The Lodge

People’s experience of using this service: People’s support plans contained clear and easy to understand information about their needs and risks and how to support them effectively. Support plans were person centred and contained information about people’s preferences, daily routines and what was important to them.

The people in the home were limited in being able to express their needs and wishes verbally, staff had detailed guidance on the behaviours, gestures and body language the person would use to communicate their needs or wishes. Some people used Makaton and others used objects of reference to make their needs known.

Medicines were managed safely and people had access to a range of health and social care professionals in support of their needs.

During our visit, we had no concerns about the support people received and the registered manager and small, consistent staff team were committed to providing a good service.

In June 2017, CQC published best practice guidance called ‘Registering the Right Support’. This good practice guidance sets out the values and standards of support expected for services supporting people with a learning disability and or autism. During our visit, we found that the service had not been designed in line with this best practice guidance. The service was situated on the edge of a campus style setting with other services for people who have a learning disability. However, we could see that the service focussed on the values set out in the ‘Registering the Right Support’ guidance which advocates that people’s choice, independence and ability to live as life as ordinary in their own home should be promoted in service delivery.

Rating at last inspection: The service had previously been rated as Good in September 2016.

Why we inspected: The service was inspected in accordance with our ratings programme.

Follow up: We will continue to monitor the service and will inspect again in accordance with our inspection principles.

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

The Lodge is registered to provide accommodation for persons who require personal care for up to three people. At the time of our inspection, there were two people living in the home. The people who lived in The Lodge were on the autism spectrum.

The service is located on the Raby Hall site and is a distinct and separate building from the others.

The Lodge is a bungalow situated on the edge of the complex. It is owned and staffed by the provider, Wirral Autistic Society (WAS), which now has the ‘working name’ of Autism Together. The service is still registered as being provided by WAS. Also nearby this building were other WAS homes and a home farm centre and day services for the people living on the site.

The home required 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.

We looked at information the Care Quality Commission (CQC) had received about the service including notifications received from the registered manager. We checked that we had received these in a timely manner. We also looked at safeguarding referrals, complaints and any other information from members of the public.

The home is a domestic style and had previously some years ago, been used as accommodation for the gate keeper. It was furnished in a homely way which was according to people’s taste, especially in their own rooms. We observed the people in the home on the day of our inspection. However we were unable to speak with the two people as they had limited verbal communication. We spoke with the relatives of the two people who used the service. People appeared happy and comfortable with their surroundings and with staff.

We saw that people received sufficient quantities of food and drink and had a choice in the meals that they received.

Medication procedures were followed and the medication stored tallied with the records.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations were in order to maintain people’s rights.

We found that the care plans and risk assessment monthly review records were all up to date in the files looked at and there was updated information that reflected the changes of people’s health.

The home used safe systems for recruiting new staff. These included using Disclosure and Barring Service (DBS) checks. New staff had an induction programme in place that included training them to ensure they were competent in the role they were doing at the home. Staff told us they did feel supported by the deputy manager and the registered manager.

The staffing levels were seen to be appropriate to support people and meet their needs and the staff we spoke with considered there were adequate staff on duty.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidents. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded.

The Wirral Autistic Society (WAS) locations and premises contained limited, records, apart from the care files for the people living at any particular location. The bulk of the files relating to such things were kept in the headquarters of WAS at Oak House. In light of this, we visited the headquarters of WAS at Oak House on 16 June 2014. We sampled records and files for each of the locations in order to fairly appraise them. We looked at 17 staff files and various other audits and records. Some of the records were kept as paper records, others were computerised.

The Lodge had a total of 7staff. There were a total of three people using the service. The service comprised a small older building with an extension added. Each person had their own room and shared a large bathroom, a walk in shower and separate WC. The Lodge had a communal kitchen and dining room. The kitchen area had recently been re-fitted to have an adjustable sink and units to meet the needs of one of the people who lived there.

We talked with two people who used the service although their communication was limited. One other person was away for the day, using day care services. We observed that they appeared to be well supported by the staff member on duty. They seemed to be relaxed and content.

We also talked with the member of staff on duty as well as the registered manager for the home. We looked at various records including three care plans and the staff files. We had seen other records relating to The Lodge at Oak House.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available or on call in case of emergencies. Staff had been appropriately and properly recruited, ensuring that Criminal Records (CRB) or Disclosure and Barring Scheme (DBS) records had been checked. Staff had been trained in safeguarding principles and procedures and the people living in the home had been given information in easy read format to help them raise a concern if they were worried about anything. The home had a safeguarding policy which was regularly monitored. The Lodge had a friendly and sociable feel.

Appropriate risk assessments had been carried out and action plans put into place for safe practice. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. We spoke with one person using the service who nodded 'yes' when asked if they liked living at The Lodge.

Staff had received training to meet the needs of the people living at the home. The staff member said, "The training is good'.

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Is the service caring?

People were supported by kind and attentive staff. We saw that the worker was patient and gave encouragement when supporting people. We saw that people were able to do things at their own pace and were not rushed. People and their families had been involved in the creation of their care plans and continued to be involved throughout their stay in the home. We noted that peoples preferences about, for example, activities, room layouts or clothing choices, were respected by the staff. The people who used the service people were supported, where necessary, to make these choices and decisions.

Is the service responsive?

People's needs had been assessed before they moved into the home and frequently re assessed whilst they lived there. They had key workers who related to them specifically, but they were also happy with other team members and spoke well of them. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their needs and wishes. Other professionals, such as speech and language therapists and the organisation's own 'Autism Practice' department, were involved in peoples care when necessary. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. Both of the people we saw appeared happy and content in the home and were supported well by staff.

Is the service well-led?

The home had a registered manager in post which indicated that the person had undergone the relevant checks. This meant that they were of good character, is physically and mentally fit and has the necessary qualifications, skills and experience. The staff member we spoke with and the registered manager had a good understanding of the ethos of the organisation.

Quality assurance processes were in place. People, staff and other professionals had been asked for their feedback on the service. This also confirmed that respondents were listened to and as a result, some changes had been made. The home completed various other audits throughout the year, which contributed to an annual audit. An action plan had been produced to address any areas of concern raised through all of the audit and feedback processes.

The provider had a number of homes and they all same systems and IT package for much of its record keeping and policies. The provider had a centralised administration at the head office. The manager was able to demonstrate effective knowledge of this and show us that he had acted according to policy regarding such things as recruitment, safeguarding procedures and CQC notifications.

You can see our judgements on the front page of this report.

The people who lived at The Lodge were registered with a local health practice and with a local dentist. They had an annual health check with the practice nurse. Equipment was provided to meet people's needs. Care plans identified people's needs and how their needs should be met and were reviewed regularly.

People's medicines were handled and stored safely. The premises were clean, comfortable and well maintained. There was a small team of staff who were supported by a registered manager and a team leader.