The inspection took place on 4 October 2018 and was unannounced. The service was last inspected 15 March 2016 and was rated good overall and for all the key questions we inspected against. At our latest inspection we identified a number of concerns in relation to the deployment of staff across the day and unassessed risks posed from the environment and at times of reduced staffing. We have therefore made safe requires improvement.

Adrian 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.

Adrian Lodge can accommodate up to ten people who have a diagnosed mental health condition. It does not provide nursing care. At the time of our inspection there were nine people living permanently at the service.

The service is situated on the edge of the town of Kings Lynn and provides accommodation on ground, first and second floor. It also had a cellar.

At the time of our inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

During our most recent inspection we had a number of concerns about the building in relation to its current use and the physical needs of people using the service. Some people had been using the service for many years and their physical and cognitive needs were changing which meant that the service may no longer be appropriate. For example, there was a steep flight of stairs which could not be adapted and there was no lift on the premises. Some risks posed from the environment had not been considered in the overall environmental risk assessment. This included uncovered radiators and potential ligature risks. The registered manager said no one was presenting with unstable mental health or at risk of self -harm.

We had concerns about fluctuating staffing levels at the service. At times there was only one member of staff in the building and people were not regularly monitored at night to ensure they were safe and well. We had concerns about how one member of staff would be able to adequately respond to adverse incidents within the service and keep themselves and others safe.

The registered manager said additional staffing could be provided if people’s needs changed. However, we felt within the existing staffing levels people did not get much input in terms of individualised support or encouragement to participate in the wider community which might increase their emotional resilience.

We found, overall, other factors considered, that the service was safe and individual and generic risk assessments helped to ensure the building and equipment was safely maintained and individual risks identified and controlled.

People received support from a well-established and experienced staff team which helped people feel secure.

There were robust systems in place to help ensure medicines were there for when people needed them and were administered as prescribed.

There were robust staff recruitment processes in place to help ensure only suitable staff were employed and this helped to protect people using the service who could be vulnerable by their circumstances.

Staff knew how to safeguard people from abuse and were skilful in intervening as necessary to ensure people were appropriately supported with their emotional and mental health.

Staff were well supported by the registered manager and had trust and confidence in them. There were robust systems in place to ensure all staff had access to the training they needed and had a sufficient induction into their role. Staff received regular su

This inspection took place on 15 March 2016 and was unannounced. At our previous inspection in May 2014, we found the provider was meeting the regulations in relation to all the outcomes we inspected.

Adrian Lodge provides accommodation and residential care for 10 people living with mental health issues. At the time of our inspection the home was providing support to 10 people. The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

There were systems in place to protect people from abuse, staff had received appropriate support and training which enabled them to identify the possibility of abuse and take appropriate actions to report and escalate concerns. Risks were assessed and managed appropriately through the use of detailed risk assessments.

There were systems in place to monitor the safety of the environment and equipment used within the home minimising risks to people. There were arrangements in place to deal with emergencies.

There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff started work ensuring people were supported by staff that were suitable for their role. There was enough staff on duty to meet the needs of the people living at the home.

Medicines were managed, stored and administered safely by trained and competent staff.

There were processes in place to ensure new staff were trained appropriately and staff received regular training, supervision and annual appraisals. Staff gained consent for the support they offered people. The registered manager and staff were able to demonstrate their understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation.

People were supported to maintain good health and had access to a range of health and social care professionals when required. People's nutritional needs and preferences were met.

Staff had a good understanding of the needs of the people and how they liked to be supported. Staff spoke with and treated people in a respectful and caring manner and interactions between people, their relatives and staff were relaxed and friendly. Staff respected people's privacy and dignity. People and their relatives told us they were made welcome in the home.

People received care and treatment in accordance with their identified needs and wishes. Care plans documented information about people's personal history, choices and preferences and preferred activities.

There was information on how to make a complaint was on display on the notice board for people living at the home. People knew how to complain and felt that when they did that their concern was taken seriously.

