to think outside of the box and use facilities that the person trusted which are not on site.” This meant that they had to approach another venue that the person trusted to request their assistance. The person told us they were happy with the arrangement made and their aim was that they would be able to use the facilities in September Lodge in the near future.
A person said they wanted to have more direct contact with management. The person was allocated their own deputy manager to be responsible for overseeing their support plan and to ensure that it was adhered to each day. In addition following a request from the person, the registered manager downloaded a messenger application on their phone so that they had direct contact between them. The registered manager said this enabled the person to feel more confident that managers were available for them when needed.
People’s support plans were presented in a format that each person could understand. For example, a person videoed their support plan. On the video they explained their health issues and how they needed staff to support them to manage their health condition. This demonstrated that the person was aware of their health needs, and how they wanted staff to respond to them. Alongside the video support plan was a written support plan. Details of how people wished to be supported with their care needs were personalised to the individual and provided clear information to enable staff to provide appropriate and effective support. The support plan was also signed by the person which evidenced that they agreed with its contents and how staff should support them.
Care records were up to date, regularly reviewed and accurately reflected people’s care and support needs. People, who received care, or their advocates, were involved in decisions about their support and consented to the care provided. Risk assessment procedures were designed to enable people to take risks while providing appropriate protection.
People were supported to maintain good health, have access to healthcare services and receive on-going healthcare support. Staff supported people to arrange and attend appointments to see their GP and other necessary healthcare appointments.
People were supported to access the local community and take part in a range of activities of their choice. Staff supported people individually and in groups to attend work placements and activities of their choosing.
Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse.
People were supported to eat and drink enough and maintain a balanced diet and were involved in meal planning. Menu planning was done in a way which combined healthy eating with the choices people made about their food.
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. A person had restrictions in place around accessing food. The approved Deprivation of Liberty Safeguards (DoLS) condition allowed the service to lock cupboards where food was stored. However the registered manager told us “It’s not about locking cupboards it’s about managing [the persons] condition. Locking cupboards would be a last resort.” We saw the person was supported to access the kitchen, and had access to food and drinks.
People and their families were given information about how to complain. The registered manager and operational manager were visible in the service, regularly working alongside staff to provide care and support for people. There was a positive culture within the staff team and staff said they were supported by the registered manager.
There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. People and their families were involved in the running of the service and were regularly asked for their views through on-going conversations with staff and surveys.
Further information is in the detailed findings below
We inspected September Lodge on 13 October 2015, the inspection was unannounced. The service was last inspected in May 2014, we had no concerns at that time.
September Lodge provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection five people were living at the service. Four people were living in the main house and one person was living in a self-contained flat adjacent to the main property. September Lodge is one of a number of services in Cornwall which are run by the provider, Greenlight PBS Limited.
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 at September Lodge were supported to lead fulfilling lives which reflected their individual preferences and interests. There were enough staff available to make sure everyone was supported according to their own needs. On the day of the inspection two people were attending separate college placements, two people were in the main house and one person was in their flat adjacent to the house. The person occupying the flat chose when they wanted support. The two people in the main building were engaged in their individual routines and activities and one of them went out for part of the day to visit a café. Relatives told us they believed their family members had choice and control in their lives and were supported safely and with respect.
Staff were well trained in a range of subjects which were relevant to the needs of the people they supported. New employees undertook a rigorous induction programme and told us this was beneficial and prepared them well for their roles. The staff team were well supported by the registered manager and received regular supervision and staff meetings. These were an opportunity to share any concerns or ideas they had with the staff team and management.
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. Staff had a good understanding of the principles of the legislation and training was updated regularly.
There were plenty of opportunities for people, relatives and staff to voice how they felt about the service and any concerns they had. Annual surveys were circulated to all stakeholders and visitors were asked for their feedback. The registered manager was committed to engaging with families face to face where possible. Families were kept informed of any changes in people’s needs or appointments.
Care plans were informative and contained clear guidance for staff. They included information about people’s routines, personal histories, preferences and any situations which might cause anxiety or stress. They clearly described how staff could support people in these circumstances. Adapted easy read versions of the care plans were made available to people and these showed people were involved in the care planning process.
