EAM Lodge CIC

We found the following examples of good practice.

Staff had completed regular infection control and use of PPE training. Staff were observed in these areas to ensure their competency. Staff were seen to be using the correct PPE during our inspection.

The home was clean throughout. Staff cleaned touch points, for example door handles, throughout the day. Monthly infection control audits showed a high level of compliance.

No one living EAM Lodge had an identified essential care giver. A separate summer house was used for visitors to minimise the risk of COVID-19 infection. All visitors had a COVID-19 test prior to their visit.

All staff had had their COVID-19 vaccinations and took part in the regular testing programme at the home. All professional visitors were checked to ensure they were fully vaccinated before entering the home.

EAM Lodge CIC (known as EAM Lodge) is a nursing home providing personal and nursing care to five young adults who have complex needs. The service can also support one person on a respite basis. Each person had their own room, with the use of a shared accessible bathroom. There is a large accessible garden to the rear of the property.

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.

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

People were observed to be relaxed and engaged with the care staff. Relatives were very positive about EAM Lodge and the kind and caring staff.

People’s needs and possible risks were assessed, and clear guidance given on how staff would meet these identified needs.

People’s complex health and nutritional needs were being met. Referrals were made to medical professionals appropriately. Staff knew where people required a modified diet; however, they did not always record when they added a thickener to fluids to reduce the risk of choking.

People received their medicines as prescribed. There was a safe system for the ordering, storage and recording of medicines.

A new management structure had been introduced. The registered manager was responsible for three small homes and an operations manager had been appointed for EAM Lodge. Staff enjoyed working at the home and said the management team were open, approachable and supportive.

Staff champions had been appointed for a variety of areas, including dignity, infection control and communication. The champions were starting to complete audits for the service, monitored by the operations and registered managers. The registered manager had completed a full audit of all areas in March 2019. Actions identified had been addressed.

People’s communication needs were identified. Easy read information for a wide variety of topics was available. Staff read through the guides with people to assist their understanding.

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 to take part in a variety of activities, both within the home and in their local community. Friendships had developed through these activities. With local people being invited to one person’s birthday party and other events at the home.

Staff were safely recruited. People living at the service were involved in the recruitment process if they wanted to be.

Staff were positive about the training and support they received. Training was all up to date and annual observations of staff competency were completed. Staff found their supervision meetings and team meetings supportive and informative.

All incidents were recorded. A rigorous process was in place to investigate any incidents or complaints. Lessons learnt were shared across the providers three homes.

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.

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 10 January 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.

The previous inspection took place 24 July 2014 and we found that the service had met all regulatory requirements at that time.

EAM Lodge CIC (known as ‘EAM Lodge’ by the people who live there) is registered to provide nursing care and accommodation for a maximum of six young people at any one time. At the time of our inspection there were five people living at EAM Lodge on a permanent basis and one person was also beginning a period of respite on the first day of our inspection. Respite can be a period of either planned or emergency care provided to a person in order to provide temporary relief to family members who are caring for that person. Care is provided for young people with complex health needs with medium to high levels of intervention.

EAM Lodge is a large, extended detached house within its own grounds. On the ground floor, there is the kitchen and lounge with a sitting and dining area housed within a large conservatory extension that looks out onto an accessible garden area.

The service had a registered manager who had been registered with the Care Quality Commission (CQC) since September 2014. 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 staff files we reviewed contained appropriate recruitment documents including application forms, interview records, references, proof of identity and Disclosure and Barring Service checks.

We found appropriate health and safety checks for the environment and equipment were done and up to date.

Staff were able to explain types of abuse and how they would protect young people from abuse.

There were sufficient numbers of suitably qualified staff to care for people living at EAM Lodge on a permanent or respite basis. People’s needs were safely and effectively catered for.

We saw that the provider ensured that induction and mandatory training was completed before staff started in their caring role. This meant that staff were skilled in meeting the needs of the young people at the service.

People developed good relationships with the staff and management at the service. We observed many instances of good rapport and positive interactions between people, staff and visiting relatives.

