The inspection took place on 31 August 2018. We gave the provider notice of our intention to visit so that they could prepare people with complex needs whose routines might be disrupted by our inspection process.

Franklyn Lodge – The Bungalow is a care home which is registered to provide personal care and accommodation for a maximum of four people. People living in the home have learning disabilities. At the time of our visit, there were three people living in the home.

There was a registered manager in place at the home. 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.

Following our last comprehensive inspection of Franklyn Lodge – The Bungalow in August 2017 we rated the home as ‘Requires Improvement.’ We identified that risks to people's health and safety were not safely managed. Personal emergency and evacuation plans (PEEPS) of people were not kept on site, which meant they were not accessible in emergency situations. There was a lack of scrutiny and effective quality monitoring, which placed people at risk of harm or of not receiving appropriate care.

At this inspection we found that the service had started to make improvements. Action had been taken to deal with some concerns that we had raised in our previous inspection. However, further improvements were required in quality monitoring processes. Most of the audits and quality checks were at an early stage of completion, which meant we were not able to fully assess the usefulness of these. Whilst we were reassured that action was underway, we were concerned about the length of time taken to improve the usefulness of the quality monitoring processes.

Improvements were required in the management of medicines. Although there were arrangements for recording medicines that were prescribed to be taken ‘when required’ (PRN), we found this not to be comprehensive. The service did not provide clear and precise instructions to staff to ensure PRN medicines were administered as intended. Also, whilst we generally observed suitable arrangements for the recording, storage, administration and disposal of regular medicines, further improvements were required. People did not have a person-centred medication profile. This was important for medicines that needed to be specifically monitored due to special requirements.

There were effective systems and processes in place to minimise risks to people. Safeguarding and whistleblowing policies were in place. Staff had been recruited safely. They underwent appropriate recruitment checks before they could commence working at the service to ensure they were suitable to provide people's care. There were effective systems and processes in place to minimise risks to people. Care plans contained risk assessments which identified the risks to the person and how these should be managed.

Relatives gave us positive feedback about how the service was meeting people’s needs. People were supported to have sufficient amounts to eat and drink. Their needs had been assessed by the service prior to using the service. Care plans included guidance about meeting these needs. The service also involved a range of health and social care professionals. People's capacity to make choices had been considered in line with the Mental Capacity Act 2005 (MCA). Staff had received regular training and support.

People were treated with respect and their dignity maintained. Their individual preferences were respected. Care plans were detailed so that staff could understand their preferences. Care workers had a good understanding of protecting and respecting people's human rights.

People received person centred care. They were involved in the development of their care plans. People's

We undertook this unannounced inspection on 3 August 2017. Franklyn Lodge – The Bungalow is a care home which is registered to provide personal care and accommodation for a maximum of four people. People living in the home have learning disabilities. At the time of our visit, there were three people living in the home.

At our previous inspection on 7 October 2015, we rated the service as “Good” and there were no breaches of regulation. At this inspection we rated the service as “Requires Improvement”.

People who used the service indicated to us that they were satisfied with the care and services provided. They had been treated with respect and dignity in the home. This was confirmed by relatives and a social care professional we spoke with. Care workers showed an understanding of how to recognise and report allegations of abuse. Risks to people who used the service were assessed and risk management plans were in place. Medicines were managed safely. The premises were clean and tidy and infection control arrangements were in place. We however, noted that the COSHH (Care of substances hazardous to health) cupboard where cleaning detergents were stored had not been locked. This was locked soon after we raised it with the new manager. The PEEPs (personal emergency and evacuation plans) were not kept in the home. However, they were brought to the home by senior staff of the organisation on the afternoon of the inspection. Failure to ensure these safety measures were in place is a breach of regulations and we have made a requirement in respect of this.

Care workers were carefully recruited. They had been provided with essential training. There were regular staff supervisions. Appraisals had been carried out in the past twelve months. The staffing support for one person was not in accordance with that recommended by health and social care professionals. This had been brought to the attention of the funding authority so that additional support could be provided.

Care workers understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Restrictions placed on people had been authorised. People’s healthcare and nutritional needs had been attended to.

