About the service:

Haydon Park Lodge is a residential care home providing accommodation and personal care to 11 people who have a learning disability. One person was in hospital at the time of our inspection.

People’s experience of using this service:

• People told us they loved living at Haydon Park Lodge. They were cared for by a long-standing group of managers and staff who respected them and actively promoted their rights, welfare and independence.

• People using the service had ownership of the service, felt it was ‘their home’ and knew each other and staff very well.

• People could access a range of interesting things to do. They were supported to enjoy a range of activities which enhanced their lives. This included support to enjoy swimming, football, evening clubs, day centres and going out in the community doing things they liked.

• People were supported to keep in touch with relatives and friends who were important to them.

• People had access to the healthcare they required. Staff had been provided with clear guidance so people would receive the support they needed if they required emergency health care.

• Staff understood people’s safety needs well and supported people so their individual risks were reduced. People were supported to have their medicines safely, by staff who were competent to do this.

• The environment at the home was clean, well maintained and regularly checked. The risk of accidental harm or infections was reduced as staff used the resources and equipment provided to help ensure this.

• There were sufficient staff to care for people. Staff received effective training and support to develop the skills they needed to care for people.

• People’s care needs were assessed and detailed support plans put in place based on their individual needs and to promote their well-being. These were reviewed regularly and kept up to date.

• People, their relatives, staff and other involved healthcare professionals were encouraged to make any suggestions for improving the care provided and the service further.

• There was an open and transparent and person-centred culture with good leadership evident. The provider, registered manager and the staff team were committed to providing high quality person centred care and support. They reflected on the support provided and made constant improvements to enhance this.

•The outcomes for people using the service reflected the principles and values of Registering the Right Support. For example, people's support focused on them having maximum choice and control in their day to day lives.

• We found the service met the characteristics of a “Good” rating in most areas; Outstanding in caring.

More information is available in the full report.

Rating at last inspection:

At our last inspection, the service was rated Good. Our last report was published on 20 September 2016.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 23 August 2016 and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the service was carried out in July 2015. At that time we gave the service an overall rating of ‘requires improvement’. We also imposed three requirement notices which we checked during a focused inspection in December 2015. We found the provider was meeting the regulations we looked at that inspection, but we did not amend our rating as we wanted to see consistent and sustained improvements made at the service over time.

Haydon Park Lodge is a small family run care home which provides personal care, support and accommodation for a maximum of thirteen adults. The service specialises in supporting people with a learning disability and/or sensory impairment and mental health needs. There were ten people living at the home at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

At this inspection we found the provider had made and maintained improvements at the service. Arrangements for the safe management of medicines in the home were consistently followed and people were supported to take their medicines as prescribed. Staff had maintained appropriate records to reflect this. Medicines were stored safely in the home.

The provider consistently followed good practice in relation to staff recruitment. Appropriate employment and criminal records checks were made on all staff to ensure they were suitable to work for the service.

The provider had a programme of audits in place that they followed to check that expected standards were being maintained by all involved in the provision of care and support at the home. They used these checks along with feedback they received from people and others to review the quality of care and support that people experienced. They ensured records maintained by the service were accurate and up to date.

People views were taken into account when staff assessed their care and support needs. The provider had made improvements and up to date support plans were now in place which set out how people’s needs should be met by staff. These reflected people’s individual choices and preferences. They had been reviewed to identify any changes that may be needed to the support people received. People said staff were able to meet their needs.

People were satisfied with the care and support provided. People told us staff looked after them in a way which was kind, caring and respectful. People knew how to make a complaint if they had any issues or concerns about the service. The provider had improved the arrangements to deal with any concerns or complaints so that people had up to date information about how they could make these.

People said they were safe in the home. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and plans were in place which instructed staff how to minimise any identified risks to keep people safe from harm or injury. The provider ensured these were kept up to date so that staff had access to the latest information about how to minimise identified risks. The premises and equipment were regularly serviced and checked to ensure these did not pose unnecessary risks to people. The home environment was free of obstacles or objects that could pose a risk to people’s safety.

