The Italian Lodge

The Italian Lodge (which is also known as Support 2 Independence) is a domiciliary care agency providing personal care and support to people who live with mental health problems, progressive neurological conditions, learning disabilities, acquired brain injuries, alcohol related conditions, autism, or a combination of these. It works in close collaboration with a housing association to provide tenancies and support for those people who live or who want to live in that accommodation. People's care and housing are provided under separate contractual arrangements. The housing association provided accommodation, in blocks of flats or in converted houses, on the Wirral peninsular. CQC does not regulate such premises; this inspection looked at people's personal care and support. At the time of our inspection the service supported approximately 90 people.

At our last inspection we rated the service as good. At this inspection we found evidence which demonstrated ongoing and continuous improvements in the care, responsiveness and leadership of the service and therefore the overall rating is now outstanding.

We saw that staff were very caring and treated people with great kindness, consideration and respect. Staff promoted people's privacy and dignity and enabled and encouraged them to be involved in decisions about their care. People contributed to their care plans and these were available in a format which was accessible to them.

People's care was entirely person centred and their care plans written with contributions from them, their relatives and any health or social care professionals involved in their care and reviewed regularly. The information included for example, people's dietary, sexual, histories, cultural preferences and choices and the outcomes they wanted to achieve.

Staff and management were fully committed to ensuring that people's communication needs were met. Many communication methods were used, including modern technology, easy read and pictorial information and human translators. The service told us they would cater for any communication needs and that they would use innovative and effective ways to communicate and follow each person's wishes on their preferred method of communication.

A wide variety of educational, employment and voluntary activities were offered and there were many leisure activities arrange for the people who used the service. People were encouraged to learn new skills by attending training sessions, such as learning how to cook.

There was a complaints policy which all the people we spoke with knew about and there were processes in

place to deal with any complaints. People told us that any issues they had were resolved through discussions with staff and the management of the service.

The management team were open and transparent during and after the inspection visit. We were supplied with thorough documentation which showed that effective systems and quality assurance processes were in place to provide and monitor the service. The management team were clear that they wanted to provide a service which met the needs of the people they were supporting and which achieved good outcomes for them.

The managers fully engaged with the people who used the service, their relatives', health and social care professionals and staff to consult with them and obtain their views about the service.

The 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 and that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Policies and systems supported people to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

We saw that people's needs were supported by good working relationships with other organisations. These supplied health and social care, employment, education and leisure opportunities to the people who used the service.

We found the people were cared for in a way which was safe and which encouraged them to live their lives safely. Staff were recruited using safe methods and where medication was administered it was done so properly. Staff knew about how to protect people from abuse and people's needs had been properly risk assessed.

There were sufficient numbers of staff to support people throughout a 24-hour period, according to how each person's needs had been assessed. Medication was stored and administered safely and people were encouraged to be safe by learning skills to help them stay safe around their homes, such as cooking and in the outside environment, such as going out shopping or to work on the providers small farm

Staff were appropriately inducted, trained and supervised on a regular basis and demonstrated to us that they had good skills. People were encouraged to eat and prepare healthy diets and where needed, supported appropriately.

The five questions we ask about services and what we found