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Inspection carried out on 22 May 2018

During a routine inspection

We carried out a comprehensive inspection of Lulworth on 22 May 2018.

Lulworth is a care home. People in care homes receive accommodation and nursing or personal care as a 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.

Lulworth is registered to provide accommodation for people requiring personal care for up to 16 people and younger adults with learning disabilities or autistic spectrum disorder, physical disabilities, sensory impairments and mental health support needs.

People lived in two separate buildings in the premises of the service; a larger building named Lulworth and a smaller annex called Blake. At the time of the inspection there were 16 people in total living at Lulworth. 11 people lived in Lulworth and five people lived in Blake.

Lulworth 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 this service can live as ordinary a life as any citizen.

The service had 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.

This was the first inspection of the service since it was registered with the Care Quality Commission (CQC) in June 2017.

People told us they thought the service was safe. One person said, “I feel very safe here”. A relative told us, “It is a safe place, environmentally and with the quality and availability of staff.” There were systems and processes in place to keep people safe from abuse. People and staff knew how to recognise abuse situations and know what they could do, or who they could speak with, to get help to prevent this.

Safeguarding and accident and incidents were reviewed internally and the service shared information and worked in partnership with relevant health and social care agencies following any incidents. This helped staff and people to learn and put in place actions to prevent these situations occur and to keep people as safe as possible.

People had risk assessments in place that identified any potential hazards to their well-being. Actions were in place to help people and staff manage the risk safely and positively, in the least restrictive way. Systems and processes were in place to ensure medicines were safely and properly managed. There were enough staff to meet people’s needs and there were safe recruitment practices help prevent unsuitable staff from working at the service.

The service was clean and hygienic and risks to people from infection were well managed. The premises and equipment used in the service was safe and well maintained. There were regular fire alarm tests and fire drills. People had Personal Emergency Evacuation Plans (PEEPs) in place so staff knew how to support them safely in the event of a fire.

People told us that the service was effective. A relative told us, “The staff are brilliant” and the service met their family member’s needs very well. We found people had support to achieve good outcomes and quality of life.

Assessments of people’s physical, psychological and social needs took place and people’s needs were regularly reviewed. This holistic process helped staff know how support people to achieve their support outcomes in all areas of their lives and have a good, well-rounded quality of life.

The provider was committed to promoting inclusion and supporting people with a learning disability to overcome any social prejudice that could act as a barrier to them achieving their chosen outcomes. Staff received Equality and Diversity training and there was an 'Equal Opportunities, Diversity and Anti-Oppressive Practice' policy in place.

Staff worked well with external agencies, such as local authority social and healthcare services and other providers to help co-ordinate people’s support so their needs could be effectively met. This helped people achieve their chosen outcomes and improve their overall quality of life.

Staff had regular training, in a range of subjects, including learning disabilities and autism. Training was regularly updated. Staff also had comprehensive and effective on-going supervisions, support and guidance from management in line with best practice guidance. This gave staff the right knowledge to be able to meet people’s assessed needs.

People had support to understand and share information and access external services to ensure their healthcare needs were met. People’s nutritional and hydration needs were effectively assessed and monitored. People had support to safely manage complex eating and drinking needs. Staff promoted healthy eating and supported people to understand how they could do this.

The service worked in line with the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). As far as possible, people made their own decisions. If it was necessary, people had had appropriate support to make decision in their best interests and in the least restrictive ways possible.

The service had been adapted to meet people’s support needs, including adaptations to enable people with physical disabilities to be able to move as freely as possible. People were involved in making decisions about decorations and communal areas and people’s bedrooms had been personalised.

Staff were kind and caring and respected people’s privacy and dignity. Staff included people and listened to how they liked to be supported and knew what their personal support preferences were. People told us they felt involved in making decisions about their care. They said, “Staff ask me where I would like to go or I can go down and ask them”. This helped people feel included and gave them control over their support.

Where necessary, staff used accessible ways to communicate with people to help remove or reduce any barriers for people with protected characteristics under the Equality Act 2010. For example, using simple signs, expressive body language or less complex language and shorter sentences.

People were encouraged to be as independent as possible. Some of the people using the service were younger adults and we saw that staff recognised this and gave them choice and flexibility about their privacy, including the amount of parental involvement in managing their support.

Staff understood the importance of maintaining people’s confidentiality. There were data protection and record keeping polices in place that the registered manager and staff adhered to. This ensured people’s personal information was correctly stored, used and shared.

People received personalised care that met their needs. A relative said, “The home is tailored to individuals.” People were involved in planning their care and had care plans that contained details about who they were as an individual, such as their life histories, social relationships and their interests and aspirations.

People’s care plans were regularly reviewed and staff shared information about people’s support needs in daily notes and handovers. This allowed staff to recognise and respond to any changes in people’s needs appropriately and in a timely manner. This ensured that people’s quality of life was affected as little as possible and they could maintain or develop their strengths and levels of independence.

People had support to follow their interests and take an active part in the wider community. There were individual activity plans in place for each person based on their preferences and needs. People and their relatives told us about how they took part in social activities of their choosing regularly, both inside and outside of the service.

People were encouraged and supported to develop and maintain social relationships to help them avoid becoming socially isolated. Staff were aware of people’s individual communication needs and used the most accessible means to share information about their support with them.

Information for people with a disability or sensory loss related communication need was available for people, as outlined in the principles of the Accessible Information Standards (AIS). There was a complaints policy in place and people told us they knew how to raise a complaint and were confident they would be listened to and receive an appropriate response.

People told us service was a nice place to live and that managers were approachable and visible. The registered manager had a clear vision of providing person-centred support to people to achieve their chosen support outcomes. People had decided the values that they expected and thought were important for them for staff to display when supporting them. These included respecting and promoting choice and including and empowering people. The registered manager re-visited these values when reviewing staff performance to help make sure they were displaying these when supporting people.

The registered manager promoted open and transparent communication with staff and external agencies to help ensure the delivery of high quality support. Staff said there was a positive and open culture at the service and felt listened to and included. Staff well-being was respected and the registered manager was committed to supporting the equal rights of staff with protected characteristics under the Equality Act 2010.

Staff were motivated and felt valued. Individual and team achievements were recognised and rewarded. The staff team cooperated and supported each other and worked together, sharing responsibilities to help people achieve good outcomes.

Staff, people and relatives had regular meetings and forums and completed surveys to involve them in developing the service. Feedback from these sources helped to identify resources and support to help drive improvement. There was effective quality assurance and governance systems in place to help identify actions to take to ensure and sustain high standards of quality and safety at the service.