White Lodge provides accommodation and personal care for up to four people who have a learning disability, sensory impairment and physical disability and health care needs. There were four people living at the service. The service was as domesticated as possible. People had their own rooms and the use of a comfortable communal area. It was open plan and included a kitchen and dining area. The main lounge was also used a sensory area. There was a private rear garden and large summer house which was accessible for people with mobility aids.

The service is situated in the residential area of Bordon. All the people living at White Lodge had either no independent mobility or it was restricted by physical disability. There were a range of suitable adaptations and mobility aids specifically designed to support people both in the service and community.

At the last inspection the service was rated good. At this inspection the rating remained good.

We carried out a comprehensive inspection of White Lodge on 21 May 2017. This was an announced inspection. We told the provider two days before our inspection visit that we would be coming. This was because we wanted to make sure there would be staff and people to speak with and access to records.

Most people had lived at the White Lodge for several years and staff knew the people they supported well. The registered manager took an active role in the running of the service. They were supported by a core staff team who had worked at the service for some time.

People had complex needs with limited verbal communication skills so we spent time observing people and their interactions with staff. The atmosphere at White Lodge was calm and friendly. Interactions between staff and people were kind and supportive. Staff described to us how they worked to support people to make day to day choices and enable people to lead a quality of life within the constraints of individual disabilities.

There were sufficient numbers of suitably qualified staff to keep people safe. Recruitment practices helped ensure staff were fit and appropriate to work in the care sector. Staff received an induction when they first started work which included training in areas identified as necessary for the service. This included training in safeguarding and staff knew how to recognise and report abuse. They were confident the registered manager would take any concerns they had seriously.

The premises were well maintained, pleasant and spacious. People’s bedrooms had been decorated and furnished in line with their personal preferences. Risks associated with the environment had been identified and action taken to minimise them.

People were supported to do things they enjoyed and keep in touch with those people who were important to them. Risks to people's safety were understood by staff and people benefited from receiving care and support which took into account their health and welfare. Staff understood what actions to take if they had any concerns for people's wellbeing or safety. Risk assessments had been developed to minimise the potential risk of harm to people who lived at the service. These were kept under review and were relevant to the care and support people required.

While people had complex needs which affected their ability to communicate their likes and dislikes, staff took the time to find out about the person. This meant people living at White Lodge were supported to lead fulfilled lives which reflected their individual preferences and interests.

There were enough staff available to make sure everyone was supported according to their own needs. Staff told us they loved their jobs and felt they had all the support they needed to carry out their role. They told us, “Been here for many years and seen the changes for the better. Everybody has a really good quality of life and lots of opportunities to enjoy that life,” and “It’s a very special job and I love it.”

Everybody living at White Lodge requi

The inspection took place on 27 April 2015 and was unannounced. White Lodge is registered to provide accommodation and support to people with learning disabilities. At the time of the inspection there were four people living at the service.

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.

Staff had received safeguarding training and had access to relevant guidance. Risks to people had been identified in their care plans and measures were in place to manage these. Staff understood the potential risks to people and how to manage them. People’s medicines were administered safely by competent staff.

There was flexibility in the staffing levels to ensure people’s individual needs were met. Staff had undergone the required pre-employment checks, to protect people from unsuitable staff. Staff had received an induction into their role, ongoing training, opportunities for professional development and regular supervision. People were cared for by sufficient numbers of trained and well supported staff.

Where people lacked the capacity to make specific decisions staff had followed the requirements of the Mental Capacity Act 2005. Assessments and best interest decisions were clearly documented. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. All people living at the service were subject to DoLs. People were protected as decisions made on their behalf met legal requirements.

Staff ensured people had sufficient to eat and drink and provided people with a range of nutritious foods. People had health action plans in place to address their identified healthcare needs. People were supported to access a range of healthcare professionals as required.

People’s relatives told us “Staff care about people.” Staff were seen to interact with people in a positive and caring manner. They showed concern for people’s welfare. Staff understood how people communicated and encouraged them to make choices. People were supported to have regular contact with their families. People were treated with dignity and respect by staff.

A person’s relative said “Staff understand her well.” People’s care plans reflected their individual needs and preferences about how they wanted their care to be provided. Where possible people were consulted about their care. Staff regularly reviewed people’s care with them to ensure they were satisfied. People were supported to go on holiday and take part in a range of activities.

People’s views on the service were sought through both individual and group meetings. The views of people’s relatives were sought through the provider’s quality assurance process. There was a complaints process if people wanted to make a complaint about the service.

The provider had a clear set of values which staff understood and implemented in the course of their work with people. People’s relatives, professionals and staff told us the service was well led. Staff felt well supported. There were robust arrangements in place to ensure there was adequate management cover if the registered manager was on leave or not working.

Learning took place from incidents to improve the delivery of people’s care. The registered manager completed weekly and monthly reports in relation to the quality and safety of the service in order to identify any areas which required improvement. The operations director completed regular visits to the service, to monitor the quality of the service offered and to drive improvements.

At the time of our inspection there were four people using the service. Although they were not able to describe to us their experience of the service we could observe their care and support and their interactions with the three staff on duty. Our observations indicated a caring and supportive relationship with their care workers. People smiled in response to the care workers’ interventions. One person was able to say “yes” when asked if they were happy with the care and support they received.

We found people’s care and support were effective and based on thorough assessments and detailed plans. Care and support were delivered effectively and in a caring manner. People consented to their care, and staff were aware of the procedures to follow if people did not have capacity to make decisions. Staff took suitable precautions to maintain standards of cleanliness and hygiene and to protect people from the risk of the spread of infection. People received their medicines when they needed them and there were effective procedures to store and record medicines in a controlled way.

Most of the people at this care home were unable to communicate verbally and were not able to tell us about their experiences. Of those who had verbal skills, responses were limited due to individual levels of comprehension.

During our inspection we used the Short Observational Framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of those people who could not talk with us. During our visit, we observed that staff interacted and communicated with people in an appropriate and respectful manner.

Staff explained to people what they were going to do. In some cases, rewording what they had said to help people’s understanding. Staff also asked permission from people for various things such as showing us their photographs.

We observed staff responding to non verbal communication from people. People were able to indicate their choices for food and activities in this way.

We observed medication being administered with staff explaining what each type of medication was and what it was for. This was given at the person’s own pace.

We asked one person if they enjoyed living at White Lodge. They were able to reply positively by smiling and using their own non verbal communication. We saw in their support plan what certain signs meant which enabled us to understand their response to us.