We saw that staff understood the complex needs of the young people living at EAM Lodge. This meant people were supported by staff who knew their specific care requirements but staff who also respected their preferences and wishes.

Support plans were detailed and person-centred, and contained specific information about how that young person. This meant staff had clear and specific guidance on how best to support that person.

There were various activities done at the home such as crafts and outings into the community; some of the young people accessed a local college. Managers and staff were keen to develop this area so that young people were involved in activities that stimulated them, improved their quality of life and helped them maintain links within their community.

The service had a current complaints policy on file. Relatives we spoke with told us they knew how to make a formal complaint but had not done so yet. They told us they would raise any concerns with the registered manager and would feel confident in doing this.

The service kept a compliments book which we saw contained positive feedback about the staff and management at EAM Lodge. A current complaints policy was also in place and on view in the home.

People living at EAM Lodge had access to an independent advocate. The advocate acted on behalf of two people living in the home and regularly attended resident meetings.

The service had effective quality assurance systems in place which helped ensure the quality of service people received was of a safe and good standard. These included audits of support plans; accidents and incidents; training matrix; complaints; medicines and petty cash and finances.

Staff meetings were held and we saw that staff were able to raise service specific issues and training within this forum. This meant that staff were supported by management to do their caring role more effectively.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home was suitable for people's needs and had been well maintained. Staff had received regular updates about how to use it safely and how to undertake safe moving and handling. One relative we spoke with said: 'The care plans cover all aspects of his needs, anticipating problems.' There were enough staff on duty to meet the needs of the people who stayed at the home and a member of the management team was available on call in case of emergencies.

We saw that the provider followed the local authority protocols on safeguarding vulnerable adults and the staff were very aware of how abuse might occur and were confident to report it to the manager. A member of staff we spoke with said: 'There's some things that can't be overlooked. It's people's lives.' One relative said: 'I do feel he's safe here. If we raise any issue of concern we know it is noted and communicated to staff.'

Staff personnel records contained all the information required by the Health and Social Care Act. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people who had care and treatment in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been submitted and we saw evidence that proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

The home was undergoing an extension at the time of our inspection and the building area had been blocked off to ensure people stayed safe in the home and garden.

Is the service effective?

People told us that they were happy with the care that had been delivered.Relatives of people who used the service said: "Y is very well looked after." Another relative said: 'They offer an invaluable service.'

People's health and care needs were assessed before they came to the home and their relatives were involved in updating the care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. One relative of a person who used the service said: "If they have any concerns about X's wellbeing, whatever time of day it is, they phone us. That's how we want it."

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises were suitable to meet the needs of people with physical impairments.

Is the service caring?

We saw that people were supported by kind, friendly and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One relative of a person who used the service said: "We are very happy with the care. We find it excellent." Another relative told us: "The staff are very caring towards them."

People had access to regular activities that were important to them such as attending school or college, visiting the park, wheelchair biking, having visits from pets at home, pamper sessions and baking.

Is the service responsive?

Relatives told us they met with key workers when they brought the person to the home and provided a wide range of information about what was important to them.Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. One relative said: "We discuss things on the phone and it has been handled fine." Another relative said: 'He is spoken to in a manner a young man should be spoken to.'

Relative's confirmed to us that their views and experience of caring were valued by staff. One relative said: 'If they are uncertain they will ask us.'

Records confirmed people's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. Relatives of people who lived in the home told us they had completed satisfaction surveys. One relative spoke of an issue which had arisen and how well the matter had been handled by the manager. She said: 'We were given a written report. They were very honest.' Staff told

us they were clear about their roles and responsibilities. One person said: "She (the manager) goes above and beyond to help you." A relative said: "She (the manager)is very well experienced."

We spoke with two relatives of people, who used the home for respite care or lived there on a more permanent basis. They told us that they were very happy with the care their relatives received. One said: "If there were any issues, [the staff] are always open for discussion". Another person said that "it's very much like a second home - more like a family really."

Since our last inspection, the provider had made improvements to training and competency checks of staff and was now compliant with the outcome about supporting staff. The provider was meeting all the other outcomes we reviewed on this inspection.