This inspection took place on 9 and 11 January 2017 and was unannounced.

Lammas Lodge provides accommodation and personal care for up to seven people who have been diagnosed with autism. There were six people living at the home when we visited.

The home is required to have 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. There was no registered manager in post at the time of our inspection. The current manager, with whom we met, was in the process of applying to the Care Quality Commission to become registered manager of the service.

At our last inspection on 28 April 2016, we found a breach of Regulation 17 of the Health and Social Care 2008 (Regulated Activities) 2014. We gave the service an overall rating of requires improvement. This breach related to the provider's failure to act on feedback gathered from people using the service regarding the quality of the care provided. The provider sent us an action plan setting out the improvements they intended to make. At this inspection, we found the provider had made significant improvements to the service.

The provider had taken steps to protect people from the risks of harm and abuse. Staff understood how to recognise and report abuse. The risks associated with people’s care and support had been assessed, recorded and plans implemented to manage these. Systems and procedures were in place to ensure staff had up-to-date information about the risks to people and themselves. The manager assessed and organised their staffing requirements based upon people’s individual care and support needs. The provider adopted safe recruitment practices to ensure people were supported by suitable staff. People’s medicines were handled and administered safely by trained staff.

People were supported by staff with the right skills and knowledge to meet their individual needs. The manager ensured staff had the support they needed to carry out their job roles effectively. Staff sought people’s consent to the care and support they provided. The provider protected people’s rights under the Mental Capacity Act 2005. People had the level of support needed to eat and drink enough, and to maintain a balanced diet. People were able to access healthcare services and attend routine medical appointments and health monitoring with staff support.

Staff encouraged positive, caring relationships with the people who lived at the home. Systems and procedures were in place to encourage and facilitate people’s involvement in decisions that affected them. People were treated in a respectful and dignified manner by staff who understood the need to protect people’s human rights.

People received care that was shaped around their individual needs, interests and preferences. Care plans promoted a person-centred approach, and staff made use of these. People’s relatives were clear how to complain to the provider. The provider had developed formal procedures to ensure their complaints handling reflected good practice.

The manager and provider promoted an open culture within the service. People’s relatives found the manager approachable and had confidence in their ability to act on things. Staff felt well supported by the manager. The provider and manager made use of effective quality assurance systems to assess and address the quality of the service people received.

This inspection took place on 28 April 2016 and 22 and 23 June 2016 and was unannounced.

Lammas Lodge provides accommodation and personal care for up to seven people who have been diagnosed with autism. There were six people living at the home when we visited.

A registered manager was in post, but at the time of our inspection they were on leave. 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.

People had not been fully supported and empowered to give their views about the care they received and to be involved in decisions which affected them.

There was no consistent management and leadership and this had had an adverse impact upon the care and support provided. The provider’s quality assurance systems had not been used consistently and shortfalls in the quality of the care provided had not been identified or addressed.

Staff had not been well-supported or directed by the management team. They did not have the right skills and knowledge to communicate as effectively as possible with all of the people living at the home. Staff lacked knowledge about the requirements of the Mental Capacity Act 2005 and what this meant for their day to day work with people.

People were safe because staff recognised the signs of potential abuse and knew the action to take if they were concerned about people’s safety or wellbeing. The provider had clear procedures for dealing with any concerns of abuse.

The risks associated with people’s individual care and support needs and the overall running of the home had been assessed and managed to keep people safe. Accidents or incidents were monitored on an ongoing basis to minimise the risk of reoccurrence.

There were enough suitable staff to meet people’s needs because the provider adhered to safe recruitment practices. Staff treated people with dignity and respect.

The provider had developed systems and procedures to ensure that people received their medicines in a safe manner. People also received appropriate support with eating and drinking. The risks associated with people’s eating and drinking had been assessed and managed.

People were supported to maintain good health with the involvement of a range of external healthcare professionals.

Staff helped people to keep in contact with those important to them. People’s friends and relatives were able to visit them without unnecessary restrictions. People’s relatives knew how to raise concerns or complaints about the service and felt confident that they would be listened to.

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?

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

When we visited we met five of the seven people who lived at the home. They were not able to tell us about their experience of living at the home due to their communication and special needs. We observed people being supported by the care staff.

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

This is a summary of what we found:

Is the service safe?

Risks to people had been identified, assessed and kept under review. Staff had the skills and knowledge to know how to meet people’s needs and keep them safe. They had undertaken training including fire safety, how to respond positively to people’s behaviours and manage people’s health conditions.

Procedures were in place to ensure people who lacked mental capacity had decisions made for them that were in their best interest.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one. Restrictions were in place to help keep people safe. The home was working closely with funding authorities to ensure any restrictions were correctly authorised under the DoLS. This meant that decisions were made by a multidisciplinary team which helped protect the vulnerable people using the service.

The registered manager had made appropriate safeguarding referrals to the local authority. They and the provider reviewed all accidents and incidents.

There were well developed systems to make sure health and safety risks within the home were minimised.

Is the service effective?

We found that people’s on-going needs were regularly assessed and the care and support provided for them was well planned and purposeful. People had benefitted from this and developed new skills or taken part in new activities that had enhanced their lives. One person’s relative told us they were very satisfied with the care provided to their family member. They said, “I have visited unannounced and have no criticisms about the personal and physical care” and “They are getting X (person’s name) to be as independent as possible”.

