One adult social care inspector visited Cypress Lodge. At the time of our inspection there were three people using the service. We spoke with all three people who used the service, a director, the registered manager and care staff. We reviewed the care records for all three people. We also reviewed a selection of other records that included staff files, minutes from meetings and the provider's policies and procedures.
We used the evidence we collected during our inspection to answer five questions.
Is the service safe?
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty. At the time of our inspection no person living in Cypress Lodge had a DoLS authorisation in place.
During our review of people's care records we found that people had been involved in assessing what their needs were. People had signed their care plans and risk assessments in agreement with them. We noted that people had been asked for their consent in relation to the sharing of their information with others and the administration of medicines. People could tell us what was documented in their care plans and told us that the risk assessments helped to ensure their safety.
Medicines were stored securely in locked cupboards. However, temperature sensitive medicines were kept in a plastic box in the fridge in the kitchen, rather than a secured medicines' fridge. We have highlighted this to the provider. People administered the majority of their own medicines and these were kept in a locked drawer in their own room. Medicines Administration Records (MARs) contained the necessary information for the safe administration of medicines and there were no gaps. We saw evidence that the staff who administered medicines had received the appropriate medicines management training.
The majority of staff were up to date with their mandatory training. Those that were not, were currently undertaking the training as part of an e-learning programme. This helped to ensure that staff were competent to meet the needs of the people they cared for, besides maintaining their safety and welfare.
There were systems in place to record and investigate accidents and incidents. Trends analysis was undertaken by the registered manager and action plans were put in place to help reduce the risk of repeat occurrences.
The provider had arrangements in place to manage foreseeable emergencies. These included plans in relation to fire and evacuation and loss of utilities. Both the staff and the people who used the service could tell us what they would do in the event of an emergency.
Is the service effective?
People's needs were assessed, and care and support was planned and delivered in order to meet these needs. Plans of care and risk assessments were regularly updated to reflect any changes in people's needs. All of the people we spoke with told us that they aspired to living as independently as possible. We saw that this was encouraged by the staff, and support was given where necessary. People told us that their day to day skills had improved whilst living in Cypress Lodge and that they felt relatively confident going in the community on their own.
During the review of people's care plans we saw that the provider worked closely with other health and social care professionals. These included people's general practitioner, social worker, dentist and podiatrist. This meant that people received care and treatment from a multidisciplinary team that helped to effectively address all of their needs.
Staff were supported to undertake additional specialist training to further meet the needs of the people they cared for. This included training in relation to diabetes and epilepsy. We saw evidence that staff received regular supervisions and appraisals. Staff told us that these were meaningful and effective. They said that they helped them to identify their further training needs in order to best meet the needs of the people they cared for and supported.
Is the service caring?
One person we spoke with said, 'I love living here and the staff are lovely. All of the care staff know my needs well. Staff are helping me to prepare our supper.' Another person said, 'I undertake activities that I enjoy, and we can come and go as we please. All of the staff are great, all of them. They look after us really well. I really like living here. I like the other people. We have a really nice time together.' A third person said, 'I like living here. There's lots to do and I do the things I like. All of the staff are lovely. We can all say what we think and the staff listen to us. If we have any complaints then they sort them out. I haven't got any complaints. I am really happy here.'
We observed positive interactions between staff and the people who used the service. Staff showed kindness and patience. It was evident that they knew the needs of people well.
Is the service responsive?
People's care plans responded to and reflected their needs in a holistic manner. People were supported to maintain as much independence as possible for themselves. Where people required assistance to meet their needs, the staff responded in a way that helped to keep the person safe, but maintained a level of independence for them as well.
Information throughout the service and in people's care records was available in an 'easy read' format for the people that required this. This helped to ensure that people understood what was being said.
People's likes, dislikes and preferences were taken into account. People could choose what activities they did during the day and told us that they found these meaningful to them.
People's relatives and friends were welcomed at Cypress Lodge. Staff responded to any of their questions once they had received consent to do so by the individual concerned.
We saw evidence that the provider took account of complaints or comments to improve the quality of the service. All of the people who used the service told us that they knew how to make a complaint.
Is the service well-led?
The care staff we spoke with told us that they felt supported by the management team. They said that they felt confident to raise any issues or concerns and that these would be listed to and acted upon as appropriate.
Staff told us that there were staff meetings and that they found these meaningful and productive. However, there were no minutes from the staff meetings available at Cypress Lodge. We have highlighted this to the provider.
The provider had a quality assurance system in place to assess and monitor the quality of service that people received. Questionnaires had been recently issued to the people who used the service, their representatives and health professionals. We saw that all of the results and comments were positive. The registered manager told us that if there had been any negative comments, then these would have been acted upon to help improve the quality of the service.
People told us that there were 'house' meetings. They said that the manager responded to their comments and suggestions most of the time. However, people's concerns about the uneven path and muddy back garden had not been addressed. These concerns had been raised in July 2014. We have highlighted this to the provider.