Nyetimber Lodge

Updated 10 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

This service provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 48 hours' notice of the inspection. This was because it is a small service and people are often out, we wanted to be sure there would be people at home to speak with us. We also needed to be sure the registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since they registered. We sought feedback from Healthwatch, the local authority and professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked this was a suitable communication method and people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with three people to tell us their experience.

We spoke with one relative, three support workers, the registered manager and the providers CQC compliance manager. We reviewed a range of records. This included four people’s care records and two people’s medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. One relative provided feedback about their experience of the care provided.

Updated 10 November 2021

Nyetimber Lodge is a supported living service providing personal care and support to six people living with a learning disability. The premises consist of six self-contained flats, which each open out onto a garden available to all tenants. There is an office and a room which also serves as a room for staff who sleep-in at night.

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

The provider's systems for monitoring were not consistently effective in providing the registered manager with clear oversight of risks. This meant they could not be assured all risks to people were effectively and consistently managed. Following the inspection, the registered manager developed a quality assurance monitoring tool for improved oversight of identified risk to people. We could not yet be confident these improvements were firmly embedded within daily practice and sustainable.

There were enough staff to care for people safely and medicines were safely managed. People we spoke with indicated they felt safe. Staff understood the importance of monitoring incidents and accidents and there were robust systems to safeguard people from abuse. A staff member said, “The main aim is to keep people safe and report improper treatment. I haven't ever had to, but I know our processes to do this.” Safe recruitment processes were being adhered to in order to make sure staff were suitable for their roles and responsibilities. A person said, “Staff are good.” Staff followed safe procedures for prevention and control of infection.

Risks to people's health, safety and welfare were identified and addressed. Staff ensured people's needs were consistently met and assessed to enable improvements and progress in their lives. Staff received a comprehensive induction and ongoing training to enable them to support people safely. There were effective systems for communication both at the service, and with other agencies to ensure people received the care they needed. A relative said, “Staff are very attentive to any of [person’s] medical needs and are very switched-on to recognising if [person] might be unwell and always respond appropriately.”

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; the policies and systems in the service supported this practice.

Support plans were comprehensive and reflected people's views, wishes and aspirations. A relative said, “[Person] especially enjoys the support [person] receives and the relationships built with the staff. We see this support is helping [person] move forward with [person’s] own skills.” People told us there were supported to communicate with their relatives and the managers when they were not happy or wanted to change their support.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence. People were supported to live as independently as possible at a service which encouraged and inspired people to live full lives. People's properties were respected by staff as private dwellings which enabled them to have dignity and privacy whilst receiving support. Staff supported people to make choices and to remain connected with their family, friends and the local community.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. People were supported to lead full and active lives and to take part in activities that were meaningful to them. A person described staff as, “great.” Staff knew people well and we observed people treated with kindness, respect, and involved them in making decisions.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. Staff described a positive culture where learning was encouraged.

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

This service was registered with us on 25 November 2019 and this is the first inspection. Previously this was one of many supported living sites the provider had registered under one supported living location. The provider has now registered each site as a separate location.

Why we inspected

This was the first planned inspection for this service.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.