About the service: 169 Lodge Hill is a residential care home that was providing care and support to six people with multiple learning and physical disabilities at the time of this inspection.

People’s experience of using this service:

¿ The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

¿ The premises and equipment used by the service was not always clean and appropriate hygiene procedures were not always followed.

¿ The staffing rota in place matched the numbers of staff on shift. However, feedback from relatives and staff showed that additional staff was required to provide safe care and support.

¿ Staff were not always supported through training to update their knowledge and skill in line with the provider’s policy.

¿ The systems in place for monitoring the quality of the service were not always effective to drive improvement.

¿ We received mixed feedback from healthcare professionals that staff did not always follow appropriate guidelines when supporting people.

¿ Medicines were not consistently stored safely. Despite this, people were supported to take their medicines as prescribed by healthcare professionals.

¿ Management of the service was not actively encouraging feedback from relatives, advocates, staff and other professionals to develop the service.

¿ We have made a recommendation about the fire safety procedures.

¿ Relatives were complimentary about the care and support people received but told us more could be done to improve the quality of the service.

¿ Staff knew how to recognise abuse and protect people from the risk of abuse.

¿ Staff knew of the importance to report and record all accidents and incidents.

¿ Staff received support through induction, supervision and appraisals.

¿ People’s needs were regularly assessed to ensure they could be met.

¿ People were supported to eat and drink sufficient amounts for their health and wellbeing.

¿ People were supported to maintain good health and had access to healthcare services.

¿ People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ People’s privacy and dignity was respected and their independence promoted.

¿ Staff understood the Equality Act and supported people in a caring way.

¿ People were supported to participate in activities that interested or stimulated them.

¿ The provider had a complaint policy and relatives knew how to make a complaint if they were not happy.

¿ The service worked in partnership with key organisations to provide an effective service.

Rating at last inspection: Good (report published 12 July 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, we identified breaches in regulations.

Enforcement: Please see the ‘actions we have told the provider to take’ section towards the end of the report.

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

This inspection took place on 14 June 2016 and was unannounced. At our previous inspection on 19 November 2013 we found that the provider was meeting the regulations that we looked at.

169 Lodge Hill is a care home which provides accommodation and personal care support for up to six people with multiple learning and physical disabilities. The home is based in Abbey Wood, South East London. At the time of our inspection the home was providing care and support to six people and 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.

Risks to the health and safety of people using the service were identified, assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies. There were safeguarding adult’s policies and procedures in place to protect people from possible abuse and harm. Accidents and incidents involving people using the service were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff were deployed throughout the home to meet people’s needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately. Staff received training that enabled them to fulfil their roles effectively and meet people’s needs. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their treatment and support needs. Staff respected people’s dignity and privacy. People were supported to maintain relationships with relatives and friends and we observed that people were also supported to access community services. People’s support needs and risks were identified, assessed and documented within their care plan. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. The service worked with health and social care professionals to ensure people’s needs were met.

There were systems and processes in place to monitor and evaluate the service provided. There was a registered manager in post at the time of our inspection and they were knowledgeable about the requirements of a registered manager and their responsibilities with regard to the Health and Social Care Act 2014. People’s views about the service were sought and considered through residents meetings and satisfaction surveys.

We were unable to effectively communicate with people who used the service due to communication difficulties. However, we spent time with people in the communal areas and observed the care they received, for example during their evening mealtime. We saw that staff interacted well with people and had established effective ways of communicating both verbally and non-verbally with people who lived at the home.

We checked to see if the provider had made improvements following our previous inspection on 06 and 11 July 2013 and we found that the required improvements had been made. People’s care and support plans had been updated in line with the provider’s required time frames. The provider had policies and procedures in place to protect vulnerable adults from abuse, and staff we spoke with were aware of their responsibility to safeguard vulnerable adults. Support was in place for staff through induction, training and supervision. We found that people's care and support plans, staff records and other records used for managing the service were mostly up to date and fit for purpose.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed one person being supported by staff to get ready for exercising in a room with floor mats and exercise equipment. We saw two staff speaking with this person explaining what she would be doing and speaking to them at their height level so that they could be heard and understood. Staff left the person to relax and have time alone but we saw that they returned regularly to see and ask if they were in need of any help.

We saw another person being supported to have a snack. Staff asked them what they would like to have and involved them in the process of preparing the snack. There was clear sensitive communications between the staff and people using the service, with the staff taking time to listen and wait for responses during conversations.

Throughout the inspection we saw staff were regularly interacting with four of the people who were at home, helping them to tidy their rooms and taking two of them out to shops and other community activities. People were not left alone for long periods and one person was receiving a visitor, and was given time to spend quietly with the visitor, with staff speaking and answering questions when asked to help with communications. The visitor told us that they visit about six times a year, and that they have always observed the staff to treat people with respect and communicate well with them. They said the staff were always very busy working with people on their activities. They said that it would be beneficial to have a list of words, phrases or expressions used by this person available to help aid their understanding.

One person told us that the staff were very good and always helped them to do things.

The people who used the service had communication difficulties and were therefore not able to answer questions about the care and support they received. We spent time with people in the communal areas and observed the care they received. We saw that staff interacted well with them and had established effective ways of communicating both verbally and non-verbally with people who lived at the home. A family member we spoke with complimented the service provided and told us that their relative was “happy” at the home and that staff were “nice”. They told us that they were involved in the care planning and their consent was always taken where required.

Each person who used the service had a care plan and risk assessments in place. However, these were not regularly reviewed to meet people’s current needs. We found that the provider met the legal requirements when people did not have the capacity to give consent to care or treatment. Staff we spoke with were aware of their responsibility to protect vulnerable adults from abuse. Support was in place for staff; however supervision and appraisal was not regularly updated in line with the provider’s policy. We also found issues with the management of records including people’s care and support plans not being reviewed regularly in line with people’s care needs.