There were enough staff to meet people’s needs. The provider planned staffing levels to ensure people’s needs could be met at all times. Staff received relevant training to meet people’s needs. The provider monitored training to ensure

We carried out a comprehensive inspection of this service on 21 July 2015 at which breaches of legal requirements were found. The provider had not ensured; medicines were managed properly, checks had been undertaken on new staff to ensure they were suitable and fit to work, there were effective systems in place to assess and monitor the quality and safety of the service and records were accurate and up to date. After the inspection, the provider wrote to us with a plan for how they would meet the legal requirements in relation to these breaches.

We undertook this unannounced focused inspection of Haydon Park Lodge on 22 December 2015. We checked the provider had followed their plan and made the improvements they said they would to meet legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Haydon Park Lodge on our website at www.cqc.org.uk

Haydon Park Lodge is a small family run care home which provides personal care, support and accommodation for a maximum of thirteen adults. People using the service have learning disabilities and/or sensory impairment. There were twelve people living at the home at the time

of our inspection.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection, we found the provider had followed their action plan, and legal requirements have been met. People’s medicines were managed properly and safely. Staff maintained appropriate records in relation to people's medicines. Controlled drugs were stored securely and a register was maintained each time these had been administered. Medicines no longer in use were disposed of appropriately. The provider and registered manager ensured medicines were checked regularly to ensure people received these as prescribed.

The provider had arrangements in place to ensure staff’s suitability and fitness to work at the home was checked and staff records contained evidence of these checks.

The provider had a system in place to assess and monitor standards within the home. These checks covered key aspects of the service. Prompt action to address any gaps or shortfalls was taken where these were identified. Our checks of records maintained by the service, such as people’s care records and staff files showed these had been reviewed to ensure these were accurate and up to date. Confidential information about people was now stored securely in the home.

During our last inspection of the service in August 2013, we identified essential standards of quality and safety were not being met in respect of Regulations 20 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following that inspection we asked the provider to take appropriate action to achieve compliance with these regulations.

The provider sent us an action plan on 4 October 2013 setting out the actions they would take to achieve compliance with these regulations.

During this visit we checked these actions had been completed.

We looked at staff training and supervision records. We noted, since our last inspection, staff had attended training to update their skills and knowledge. We saw evidence that ongoing training had been planned with staff booked to attend training specific to their roles.

Staff supervision records showed regular meetings took place between the manager and staff to discuss their work performance. The provider advised that all staff appraisals would be completed by the end of March 2014 using a new appraisal format.

We looked at people’s personal records. We found risk assessments for each person had been reviewed and updated. This meant staff had up to date information about how to minimise the risk of an accident, injury or harm to people using the service.

We spoke with five people using the service. People spoke positively about the care they received from staff. One person said, “They are looking after me. I like it here”. Another person told us, “Everything is fine as it is.” They also said, “They give me support to be independent. They give me help with important things.” We spoke with a visitor to the home on the day of our inspection who told us they felt people were looked after well in a nice environment.

We also gathered evidence of people's experiences of the service by looking at satisfaction surveys completed by people’s representatives and other healthcare professionals. Completed surveys showed us people were positive about the care provided by the service

We saw from people’s records their individual care and support needs had been assessed and plans were in place to meet these. We also saw care plans were reviewed annually. Staff completed daily records which they used to share information about people’s current care and support needs.

People were supported to be able to eat and drink sufficient amounts and were provided with a choice of suitable and nutritious food and drink. People’s specific preferences were taken into account when meals were planned.

However we found staff had not received regular training to refresh and update their skills and knowledge. We also found from some of the records we looked at risks to people's safety and wellbeing had not been promptly reviewed by senior staff.

Not all of the people using the service were able to share their views about living in Haydon Park Lodge. We were able to speak with 3 people using the service during our visit. One person told us ‘I like living here. I like the atmosphere. It’s homely and welcoming’. Another person said ‘I like it here. I wouldn’t want to go anywhere else’.

People we spoke with were positive about staff. One person told us’ Staff are very respectful’. They also said staff do a ‘good job’. Another person said staff were ‘nice people’. They told us they felt safe in the home.