There were clear lines of accountability and responsibility at September Lodge and at Greenlight. The organisational values were embedded in working practices and staff worked to provide a service which was designed around the needs of the individual.
Accidents and incidents were appropriately recorded and analysed monthly to identify any trends. Quality assurance systems were in place within the service and at provider level. Regular audits were carried out to help ensure the service was running effectively and safely.
Below is a summary of what we found. The summary is based on information gathered during conversations with people who used the service, relatives, staff and management of September Lodge.
Is the service safe?
We found that September Lodge provided safe care and support to people who used the service. Appropriate risk assessments had been completed and people's care plans had been regularly reviewed to ensure they accurately reflected the needs of each individual.
Is the service effective?
All of the people we spoke and interacted with who received care and support from September Lodge were happy with the quality of care they received. People told us 'the staff are brilliant. I am very happy here'. Staff members told us 'It's an excellent company with high standards'.
People's health and care needs had been assessed during face to face meetings between care managers and the individual in need of care and support. We found support plans had subsequently been reviewed and updated at regular intervals. We found that people who used the service had been involved in the process of their care planning. One person told us, 'I am always involved in discussions about my support needs'.
Staff members told us the support plans were 'really helpful', 'up to date' and 'very thorough, they clearly state what you need to do and things not to do'.
Is the service caring?
People told us they were well cared for by staff they knew and were comfortable with. Their comments included 'I like the fact I have a key worker who knows me well and I can speak to when I need to'.
We found that staff morale was high and staff members told us 'I love the job and enjoy working with the customers here' and 'It's a great place to work'.
We found that people's likes and preferences in relation to their care had been recorded during the assessment process and we found that staff had complied with people's wishes while providing care.
Is the service responsive?
The service was responsive, we found people were aware of the complaints procedure but had not wished to raise a complaint as they were happy with service they received. People told us 'I am quite happy with the service I get. It all works out OK for me' and 'I've never needed to make a complaint. They are very good'.
The provider's complaints policy also included procedures for resolving and recording minor issues raised by people who used the service. We saw these issues had been effectively investigated and resolved.
The service regularly received compliments form people who used the service. We saw the details of compliments and minor issues were shared with all staff via the staff communications book and at regular monthly staff meetings. This reduced the risk of incidents re-occurring and helped the service to continually improve.
Is the service well led?
The service had appropriate quality assurance systems in place. We saw that audits of support plans and staff files had been completed. Where issues had been identified actions had been taken to address the identified issues.
We observed staff interacting with people who used the service in a kind and relaxed manner. We saw that staff showed, through their actions, conversations and during discussions with us, empathy and understanding towards the people they cared for.
We examined people's care plans and found the records were up to date and were reviewed as the person's needs and wishes changed.
We found that people who used the service were involved in making day to day decisions and participated in tasks at home, such as cooking, cleaning and doing their laundry. The records showed they went out frequently and saw healthcare professionals when they needed to.
Staff said they had received enough training and support to enable them to carry out their roles competently and felt there were sufficient staff on duty.
Systems for safeguarding people from abuse were robust. Legal safeguards, which were in place to protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.
During the course of our inspection we talked with two people who lived at September Lodge. We also spoke with the nominated individual, the new manager of September Lodge, the compliance manager for the organisation, and three members of staff.
People who lived at the home told us that staff were kind and friendly. Comments included 'staff are absolutely fantastic', and 'they have a joke'.
We were told by one person that they felt safe. Other comments included 'I get on with other people who live here' and 'I am a lot happier here'.
We were told that staff encouraged people to be independent. One person commented it 'makes me feel good about myself'.
We were told that people would feel confident to raise concerns to a member of staff or to the manager. People told us that they felt listened to and that staff understood their individual needs.
One member of staff told us 'we like to empower these guys to always achieve'. Other comments included, 'they always do what they want to do' and 'people are always involved and are allowed to meet their goals'.
Staff told us that management 'are very supportive' and that they have received sufficient training to be able to undertake their role effectively. One person told us that they felt the organisation had a "very strong value base".