Archived: Holly Lodge

Holly Lodge is a detached house providing residential accommodation for 11 adults with a learning disability and autistic spectrum disorder. The home has seven rooms located on the first floor and one on the ground floor. Within the grounds there is a separate single storey detached annexe which consists of a two bedroom apartment and a one bedroom apartment providing residential accommodation for a further three adults. At the time of the inspection there were nine people living in the home.

The service did not have a registered manager. The previous registered manager had left the service in August 2015. The service was being overseen by a manager from another home within Choice Pathways Limited group. 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.

Some staff had not completed all of the training relevant to their role. Training records showed shortfalls of training epilepsy management personal behaviour support and autism spectrum disorder (ASD).

People told us they were safe and well cared for at the home. People knew how they could raise a concern about their safety or the quality of the service they received.

Staff knew how to identify abuse and protect people from it.

Medicines were ordered, stored, administered and disposed of correctly.

The provider had robust recruitment systems in place.

The service had carried out risk assessments to ensure that they protected people from harm.

There were enough staff deployed to provide the support people needed. People received care from staff that they knew and who knew how they wanted to be supported.

Staff had developed caring relationships with people who used the service. People were included in decisions about their care.

People were provided with meals and drinks that they enjoyed. People were supported to prepare meals for themselves and others.

Policies and procedures governing how the service needed to be run were kept up to date

The manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood their responsibility to ensure people’s rights were protected.

There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

At the time of this inspection, Holly Lodge was providing accommodation, care and support to eight people with learning disability, physical disability or sensory impairment. Some of the people using the service had complex needs which meant they were not all able to tell us their experiences. We observed the care and support being given and how staff interacted with people. We spoke with the registered manager, three staff, three people who use the service and one relative of a person using the service. We also looked at care and support records.

This is a summary of what we found '

Is the service safe?

There were arrangements in place to deal with foreseeable emergencies. Each person living at Holly Lodge had a Personal Emergency Evacuation Plan (PEEP) in place. This gave details of the safest way to support a person to evacuate the building in the event of an emergency, for example fire.

The provider responded appropriately to any allegation of abuse. Staff we spoke with told us they were confident the registered manager would respond effectively to any allegation of abuse.

The provider took account of identified risks. Health and safety checks, audits and servicing took place, including gas and electricity and cleaning materials were stored appropriately.

People's personal records including medical records were accurate and fit for purpose. All records we looked at provided up to date information and guidance on how best to meet people's care needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, 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. The area manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation.

Is the service effective?

The service was effective. One person who uses the service said: 'The staff have helped me to control my anger and jealousy issues and I'm really enjoying life now. I am on a course at college to help me with my social interaction skills and I enjoy that'.

Daily records were completed during each shift and included any observations throughout the day and any actions taken. These evidenced people received support and care that was specific to their needs and wishes.

Each person had a section in their care plan which evidenced regular contact with medical professionals. This helped to ensure health care professionals knew about the needs of the individual.

Is the service caring?

The service was caring. Records we looked at, discussion with staff and observations showed that people's wishes were respected and acted upon. People took part in varied activities that were meaningful to them. One person who uses the service told us how staff had supported them to go home once a month and how much they looked forward to it.

Is the service responsive?

The service was responsive. We spoke with one person who uses the service that we had previously spoken to during our visit in 2013. They told us: 'A year on and I feel more grown up and independent.

Is the service well led?

The service was well led because the registered manager informed us the provider had many systems in place to ensure people received a safe and effective service. The manager was able to show us copies of completed audits which were carried out on a regular basis. Audits were carried out weekly, monthly and quarterly.

People using the service told us they had a formal review of their care with their key worker on a regular basis and that they could discuss any concerns they had at that time. We were shown minutes of the monthly "Service users' meetings". We were able to see when issues were raised these were discussed and the outcome was recorded.

The care workers we spoke with told us that they had completed training in safeguarding of vulnerable adults. Records showed that this training had formed part of the induction process for all staff. There was a process for all care workers to have a regular update.

The registered manager told us, and we saw from looking at the training programme that all care workers who were responsible for the management of people's medicines undertook a competency assessment following training. This meant that they were observed and put their learning into practice.

New staff completed an application form and the registered manager confirmed that references were sought including those from their last employers. We saw that references and Disclosure and Barring Service checks (DAB) were completed and records of these were maintained.

The provider had arrangements in place to deal with complaints. There was a complaints procedure in place and this was available, including an easy read pictorial format on the notice board at the entrance to Holly Lodge and also in the service user guide.