Care workers treated people with respect and ensured their dignity and privacy were maintained. There were arrangements for ensuring that the care provided was centred on the person who used the service. The care of people had been subject to regular reviews by health and social care professionals. People could participate in activities they liked. The service had a complaints procedure. Two complaints made had been promptly responded to.

Care workers worked well together. Appropriate policies and procedures were in place. Care records were up to date. The service had arrangements for quality assurance checks and audits. However these checks and audits were not sufficiently effective as they did not identify deficiencies noted by us such as incidents which were not adequately completed and another incident which was not notified to the CQC. This lack of effective checks and audits may put people at risk of receiving unsafe care. We found a breach of regulation in respect of this.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

We undertook this unannounced inspection on 7 October 2015. Franklyn Lodge – The Bungalow is a care home which is registered to provide personal care and accommodation for a maximum of four people. People living in the home have learning disabilities. At this inspection there were four people living in the home.

At our last inspection on 4 September 2014 the service met the regulations we looked at.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run.

Some people in the home had complex needs and did not provide us with feedback. However, we observed that they were well cared for and appropriately dressed. One person, a relative and three health and social care professionals informed us that they had no concerns and they indicated that people who used the service were well cared for. One person who used the service nodded and said "yes" when we asked them if they were well treated by staff. Two relatives and the professionals stated that people were treated with respect and dignity.

The home had suitable arrangements for safeguarding people. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and staff were aware of potential risks to people and how to protect people from harm.

There were enough staff to meet people's needs. Staff had been carefully recruited and provided with training to enable them to care effectively for people. They had the necessary support and supervision to enable them to carry out their duties effectively.

People’s needs were carefully assessed. Staff prepared appropriate and detailed care plans with the involvement of people and their representatives. Their healthcare needs were closely monitored and there was evidence of them being attended to. Appointments had been made with healthcare professionals when required. People had received their medication. There were suitable arrangements for the storage, administration and disposal of medicines in the home. The arrangements for the provision of meals was satisfactory and people’s dietary needs and preferences were met.

The CQC monitors the operation of the DoLS (Deprivation of Liberty Safeguards) which applies to care homes. Staff were knowledgeable regarding the Mental Capacity Act 2005 (MCA) and the DoLS. The home had policies and guidance on MCA and DoLS and staff were aware of the procedure to follow if people’s freedom needed to be restricted for their own safety. We noted that there was evidence of DoLS authorisations been given by the relevant authorities.

We observed that staff communicated well with people and formed positive relationships with people. We noted that people responded well to staff and were relaxed and around staff. Staff were knowledgeable regarding the individual care needs of people. There were arrangements for encouraging people to express their views regarding areas such as activities and meals provided.

People’s preferences were recorded and we found examples of preferences and choices being responded to. Concerns and complaints were promptly followed up.The home had comprehensive arrangements for quality assurance. Regular audits and checks had been carried out by senior staff and the directors of the company. A satisfaction survey had also been done and the results were positive.

We found the premises were clean and tidy. The home had an infection control policy and arrangements were in place for infection control. There was a record of essential inspections and maintenance carried out.

People who used the service had learning difficulties and some of them did not express their views to us.One person who used the service and three relatives who spoke with us by phone indicated that people were well cared for and staff had treated people with respect and dignity.

The bedrooms and the communal areas had been kept clean and tidy. Bedrooms had been personalised by people with their pictures and ornaments. We observed that people who used the service were dressed appropriately and appeared well cared for. Staff were constantly supervising and interacting with people who used the service in a friendly manner. Plans of care had been prepared for people following consultation with people and their representatives. There were appropriate arrangements in place to manage medicines.

Staff were knowledgeable regarding their roles and responsibilities. One person and three relatives indicated to us that staff were able to meet the needs of people.

Arrangements were in place to monitor the quality of care provided. These included satisfaction surveys and monthly checks and audits done by senior staff of the company.

People who use the service have severe learning difficulties and communication was limited. However, we were able to observe how they were being cared for by staff. We noted that staff were vigilant and careful to ensure that people were safe. Activities had been organised to ensure that people received mental and social stimulation. The healthcare needs of people had been attended to.

