Leigham Lodge is a small residential care home for a maximum of six people with a learning disability and associated conditions, based in the London Borough of Lambeth. At the time of the inspection there were six people using the service.

This unannounced inspection was carried out on 25 October 2017.

At the last inspection the service was rated Good, at this inspection we found the service remained Good, with one outstanding rating in caring.

The service did not have a registered manager in post at the time of our visit, however a manager was in post who had applied for registration and became registered on 26 October 2017. 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 continued to be protected from harm and abuse as the service had robust systems in place to monitor and respond to suspected abuse. Staff received on-going training in safeguarding and were aware of the whistleblowing process to escalate their concerns.

The service had robust risk management plans in place that identified the risk and gave staff clear guidance on how to respond to the risk. Risk management plans were reviewed regularly and updates shared with staff.

People continued to receive support from sufficient numbers of staff that had gone through robust pre-employment checks to ensure their suitability to work with people. Records confirmed staffing levels were flexible and based on people’s needs.

People received their medicines in line with good practice. Records confirmed people received their medicines as prescribed and these were recorded, administered and disposed of correctly.

The service had training programmes in place that ensured people received effective care and support. Staff confirmed training met their needs and enabled them to carry out their roles and responsibilities in line with the provider’s policy.

People’s consent to care and treatment was sought by staff that had clear knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people were unable to give consent, the provider had taken the correct action to do so in their best interests in line with the legislation.

People continued to be supported to have sufficient amounts to eat and drink that met both their dietary needs and requirements. People who had specific dietary requirements were catered to.

Records confirmed people were supported to access healthcare professional service, to ensure their health and wellbeing was monitored and maintained. Records confirmed concerns about people’s health and wellbeing were actioned swiftly to minimise the impact on people.

People were encouraged to maintain relationships with people that were important to them. The service supported people to visit friends and relatives, and encouraged relatives to visit the service.

Staff were aware of the importance of encouraging people to express their views. People’s views were listened to and respected, and people were supported to make decisions about the care they received. People were treated with dignity and respect by staff that encouraged their privacy.

People received personalised care that met both their needs and preferences. Records confirmed people’s likes and dislikes were sought and care delivered based around their preferences. Activities provided by the service included both in-house and community based activities.

People were supported to raise concerns and complaints, the service had developed an easy read complaints procedure, to support people to understand how to raise a complaint, who to contact and what to expect.

Staff spoke positively about the manager, stating she was approachable, caring and responsive to

Our inspection team was made up of one inspector. We inspected Leigham Lodge over one day and spoke with five health or social care professionals involved in the care of the people using the service. We spoke with a relative. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

People got individual support to keep them safe when they needed it. Safeguarding procedures were in place and staff understood what to do to protect people. This meant that people could be confident that incidents of suspected abuse would be investigated properly. systems were in place to review incidents and necessary actions taken including notifying local authorities and CQC. Equipment was maintained and serviced regularly, therefore not putting people at unnecessary risk. People were cared for in an environment that was safe, clean and hygienic.

A member of the management team was available on call in case of emergencies. Staff had received training to meet the needs of the people living at the home.

Is the service effective?

People were supported to make important decisions about their lives with help from family and health and social care professionals. Staff knew that people could make day to day decisions and how to help people to make daily choices. Areas of support required for each person had been identified in personalised and accessible care plans. Our observations confirmed that this support was provided.

Is the service caring?

People were supported by kind and attentive staff. Our discussions with staff on duty and our observations of the care and support provided confirmed this. We saw that staff showed patience and gave encouragement when supporting people.

Is the service responsive?

The staff responded quickly when people needed extra support from their health professionals. People regularly completed a range of activities inside the home and in the community. Staff were available to take people out when they wanted to go out. When incidents happened action was taken to reduce reoccurrence. People can therefore be assured that the service responds to their needs.

Is the service well-led?

The service was well- led. The manager was registered and we received good feedback about their management of this service and their approach and care of the six people using it. The manager facilitated the inspection well and demonstrated good leadership. The provider visited the service often and followed up on any quality issues identified. The service worked well with other agencies and services to make sure people received their care in a joined up way.

You can see our judgements on the front page of this report.

When we visited we saw five of the six people living at Leigham Lodge. People were dressed appropriately for the warm weather and were being supported by staff to take part in the educational and leisure activities they had planned for that day. People using the service needed support to communicate their needs. Staff knew people's preferred routines and understood how they expressed themselves.

