L’Arche London Gothic 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. The home is registered to provide support to a maximum of five people. At the time of the inspection there were five people using the service. 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.
At the last inspection in November 2015 we rated the service ‘Good’ overall. At this inspection the service remains ‘Good’.
The service continued to have systems and processes in place to protect people against the risk of harm and abuse. Staff received safeguarding training that enabled them to identify report and escalate suspected abuse and keep people safe.
The service had developed risk management plans that were regularly reviewed and detailed identified risks and strategies on how to manage those risks. Staff were aware of the importance of familiarising themselves with risk management plans and these were updated to reflect people’s changing needs.
The provider demonstrated good practice in the administration, recording and storage of medicines. Medicine administration records were completed accurately and stocks and balances identified people received their medicines as prescribed.
People continued to be protected against the risk of infection, as the service had sufficient infection control plans in place. The service employed ancillary staff who ensured a deep clean of the property was undertaken twice monthly, in addition to daily cleaning. Staff were aware of the importance of ensuring Personal Protective Equipment (PPE) was used to minimise the risk of cross contamination.
People are supported to have maximum choice and control of their lives and staff do support them in the least restrictive way possible; the policies and systems in the service do support this practice. Staff had a comprehensive understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). At the time of the inspection there were five people subject to a standard DoLS authorisation.
People were supported by staff that had undergone pre-employment checks to ensure their suitability. Staffing levels were flexible and ensured people’s needs were met in a safe manner. Training systems in place ensured staff had the right skills and knowledge to deliver effective care to people. Records confirmed staff training covered safeguarding, Mental Capacity Act 2005, deprivation of liberty safeguards, food hygiene, health and safety and medicines management. Where identified training had expired, the provider had booked refresher training.
People were supported to have access to sufficient amounts of food and drink that met both their dietary needs and preferences. People were supported to participate in the purchasing of food and meal preparation wherever possible. People who required specialist dietary requirements were catered for.
The service encouraged and empowered people to access healthcare services to monitor, maintain and enhance their healthcare needs. Records confirmed people had access to G.P, psychiatrists, psychologist, dentist, optician and learning disability specialists. A healthcare professional commented that the service will work with them to ensure people’s healthcare needs were met.
The service carried out adaptions to the property to ensure people’s needs were effectively met. For example, adaptions to bathrooms were made to ensure those with mobility issues and aids, could access the facilities safely and freely.
People were supported in a caring, compassionate and emphatic manner by staff. People’s right to privacy was respected and encouraged. People were treated with dignity. The service had an embedded culture of supporting people emotionally.
People continued to be encouraged to make decisions about the care and support they received and had their decisions respected. Care plans detailed people’s preferences in communicating and staff were observed supporting people to understand what was being asked of them in a manner they understood and preferred, which enabled them to make informed decisions.
The service had an embedded culture of delivering personalised care tailored to the individual. Care plans were regularly updated to reflect people’s changing needs. Where possible people were encouraged to develop their care plans with support from staff.
People were able to express their discontent and share their concerns with staff. The service had a complaints system in place; and staff were aware of how to respond to, report and escalate complaints in line with the provider’s policy.
The service was aware of the importance of supporting people at the end of their lives. At the time of the inspection the service were in the process of developing support circles for people, which meant they would be able to share their wishes in line with the end of life care they received.
Staff and relatives spoke positively about the registered manager, saying she was approachable, compassionate and supportive. The registered manager was a visible presence within the service and operated an open door policy, which enabled people to approach her at any time convenient to them.
The service notified the Care Quality Commission of safeguarding and statutory notifications in a timely manner.
The service had an embedded culture of ensuring people’s views were heard, listened to and where appropriate acted on. This was done through regular keyworker and house meetings. People were supported to access advocacy services should they wish. Relatives and healthcare professionals were encouraged to give feedback on the service through quality assurance questionnaires.
The registered manager actively encouraged partnership working with other healthcare professionals to drive improvement and enhance people’s lives where possible.
Further information is in the detailed findings below