Staff received training to keep their skills and knowledge up to date. They told us they worked in a supportive environment. One member of staff told us they felt like they were part of ‘an extended family’ when working in the home.

The provider used surveys to assess the quality of service being provided. They also carried out checks within the home to make sure that risks to people’s health and wellbeing were identified, managed and mitigated.

This inspection took place on 21 July 2015 and was unannounced. At the last inspection on 13 February 2014 we found the service was meeting the regulations we checked.

Haydon Park Lodge is a small family run care home which provides personal care, support and accommodation for a maximum of thirteen adults. People using the service have learning disabilities and/or sensory impairment. There were twelve people living at the home at the time of our inspection.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During this inspection we found the provider in breach of their legal requirement to ensure that people’s medicines were managed properly and safely. We identified concerns with how some prescribed medicines had been administered and the way information was recorded. There was no guidance for staff on people’s records as to how, when and why some medicines should be administered. We also found medicines were not properly disposed of and a controlled drug was not stored safely.

We also found them in breach of their legal requirement to ensure appropriate checks had been undertaken for new members of staff at the service to ensure they were suitable and fit to work at the home.

And, we found them in breach of their legal requirement to operate an effective system to assess and monitor the quality and safety of the service and maintain up to date, accurate records relating to people, staff and to the management of the service.

Despite the issues we identified, people and their relatives told us people were safe at Haydon Park Lodge. Staff knew how to protect people if they suspected they were at risk of abuse or harm. They had received training in safeguarding adults at risk and knew how, when and to whom they must report their concerns to if they suspected someone was at risk of abuse or harm.

Staff knew how to minimise identified risks in order to keep people safe from injury or harm in the home and community. The provider ensured maintenance and service checks were carried out at the home to ensure the environment and equipment were safe. Staff kept the home free of obstacles so that people could move freely and safely around.

There were enough staff to care for and support people. Staffing levels had been planned to ensure there were enough staff to meet the needs of people using the service. Staff received relevant training to help them in their roles and they felt well supported by the provider and registered manager.

People and relatives’ feedback about the service praised the care and kindness shown by staff. Staff had a good understanding and awareness of people’s specific needs and how these should be met. They knew people well and were able to anticipate what people wanted or needed. The way staff supported people during the inspection was kind, thoughtful and caring.

Staff knew how to ensure that people received care and support in a dignified way and which maintained their privacy at all times. They treated people with respect and ensured communication with people was done in a way that people could understand. Staff supported people to retain as much control and independence as possible when carrying out activities and tasks.

People were supported to keep healthy and well. Staff ensured people were able to access other healthcare services when this was needed. They worked proactively with healthcare professionals to ensure people got the care and support they needed. They also encouraged people to drink and eat sufficient amounts to reduce the risks to them of malnutrition and dehydration.

People had been involved in making decisions about their care and support needs. Support plans had been developed for each person using the service which reflected their specific needs and preferences for how they were cared for and supported. These gave guidance and instructions to staff on how people’s needs should be met. However we found people’s support plans had not been reviewed and updated regularly.

Staff demonstrated a good understanding and awareness of how to ensure people were able to consent to the care and support they received and what to do if they felt people may lack capacity to make decisions. The registered manager had sufficient training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) to understand when an application should be made and in how to submit one. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

People and relatives told us the home was always open and welcoming. People were encouraged to maintain relationships that were important to them. People were also supported to undertake activities and outings of their choosing. Relatives said they would feel comfortable raising any issues or concerns directly with staff. There were arrangements in place to deal with people's complaints however the procedure for dealing with these was out of date and contained inaccurate information for people.

People, their relatives and staff spoke positively about the management of the home. People said they were approachable and supportive. The provider and registered manager sought the views of people, relatives, and other healthcare professionals about how the care and support people received could be improved. The registered manager worked proactively with healthcare professionals to continuously improve the service’s knowledge, learning and understanding of how to care for and support people.

You can see what action we told the provider to take at the back of the full version of the report.