Changes in how the care was provided were discussed with people when possible and their relatives, the staff and professionals involved in their care. Behaviour monitoring records were kept up to date and accurate. This provided reliable information to staff and professionals to ensure the support provided met people’s current care needs.

There were systems in place to ensure the staffing arrangements met people’s needs. Each person had staff assigned to them each day. Activities were planned ahead based on what people enjoyed, so staff knew what to offer people. Each person had their own activities planned for the day we visited. Staff discussed people’s needs during their shift to ensure that there was a continuity of the care provided. Staff meetings and supervision sessions were held regularly and staff were expected to attend training and gain qualifications. This meant that staff were well trained and skilled in their work.

Is the service caring?

We observed that the staff worked calmly and were well organised. They smiled and engaged with people in a natural and caring way. The atmosphere was relaxed and homely.

One person’s relative told us, “X (person’s name) interacts well with the staff and the transition has gone amazingly well” and “I can tell they are happy” and “The staff are open to ideas and I feel part of it”.

Staff discussed what people enjoyed and shared ideas of activities to try. Decisions were made in people’s best interest after consultation with their relatives and professionals.

We saw that staff did not rush people and they encouraged them to make choices and gave them time to make their decision. Discussions and observation showed that staff knew people's preferred routines, likes and dislikes well.

Is the service responsive?

We found that the management team were open to feedback. Ideas were listened to and used continually to try to improve outcomes for people living in the home.

The service worked in close cooperation with people’s relatives and others involved in people’s lives to help ensure the best outcomes for people. Concerns were listened to and taken seriously.

The service had responded positively to people’s behaviours that had an impact on the environment and been creative with finding solutions so people’s freedom was not restricted unnecessarily.

Staff felt that their views were listened to and any concerns were taken seriously.

Is the service well led?

We found that there were good care outcomes for people living at the home. The team were committed to giving people enjoyable lives and new opportunities.

One person’s relative told us, “I have a good relationship with the manager and feel I can raise any issues”.

Staff told us that they felt part of a good team and that they were well supported. They said the registered manager listened to any issues and took action quickly when needed.

The service operated in an open way and welcomed the involvement of people’s relatives and other professionals. People’s relatives had confidence in the service and felt they could give their ideas and views.

We found the management team were committed to continually improving the service and outcomes for people living at the home. There were well developed quality assurance systems and risks to people’s safety were kept under close review.

When we visited we saw most of the people who lived there. People were not able to give us their views because of their special needs. People looked well cared for and the staff were able to describe how each person preferred to be supported. People’s care needs had been assessed with the involvement of relatives and professionals. The manager was increasing the level of involvement of people’s families. One person’s relatives told us that they had confidence that the staff knew the family’s role in making decisions. We saw there were care plans and risk assessments in place which had been kept under review.

People were being supported by some staff who knew them very well. Five new staff had recently joined the team and the improved staffing levels meant that people were being offered more activities. A team of specialists employed by the providers reviewed people's emotional, behavioural, communication and medication needs regularly.

Incidents were monitored and the more serious incidents had been appropriately referred to the local authority. The manager was working with external agencies to make improvements and reduce the risk of incidents reoccurring. They were making good progress towards completing their action plan. Systems were in place to monitor the quality of the service. The staff team felt supported by the new manager and morale had improved. Suitable training and staff supervision arrangements were in place.

At this inspection we met four of the six people who lived at the home and we spent time with three of them watching how they spent their time during the afternoon. They were not able to tell us about their experiences because of their learning disability and autism. The registered manager told the relatives of the people who lived at the home about our visit and five families gave us their views. We spoke to two of the care staff and spent time watching how four of the five staff on duty supported people.

One person’s mother told us, “I am very content with the care given to my son and cannot fault Lammas Lodge”.

The care staff we spoke with talked about the people in the home in a caring and respectful way. They understood that people had different needs and could cope with different pressures due to their learning disability and autism. We saw that care staff quickly responded to people’s requests or signals that showed they wanted something or needed staff support.

One person’s mother told us, “My son has been at Lammas now for several years and I can honestly say he is a happier person for being there. I visit every two weeks and have always found him happy and well cared for. The staff there are always welcoming and courteous. My son appears to get on well with them. When he comes home he is always pleased to go back”.

We found that people could use their bedrooms whenever they wanted. Those we saw had been nicely personalised with photographs and contained hobby items such as stereos and sensory equipment.

We saw that care staff interacted with people who lived in the home in a friendly and appropriate manner. They showed that they were aware of people’s care and support needs. People seemed relaxed with the care staff being near them, for example we saw one person bring a book to a care worker so this could be read to them. People’s daily records confirmed that there were enough care staff to enable them to go out regularly and take part in activities they enjoyed or that helped them develop life skills.

The registered manager told us that systems were in place to help make sure that other agencies and interested parties were always informed when someone living in the home was involved in a serious incident. The incident forms we sampled had been completed by care staff but they had been read and signed by the registered manager. Safeguarding alerts had been made appropriately when incidents had resulted in one person who lived in the home hurting another person they lived with.

The providers had recently arranged for feedback surveys to be sent out to people using the service and their families to gather their views about where improvements could be made.