People and their relatives felt that the atmosphere in the home was open, friendly and welcoming and that the registered manager and staff were approachable.

There were systems and processes in place to monitor and evaluate the quality of the service provided. The management of the home's records were maintained to a good standard. The records that we inspected were clear and easily accessible for staff to use.

The service had a positive culture that promoted independence and was responsive to peoples changing needs.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service caring?

Our observations showed us that people living in the service were treated with respect at all times. Staff knew the routines that people had chosen and were aware of their care and support needs. We saw staff supporting people in a caring and considerate manner.

Two people who lived in the service said that they were looked after, supported and had everything they needed at this time.

Is the service responsive?

We saw that people's individual social and physical needs were being met. People were encouraged to decide what they wanted to eat and what they wanted to do on the day of our inspection. We saw that staff allowed time for the individual to fully understand their choices and the options offered to them. Staff introduced people to us and then continued to include them in our conversations throughout the day.

Is the service safe?

Records showed us that risk assessments were completed for any activities inside and outside of the service. All assessments included an evaluation for the level of risk that was presented plus any actions to be taken to reduce or eliminate such risks. Lawful requirements under the Mental Capacity Act 2005 were recognised and staff expressed a thorough knowledge of matters relating to the Deprivation of Liberty Safeguards (DoLs).

People who lived in the service told us that they felt safe and if they had any concerns they spoke with staff. One person told us, “I talk to (name of key worker) and they help me.”

Is the service effective?

We saw positive interaction between members of staff and people who lived in the service. People were relaxed and looked happy, particularly when staff were talking and supporting them in any way.

The bedrooms we saw at this inspection reflected the personality of the person. We were told by one person that they liked the room because it suited them and they then explained how comfortable they were.

Is the service well led?

Staff explained that they undertook regular training and we saw a list of dates that showed us that training was updated regularly. People were therefore supported by a staff team who knew how to provide support in a safe and appropriate way.

Quality assurance systems were in place and regular quality audits were completed for all areas of the service. We saw records that clearly documented the observations that had been made when any improvements were needed. The dates of completion were also recorded when maintenance or alterations had been completed.

All of the five people we spoke with gave us positive feedback about the service. One of them said, “I feel the staff have the correct skills to care for me. They look after me well here, they respect me and I feel safe here”. Another person said, “Staff treat me with respect and always observe my dignity”.

We saw that people had been given accurate information about the fees they would have to pay. Records showed that people had been correctly charged for the facilities and services they had received.

People said they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

We saw that people received medication in a safe and reliable way.

Documents and records were accurate and supported staff to provide people with the care they needed.

During our inspection of 16 January 2013 we saw that people provided appropriate consent before receiving care and support whilst living at Adrian Lodge. One person we spoke with told us, "I like living here. I can cycle to the allotment when the weather is good and I am well looked after".

We examined documentation which demonstrated to us that people received appropriate care and support that met their needs, and that they also had full access to external healthcare services.

People lived in a clean and appropriately maintained environment. Policies and procedures were seen to be in place to reduce the risk and spread of infection.

People were cared for, and supported by, suitably qualified, skilled and experienced staff. Appropriate checks were undertaken before staff members began working with vulnerable people.

There was an effective complaints system in place, and when people did complain about the services provided to them they were responded to appropriately.

People living at Adrian Lodge told us they were supported to be independent and they made their own choices and decisions. We were told that they could go out when they wished and were able to pursue their own activities and interests.

People we spoke with told us that Adrian Lodge was a good place to be and there was a good, positive atmosphere in the home. Everyone we spoke with told us that staff treated them with dignity and respect. They said they felt safe living in the home and that abuse would not be tolerated.

People were complimentary about the manager and staff. We were told that staff understood people's needs and that they provided the support they needed. People gave us examples of how staff had helped them to manage their health care needs.

Three of the people we spoke with made some negative comments about staffing levels at the weekend but said that the rest of the time there were no problems.

People had opportunities to air their views. They told us that they felt involved and that they had some influence over how the service was run.