The inspection took place on 6 and 7 February 2018 and the registered manager was given one days' notice. This was because some of the people who use the service have autism and it was important that there was sufficient numbers of staff on duty to ensure our inspection did not disrupt the daily routine of the people who lived at the service.

Park Lodge provides care and accommodation for up to 10 people with learning disabilities. On the day of our visit eight people lived in the service. In relation to Registering the Right Support we found this service was doing all the right things, ensuring choice and maximum control. Registering the Right Support (RRS) sets out CQC’s policy registration, variations to registration and inspecting services supporting people with a learning disability and/or autism.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a new registered manager in post since the last inspection. 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.

At the last inspection on the 28 July 2016, the service was rated Requires Improvement overall and Requires Improvement in Safe, Effective and Well-Led.

At this inspection we found the service Good overall.

Why the service is rated good:

We met and spoke with all the people living in the service during our visit. People were not all able to fully verbalise their views and used other methods of communication, for example pictures. Due to people’s needs we spent time observing people with the staff supporting them.

The service was now safe. At our inspection in July 2016 there was a breach of Regulation. The provider had not ensured care and treatment had been delivered in a safe way because medicines had not always been managed and administered safely. This is breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The report for July 2016 stated; “The providers processes had not ensured that people always received their medicines as prescribed and intended.” At this inspection we found people received their medicines and they were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received medicines training and understood the importance of safe administration and management of medicines.

The service was now effective. At our inspection in July 2016 it recorded that the service was not consistently effective. The report for July 2016 stated; “The provider had not ensured all staff had completed the training the provider considered to be mandatory.” At this inspection we found that all staff had completed suitable training and had the right skills and knowledge to meet people’s needs. New staff completed an induction programme when they started work and staff competency was assessed. Staff also completed the Care Certificate (A nationally recognised training course for staff new to care) if they did not have any formal care qualifications. Staff confirmed this training covered the Equality and Diversity policy of the company.

The service was now well-led. At our inspection in July 2016 it recorded that the service was not consistently well led. The report for July 2016 stated; “At this inspection we found that the provider had followed their action plan and that steps had been taken to ensure the breach was met, (This was for a breach of Regulation 17 in the inspection completed December 2014), however some of the improvements made needed to be embedded into day to day practice and sustained in order

This service is registered to accommodate 10 people who require support with their personal care. The service specialises in supporting younger adults with learning disabilities. There were 10 people using the service at the time of the inspection the majority of whom had a learning disability, autism, a mental health condition or communication difficulties. Two people were staying at the service on a respite basis.

This comprehensive inspection took place on the 28 July and 4 August 2016 2016. Some of the people who use the service have autism and can become distressed if their daily routine is not followed. Therefore we gave the registered manager one days’ notice of the inspection so they could ensure they had sufficient numbers of staff on duty to facilitate the inspection without disrupting the daily routines of the people who lived at the service.

The accommodation was arranged over three floors. The upper floors were accessed by a flight of stairs and there was level access to the rear of the property and gardens. The service had the use of a vehicle which was used to transport people to activities.

The service had 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.

The service was previously inspected on 9 December 2014 and we found two breaches of the Health and Social Care Act 2008. These were in relation to people’s care plans and risk assessments not being up to date, staff had not received supervision or an annual appraisal as often as the providers policy stated, residents and relatives meeting minutes had not been typed up and some shortfalls identified as part of the providers own quality assurance processes had not been addressed such as the laundry room was in need of refurbishment. The provider submitted an action plan to address these shortfalls and we reviewed the effectiveness of this plan as part of our inspection. At this inspection we found that the provider had followed their action plan and the breaches were now met. However some areas of practice still needed to be embedded and sustained. We also identified concerns in relation to the administration and management of medicines.

The management of medicines was not always safe. The provider had not ensured that people’s medicines administration records (MAR) were accurately completed, gaps on the MAR were unaccounted for, the guidelines in place for when as and when needed medicines should be administered where not always in place and one person had not received their medicines as prescribed and intended. This is an area of practice that requires improvement.

Improvements had been made in relation to quality assurance. Action had been taken to address the shortfalls identified as part of the providers own quality assurances processes. The laundry room had been refurbished and shortfalls in relation to cleanliness had been addressed. The provider had systems in place to ensure that audits were completed to check that staff were following the providers policies and procedures. However the registered manager had not consistently completed these audits or recorded the date that shortfalls identified as needing to be rectified had been actioned. This is an area of practice that needs to be fully embedded and sustained.

Improvements had been made in relation to the recording of relatives, residents and staff meetings which were held on a regular basis. A record had been maintained of who had attended the meetings. However the minutes of these meetings were not all available to view in order to demonstrate the actions taken in response to feedback. This is an area of practice that needs to be fully embedded and sustained.

Improvements had been made

The inspection took place on 9 December 2014 and was unannounced.

Park Lodge Care Solutions is registered to accommodate up to ten people with a learning disability and additional needs, such as behaviour that challenged or autism. The accommodation, which is a large two storey, detached Victorian house, is situated in a residential area of Southgate, Crawley. People have their own bedrooms and ensuite facilities. There is a large communal area where people can engage in a variety of activities and a separate dining area. A garden is accessible at the rear of the property.

The service has 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.