Two relatives who spoke with us stated that people had been treated with dignity and respect and they were well cared. Their views can be summarised by the following comment,” I regularly visit the home and am satisfied with the care provided. I find my relative well dressed and happy.”

Relatives described staff as kind and professional. They said staff kept them informed of the progress of people. Staff informed us that they worked well as a team and felt supported by their managers. Staff were aware of the safeguarding policy and procedure aimed at protecting people from abuse.

Relatives said the home was clean and tidy when they visited. Staff were aware of the infection control policy and procedure and could describe action they took to reduce infection. The home was well maintained and the required safety inspections had been carried out.

People living in the home told us that they “liked the holiday” that they had recently been on. They spoke of some other activities they attended such as day care services and church.

People spoke positively about staff. We saw that staff understood people’s needs and generally provided them with support where needed. A relative told us that “staff are good to people.” The relative said that they could visit the home at any time, and that it was “always fine” when they arrived. They also spoke of being kept informed by the service.

We saw that people were generally appropriately dressed and presented. Most people needed support with personal care, so it was evident that they received timely support from staff in this respect.

We saw that people could not always leave the home when they wanted. Whilst this kept people safe, it may not be upholding their rights, for which improvements were needed.

A single Inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

We used a number of different methods to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

We observed the care provided and the interaction between staff and people who used the service. We also spoke with three care staff, and the registered manager. We also read feedback from relatives.

Below is a summary of what we found. The summary describes what 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?

People who used the service had support plans and risk assessments which helped to ensure their safety and welfare.

We found the home had safeguarding, whistle blowing and Deprivation of Liberty Safeguards (DOLs) policies and guidance in place. Training records showed staff had received training in safeguarding adults and DoLS. When speaking to them, they were able to provide examples of what constituted abuse and how they could identify abuse. They were aware of action to take and how to report allegations or incidents of abuse to the relevant authorities.

CQC monitors the operation of the DoLS which applies to care homes. While no applications have been submitted, appropriate policies and procedures were in place. When speaking with staff we found they had an understanding of the Mental Capacity Act (MCA) 2005 and the DoLS and how it applied to the people they were providing care and support to on a daily basis.

We found the home ensured people were cared for, or supported by, suitably qualified, skilled and experienced staff. We saw there were recruitment and selection procedures in place and found that the appropriate checks had been undertaken before staff began work. Staff were trained in areas of relevance to their job roles and demonstrated knowledge of people’s individual needs and requirements.

Is the service effective?

We found the home had taken steps to ensure that people were included and involved as much as possible in their care and support. We found they used various methods of communication to engage and involve people who used the service as much as possible such as pictures, facial expressions, sign language, key objects and words.

We looked at four care plans and saw that people's needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. We found people’s care plans were person-centred, very detailed and specific to each person and their needs. Risk assessments had been carried out.

Is the service caring?

We found good feedback had been received about the home. Feedback from one relative read “thank you for taking good care of [relative]” and “we are pleased with [relative’s] progress, the carers are fantastic.”

We saw people being treated with respect and dignity. Staff communicated well with people and explained what they were doing and why. We observed people were supported to make choices by staff and asked what they wanted to do. During the inspection, we observed people who used the service were relaxed and happy.

Is the service responsive?

We saw the home had a complaints policy and procedure, which was easily accessible to staff and people who used the service. We found staff were aware of how to make a complaint and felt comfortable approaching the manager with any concerns they had.

We also found regular reviews were being held between people who used the service, their family or representatives and the registered manager, where all aspects of their care were discussed and any changes actioned if required.

People's health and medical needs were assessed and we viewed records demonstrating that people had access to health and medical services when necessary.

Is the service well-led?

We found the home had a system in place to obtain feedback through surveys which showed good feedback had been received from relatives of people who used the service.

There were regular consultations and resident meetings with the people who used the service which gave them the opportunity to discuss any issues or concerns they had and to raise any complaints they had.

We also found regular monthly staff meetings took place which ensured staff had the opportunity to communicate their views about the service and to discuss the care and support needs of people who used the service.

We found the home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Checks had also being conducted on all electrical equipment and maintenance checks and service records were up to date.