The home manager had registered with the Commission and had familiarised themselves with the needs of the people using the service. This had enabled them to review everyone's support and risk management plans which were up to date with people's current care and support needs.

People were protected from the risks of inadequate nutrition and dehydration. Staff prepared meals and snacks that met people's dietary needs and their cultural, religious and personal preferences. The kitchen was visibly clean and food was stored safely. There were supplies of fresh fruit and vegetables.

There were enough qualified, skilled and experienced staff to meet people’s needs. The provider had taken action to recruit more staff since our last inspection.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

There was an effective complaints system available.

We found that there had been an extended period of management and staff change and instability at Leigham Lodge. This had not provided the people who use the service with the required consistency of support that they needed.

When we arrived we saw that staff were preparing breakfast. A member of staff provided by an agency that had worked in the home on two previous occasions supported one person from the lounge to the dining room and seated them at the table before the breakfast was on the table. The person began to vocalise loudly and became agitated. The permanent staff member leading the shift heard the noise and came to the dining room to advise the agency worker that this was not in accordance with the person’s support plan at meal times. The person should not have been brought to the dining room until their breakfast was ready as this was known to trigger such behaviours. We saw that the person, who had a visual impairment and communication needs, was led back to their chair in the lounge where they continued to vocalise their agitation and slapped themselves repeatedly on the face. Another agency worker was in the lounge at that time and we observed that they repeatedly told the person to "stop that" which did not reassure the person or help them to settle. We saw that the person only settled when their expected routine was followed.

Stakeholders spoke positively about the care and support provided by staff. We heard of their observations of excellent staff interaction with people who have significant communication needs and of a caring staff attitude. However, our inspection and provider quality assurance found that more could be done to work more effectively with external health and social care professionals in some cases.

Staff told us that they felt adequately trained to do their jobs and that there were a sufficient number of staff on duty to support the needs of the people they were caring for. Staff told us that they were supported by the management structure in the home who were always available to give advice.

The people using the service were not able to answer our questions but we observed that they were generally being supported well by staff who understood their needs.

The people who we met at Leigham Lodge were not able to tell us about their experiences of living at the home. However we saw that they appeared relaxed and happy there. The staff treated them respectfully and with kindness.

We spoke to some of the professionals who work with people who live at the home. They told us that they felt people received a good service.

This inspection took place on 23 and 24 September 2015 and was unannounced.

Leigham Lodge is a residential home for up to six people with learning disabilities and associated conditions. At the time of the inspection there were six people living at the service.

There was a registered manager in post. 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 received their medicines in line with company policy. Staff received training in medicine administration and had good knowledge of the types of medicine and their purpose. At the time of the inspection one medicine was being stored securely however this was not in line with good practice. Subsequent to the inspection the registered manager had taken reasonable precautions to ensure that the medicine was securely stored and in line with legislation and good practice.

People at the service indicated that they felt safe. Staff had sound knowledge of how to identify abuse and who to raise their concerns to should they suspect abuse. This meant that people were protected against the risks of abuse. The service had policies and procedures relating to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. These aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not deprive them of their liberty and ensures that people are supported to make decisions relating to the care they receive. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and lawful manner.

The service had robust systems in place to ensure that suitable staff were employed by carrying out the necessary safety checks prior to employment. For example Disclosure and Barring Services (DBS) checks. Staff told us they underwent a comprehensive induction process when first employed. Inductions were tailored to staff’s individual needs and could be extended should staff require additional support and training. Staff received on-going supervisions from the registered manager whereby they were supported to reflect on their work and identify training requirements.

Care plans were person centred and where possible people were involved in the development of their care plan. Care plans covered all aspects of care delivered and were regularly updated and reviewed to reflect people’s changing needs.

Both known and suspected risks were identified and recorded in the risk assessments which gave staff clear guidance on how best to support people when faced with the risk. Staff had a clear understanding on how to minimise these risks and were aware of the importance in following the set guidelines.

Staff told us they could approach the registered manager should they need. Staff stated that the registered manager operated an open door policy and that they found her to be supportive. One staff member told us, “It’s all about supporting the people and the registered manager ensures that’s what we do at all times”.

The service actively sought feedback on the delivery of care. Yearly quality assurance questionnaires were sent to people, their relatives and staff to seek their views on how the service is run. An action plan was then put together to act on appropriate suggestions received.

Staff told us that their complaints and concerns were listened to by the registered manager and that they could contact senior managers if they felt that they could not approach the registered manager. People’s concerns and complaints were recorded and acted upon appropriately.