The Lodge

The Lodge Trust is a residential care home providing personal and nursing care to up to maximum of 30 people. The service provides support to autistic people and people with a learning disability. At the time of our inspection there were 29 people using the service.

The Lodge Trust is a Christian home and supports people to lead a Christian lifestyle. The service is situated amongst a substantial country park, some of which is accessible and used by the public.

There are 6 different bungalows and houses across the site where people live. Some people lived in their own self-contained flats, whilst others had their own bedroom and ensuite and shared a dining room and living room area.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, there was not always clear written guidance in place to support staff with this. Some people’s specific health needs were not always assessed and documented. Some staff had not received mandatory training regarding supporting people living with learning disabilities and autism.

People received their medicines as prescribed, but some audit processes required improvements to ensure any issues were identified in a timely manner. People were supported to engage in activities and interests and were able to personalise their bedrooms and living spaces as they wished.

Right Care:

Systems and processes were not always effective to ensure safeguarding incidents were identified, investigated and referred to the appropriate agencies. This meant the opportunities to assess safety and take steps to mitigate risk were not always taken. Some people did not have specific health condition care plans in place such as mental health diagnoses. People were supported by staff who were passionate and committed to providing care in accordance with the Christian ethos of the service. Staff were caring and provided support to people with warmth, compassion and preserved their dignity. People were able to make choices and were involved in decisions about their care needs and lives. Staff worked closely with people and made referrals to health and social care professionals in a timely manner.

Right Culture:

Oversight of the service was not always consistent. We found areas of concern that had not been identified prior to our inspection. These included audits not efficiently identifying improvements required, and processes not always being effectively followed. People were encouraged to be independent, and staff listened to people’s views. Staff formed good working relationships with people. Staff and management were open and transparent, and acted upon feedback to improve people’s outcomes. Systems and processes to govern the service required improvement to ensure the areas of risk were identified, and improvements to drive quality care could be delivered.

Overall, the service was not always meeting ‘right support, right care, right culture.’ We are aware this is a large service supporting up to 30 people, and therefore is significantly larger than good practice guidance suggests.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 21 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge Trust on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to how safeguarding concerns were responded to and how the service was governed at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Lodge Trust CIO provides accommodation with personal care for up to thirty people with learning disabilities or Autistic Spectrum Disorder. There were four houses and thirteen flats. There was also a range of communal building such as a communal hall, café and woodwork block. The service was set in four acres of land and there was also a country park and caravan park which was open to the public. The Lodge Trust CIO is a conservative evangelical Christian home. People who used the service were expected to follow a Christian lifestyle.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 safe. Staff understood their responsibilities to keep people safe from abuse and avoidable harm. There were sufficient numbers of experienced and trained staff to safely meet people’s assessed needs. Recruitment practices were safe and made sure that checks were carried out on people before employment was offered.

People knew what being safe meant and knew what to do if they had any concerns. Risk was assessed and management plans were in place to protect people. There were plans in place to respond to emergencies and these were understood by people who used the service and by staff.

People’s medicines were managed in a safe way so that people received their medicines at the right time and in the right way. People were supported to manage their own medicines if they were able to.

People received care and support from staff who were trained and knew how to meet their needs. Staff had their performance assessed and received supervision and appraisal and were given opportunities to discuss their development needs. Staff had access to the training they required.

Consent was sought before care and support was delivered. Staff knew how to deal with behaviour that challenges others in a safe and effective way. Staff were working within the principles of the Mental Capacity Act (MCA) and deprivations of liberty safeguards (DoLS).

People were supported to eat and drink and maintain a balanced diet. Staff knew about people’s nutritional needs and followed guidelines provided by healthcare professionals. People had a choice of meals and said they enjoyed the menu provided. People had access to the healthcare services they required and were supported to make and attend appointments.

People were treated with kindness and compassion. People told us how staff made them feel that they mattered and listened to them. Staff knew people well and took action when people were upset or distressed. People had access to advocacy services should they need help making a decision. People had their privacy and dignity respected and promoted.

People had their needs assessed and regularly reviewed so that their care and support could be adjusted to meet their preferences and needs. People had access to a wide range of recreational and work based activities and were also able to access training.

Concerns and complaints were encouraged and action was taken to resolve issues as soon as a complaint was raised. Improvements were made as a result of complaints or concerns.

There was a positive and open culture. Managers were visible and accessible. There was a clear organisational structure and staff understood their roles and responsibilities. The quality of the service was monitored to check that people were satisfied and policies and procedures were followed.