We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. Our inspection took place on 31 August, 1 and 2 September 2016 and the first day was unannounced.

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

This is a summary of what we found.

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 used a number of different methods to help us understand the experiences of people using the service. This was because many of the people using the service had complex needs which meant they were not able to tell us their experiences. We observed care during our time at the home.

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.

We used a number of different methods to help us understand the experiences of people using the service. This was because many of the people using the service had complex needs which meant they were not able to tell us their experiences. We were able to speak with one person who used the service who told us: "I like the staff. I'm treated with dignity and respect. I can talk to staff and they listen to you". We spoke to the relatives of two people, who used the home for respite care. Both were very happy with the care their relatives received. This was summed up by one who said "If I wasn't happy with it, I wouldn't bring my son here for respite. I've never had any cause for complaint".