The inspection took place on 17 December 2018, the inspection was unannounced.

Windmill Lodge is a ‘care home’. 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.

Windmill Lodge is a three-floor detached house. Windmill Lodge accommodates up to eight people with learning disabilities or autistic spectrum disorder on two floors. The third floor is used by staff. There were eight people with learning disabilities or autistic spectrum disorder living at the service when we inspected. Several people were experiencing mental health difficulties. One person required a wheelchair when mobilising longer distances, such as accessing the community.

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 service had last been inspected on 26 May 2016 and was rated Good.

The service is owned and managed by a provider who is an individual and who is in day-to-day management of the service. They have been assessed as fit to carry on the service and a registered manager was not required. 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. During the inspection we identified that the provider was incorrectly registered as they were operating the service as a limited company and not as an individual. We are discussing further what action needs to be taken to remedy this.

Medicines were not always well managed. The provider was not following their medicines policies and procedures. People’s GP’s had not been consulted with about the use of over the counter homely medicines. Risks to people’s health and safety were not always well managed. Most people had risk assessments in place which detailed how staff should support people to keep safe. One person’s risk assessment had not been updated following an incident where they had wandered onto the motorway. Another person did not have any risk assessments in place at all.

Accidents and incidents involving people were recorded. However, the action taken by the provider following the incident/accident was not always clear or recorded. This was an area for improvement. The provider had carried out sufficient checks on all staff to ensure they were suitable to work around people who needed safeguarding from harm. The provider had not asked applicants for a full employment history and documented reasons for gaps in interview records. The provider agreed they needed to amend the application forms for future use and improve their recording of interview records.

People had access to food and drink which met their needs and to maintain good health and were supported to be as independent as possible at meal times. People were supported to put together a pictorial menu plan for the week. People were able to choose different foods from the menu plan when they wanted. The management team told us that people’s dietary intake was monitored to ensure people had a balanced diet. People’s care records did not contain a record of what food they had eaten.

It was not evident if each person was supported appropriately by a planned assessment and care planning process to make sure their needs were met. One person’s assessment who had recently moved to the service had not been completed.

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 did not always support this practice.

The provider did not have good systems in place to m

This unannounced inspection took place on 26 May 2016. Our previous inspection took place on 7 July 2014 when we found all of the regulations we inspected were met.

Windmill Lodge is a detached house, which is registered to provide care and accommodation for up to eight people with learning disabilities and complex needs. Accommodation is provided over two floors. There were seven people using the service on the day of the inspection.

There was a registered manager in place at the time of our visit. 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.

We found that people were happy at the service and person centred care was being provided in a homely environment.

The registered manager and staff were aware of what constitutes abuse and the action they should take if such an incident occurred. They received regular safeguarding training and policies and procedures were in place for them to follow.

There was enough staff to support people safely and to meet their individual needs.

Assessments were undertaken to assess any risks to people using the service and steps were taken to minimise potential risks and to safeguard people from harm.

There were suitable arrangements for the safe management of medicines.

Safe recruitment procedures were in place that ensured staff were suitable to work with people as staff had undergone the required checks before working at the service.

Staff completed an induction programme and mandatory training in areas such as, fire safety, health and safety, infection control and safeguarding.

Records showed that staff had received regular one to one supervision.. There was also evidence of regular annual appraisals being carried out with staff.

Two applications for Deprivation of Liberty Safeguards (DoLS) authorisation had been made to legally deprive people of their liberty. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005.

Staff showed dignity and respect as well as demonstrating an understanding of people’s individual needs. They had a good understanding of equality and diversity issues and care plans included information on how equality and diversity should be valued and upheld.

Staff knew how to support people to make a formal complaint and complaints were logged and dealt with effectively, demonstrating the outcome of the investigation and how learning was shared.

Audits and quality monitoring checks took place regularly and annual service user satisfaction surveys were undertaken to ensure the service was delivering a high quality, person centred service.

The inspection was carried out by one inspector over a period of five hours. There were eight people living at the home at the time of our inspection. They had learning disabilities and complex needs. This report is based on our observations and review of records during the inspection. We also talked with two people who used the service, two staff who were working in the home, and observed four people who had limited verbal communication skills.

During this inspection we set out to 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. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty with the appropriate skills and experience to meet the needs of the people living at the home. Staff provided care and support during the day, and at night people were supported by sleep-in staff, who had access to the call buzzer system.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While not applications have been submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us that they were happy with the care they received. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us "The staff help me go the shops and choose what I want”. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to make their own choices in their everyday lives. Our observations confirmed this. One person told us “The staff are very kind".

Is the service responsive?

People’s needs had been assessed before they moved into the home. There was evidence that staff regularly discussed any changes related to people’s care with them. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. One person told us that staff had stayed with them during a recent surgical procedure and had provided reassurance.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in a quality survey. They confirmed they had been listened to and as a result of the survey, changes to the menu had been made. Staff told us they were clear about their roles and responsibilities. They said the management had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People expressed their views and were involved in making decisions about their care and treatment.

Two people we talked with said that they were happy with the care and support that they received. A person we talked with said, “The staff are lovely and they always help me”.

We looked at some of the monthly feed back surveys that had been completed by people who use the service. People were asked about whether or not they liked various aspects of the service they were receiving.

We found that staff had a good understanding of people’s means of communication. We saw a member of staff communicating with a person who used makaton sign language. An array of information was available including pictorial menus, a service user guide and policies and procedures such as a complaints procedure.

A member of staff told us that people now participated in more activities such as going for meals out and trips to the cinema were arranged. People we talked with told us that they were in the process of planning their holiday. A person we talked with said, “I am happy living here, I help with cooking and I have a bus pass and I go shopping”.

We saw that the garden was well kept and we were told that one of the people who used the service liked to get involved in keeping the garden tidy.

We spoke with four people who used the service. Two people who used the service said that they were happy living at Windmill Lodge. Although two people who used the service said ‘Sometimes it’s all right but it depended which staff were on duty’.

One person who used the service told us that they had the choice to move into the home, and that their care manager helped them.

All people we spoke with told us that there was not enough staff. They said the staff were always busy and there was little time to play cards or go out. One person said that he would like more support to be able to participate in more activities.

Two people told us that they were not allowed to go into the kitchen as this was a health and safety issue.

People told us that they liked living in the home and that they found it comfortable and that it suited their needs.

People told us that they were able to make decisions about their daily lives and choose how they spent their time. People felt that they were involved in the home and be able to be part of the daily running.

People said that if they had any concerns or problems that they could always talk to the manager or a member of staff. One person said that although they did not always agree with decisions, they felt that they could reach a compromise and understood why agreed decisions were made.

People we spoke with told us that they felt well supported by staff and that they would always listen to them.

One person told us that they were supported to visit the dentist or G.P. whenever they needed to.

One person said that there was usually enough members of staff to help, but would like to go out more. They told us that sometimes there wasn't enough members of staff to support them with this.