People were not always protected against risks because risk assessments had not been reviewed on a regular basis at six monthly intervals, in line with the provider’s policy. There had been a number of safeguarding concerns at this location in the past year. The registered manager had been supported by the local authority safeguarding team and had an action plan in place to address the issues raised. Staff had been trained in safeguarding adults at risk and knew what action to take if they had any concerns. Accidents and incidents were reported by staff to the registered manager in a timely manner and action was taken to prevent the risk of reoccurrence. Staffing levels were sufficient to meet people’s needs safely and the service was in the process of recruiting new staff. Medicines were stored, administered and disposed of safely and staff were trained to administer medicines. Whilst the service was generally clean and hygienic, one bedroom was dirty with brown smears on the floor and on the toilet seat. The floor in the laundry room was in a state of disrepair and cleaning mops were in need of replacement. We recommend that the service consider best practice guidance available on cleanliness and infection control in care settings, such as those published by the Department of Health, The National Institute for Health and Care Excellence (NICE) and the NHS National Patient Safety Agency.

Care plans were not reviewed on a regular basis and one care plan had not been reviewed for over a year. Care plans were written in an accessible format and there was some evidence that people were involved in planning their care, but reviews were undertaken intermittently. People could be involved in a range of activities, either at the service or out in the community. Some people attended a local day centre. Complaints were acknowledged and responded to in line with the provider’s policy. Action was taken as needed.

The service did not have robust quality assurance processes in place. The registered manager, who was required to analyse trends and patterns of accidents and incidents, had failed to evaluate these. People were involved in interviewing new staff and asked which candidates they preferred. House meetings were organised with three meetings held in 2014. However, agendas and notes written up after these meetings were not in an accessible format for people who may have struggled with their reading. Relatives were asked for their feedback about the service and where issues had been raised, action was taken by the registered manager. Staff had been asked for their views about the service. One person had asked for more staff meetings. Staff meetings did take place, although notes about these were not always written up. The registered manager was proud of the achievements made by people and felt that recruiting staff was a challenge.

Staff received supervisions from the management, but not all staff had received six supervisions within the year in line with the provider’s policy. People had sufficient to eat and drink and were involved in drawing up menus. They had access to health check-ups and visited a range of professionals. Staff had received training that enabled them to meet people’s needs and support them effectively. New staff followed a comprehensive induction programme and had achieved at least National Vocational Qualification Level 2 in Health and Social Care. Staff had a good understanding of the requirements of the Mental Capacity Act (2005) and were able to put this into practice. When people gave their consent to care, this was recorded in their care plans. If they were unable to give their consent, then best interest meetings were held. Staff were knowledgeable on how to support a person who displayed physically challenging behaviour. The service was in the process of applying for Deprivation of Liberty Safeguards (DoLS) for people at the service.

People were looked after by caring staff and positive relationships had been developed. One person referred to staff and said, “They help me with my beauty sessions – my nails and my feet”. People’s privacy was respected and they were involved in decisions about their care. Family meetings took place and relatives could visit without restriction. People’s care plans were written in a person-centred way and provided staff with detailed information about people they cared for.

We found two breaches of the Health and Social Care Act 2008 (Related Activities) Regulations 2010 in relation to the lack of review of risk assessments and with quality assurance processes relating to review of care plans and analysis of incidents and accidents. You can see what action we told the provider to take at the back of the full version of this report.

There were ten people using the service at the time of our inspection of whom two were away with their relatives and four were on their activity placements. People living at the home had complex needs and were not all able to tell us about their experiences. We observed people to be calm and content and people who were able to speak with us said they were happy living in Park Lodge. One person said "the staff are nice, they help me and they are my friends". Relatives were complimentary about the care and support provided and told us that their family member was treated with kindness and respect and was encouraged to make decisions for themselves and to be as independent as possible.

Plans of care were person centred and included up to date risk assessments

We saw that the medication system was robust and found that people were supported to receive their medicines safely and as prescribed.

The recruitment and selection process in place involved the people using the service and ensured that all staff had appropriate checks before starting work and undertook the relevant training.

Systems were in place to assess and monitor the quality of the service. Feedback was sought from people involved with the service and the provider was responsive when issues were raised and lessons were learnt from incidents.

Care files showed people's ability to make choices and decisions for themselves had been assessed, and care plans were in place to guide staff as to how to support them with this.

We found that the care plans had been developed in a person centred way which guided staff to ensure they were providing care that was responsive to the individual's personal preferences, needs and values.

Records showed us that staff were trained about how to keep people safe. Staff had a clear understanding of the

policies and procedures to follow if they saw or suspected that someone was at risk.

The staff we met carried out their work in a calm, friendly but professional way. One of the people who used the service told us, "the staff here are good for me. They've helped me to talk about things to make them better."

Records showed that people were supported to be a part of house meetings with staff when they chose to.

Records also showed that a manager carried out a monthly quality assurance audit. These reviews included areas such as notifications to CQC, meals, activities, care files, risk assessments, discussions with staff, training, health and safety, and the environment. We also saw other audits had been carried out for things like medication arrangements. We noted that, where these audits had identified areas for improvement, actions had been taken to increase the levels of monitoring with a view to ensuring the safety of people who used the service.

At the time of our visit, there were eight residents living in the home. Four were present in the home and four were out of the home engaged in work or structured social activities.

We spoke to two people using the service who told us that they were happy with the care provided and felt the staff understood their needs. They told us they felt safe in the home and were able to do activities they enjoyed.

Staff members we spoke to told us that they were happy working in the home, that the team worked well together and that they had received the training and supervision they needed to provide appropriate care and support to service users.