The inspection took place on 29 December 2016 and 3 January 2017. The visit was unannounced.

Anita Janes Lodge is a residential home which provides care to people with mental health needs. It is registered to provide care for up to 16 people. At the time of our inspection visit there were 11 people living at the home.

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 and associated Regulations about how the service is run. The registered manager was responsible for the management of two homes. There was also support manager in post to manage the day-to-day running of the service.

People using the service we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area. People's risk assessments had provided staff with information of how to support people safely. People using the service told us they thought medicines were given safely and on time. Staff had been subject to checks to ensure they were appropriate to work with the people who used the service.

Staff had been trained, in the main, to ensure they had skills and knowledge to meet people's needs. Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives. People had plenty to eat and drink and everyone told us they liked the food provided. People's health care needs had been protected by referral to health care professionals when necessary.

People told us they liked the staff and got on very well with them, and we saw examples of staff working with people in a supportive and caring way. People and their representatives were involved in making decisions about care, treatment and support.

Care plans were individual to the people using the service and usually covered their health and social care needs. There were not sufficient numbers of staff to ensure that people's needs could be responded to in good time, though this was later rectified by the registered manager. Activities were in place to provide some stimulation for people and people took part in activities in their chosen community activities.

People told us they would tell staff if they had any concerns and were confident that proper action would be taken. People and staff were satisfied with how the home was run by the registered manager and the management team. Management carried out audits to check that the home was running properly to meet people's needs, though not all essential systems had been audited.

We inspected Anita Janes Lodge on 9 and 12 October 2015. The inspection was unannounced. Anita Janes Lodge provides accommodation for persons who require personal care.

We carried out an unannounced inspection of this service in May 2015. A breach of legal requirements was found. The registered person had not ensured that incidents of concern had been reported to relevant agencies so that care could be monitored and measures put in place to manage risks to people.

After this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. At this inspection we found the provider had met this breach as staff had reported these issues to relevant agencies.

We undertook this unannounced inspection to check that they had followed their plan and to confirm they now met legal requirements.

Anita Jane's Lodge is a residential care home for up to for sixteen adults with mental health needs. There is a lounge/dining room on the ground floor, and bedrooms on the ground and first floors. To the rear of the home is a large secluded garden with a patio. The home is situated on the Uppingham Road in Leicester close to shops, parks, and bus routes.

On this inspection we found breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 with regard to providing safe care and ensuring that people receive a quality service. You can see what action we have told the provider to take at the back of the full version of this report.

A registered manager was not in place. 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 and associated Regulations about how the service is run. At the time of the inspection the manager had applied to the Care Quality Commission to become the registered manager.

People using the service and relatives we spoke with said they thought the home was safe. Staff were trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

Staffing levels were not sufficient to provide proper care to people. Staff that were on duty on their own had minimal experience and had not been sufficiently trained to deal with emergency situations.

Staff were not able to meet people’s care needs promptly and did not have the time to meaningfully engage with people and take a full interest in their lives. This meant the people at the home did not always feel valued and their quality of life had not improved as a result.

During the inspection we did not see many examples of staff engaging with people and supporting them to pursue hobbies and interests. Some people told us they did not have much to do or activities to look forward to.

This was not a home where, as part of their normal duties, staff continually engaged and interacted with the people using the service, although we saw that staff were caring in their approach to the people they supported. They knew and understood people and their personal characteristics.

When lunch was served staff gave people a choice of menu. The food was not freshly cooked and did not look or smell particularly appetising though there were sufficient quantities, and people ate well.

Records showed that the service’s training programme had been improved and extended since we last inspected. Staff told us they were satisfied with the training they had though not everyone had training on all essential issues such as first aid.

Staff were knowledgeable about people’s health care needs and ensured they saw healthcare professionals when they needed to. Staff reported to health and social care staff if any incidents had happened which were a risk to people. If people needed to go to a GP appointment or to hospital and had no family member who could take them, staff from the home accompanied them.

Activities were not a big part of life in the home and some people using the service and staff wanted more activities and outings, such as having table tennis equipment and going out for meals.

People told us if they had any complaints or if there was anything bothering them they would tell the manager or another member of staff. The manager told us she had an ‘open door’ policy and people and relatives could come and see her at any time if they were unhappy about any aspect of the service.

Quality assurance audits had been carried out on a range of issues but action had not always been taken to deal with any issues. For example, information in the staff questionnaires had stated more activities were needed and teamwork between staff needed to be improved. However, there was no evidence these issues had been acted upon.

Anita Janes Lodge is owned by Samalodge Limited. The service is situated in Leicester, and provides care and support for up to 16 people over the age of 18 years with a mental health need. At the time of this inspection there were nine people accommodated.

This inspection took place on 6 and 7 May 2015.

At our last inspection in May 2014 the service was not meeting the regulations we inspected with regard to the care and welfare of people, medication arrangements, the premises and having systems to ensure the quality of services provided to people. The provider submitted an action plan to deal with these non-compliances. We followed up these issues and found improvements had been made, though further improvements were needed to ensure people were supplied with a service that fully met their needs.

A registered manager was not in place. 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 and associated Regulations about how the service is run. The current manager, who had only been in post two months at the time of inspection, stated that she would make an application to the registered manager within seven days of this inspection. We will monitor this situation to ensure that a registered manager is in post.

Since our previous inspection in May 2014, we had received information from the local authority stating that the service needed to make further improvements to care planning for people living in the home to ensure they received a service that met their individual needs. We also received information that the local authority had health and safety concerns in the past year regarding the premises. At the time of this inspection the service was meeting health and safety requirements.

People and their relatives said they felt safe in the service.

Testing of fire systems was in place.

The service was not completely following the guidance in people’s risk assessments and people were at risk of unsafe care.

Staff had received training on how to protect people who used the service from abuse or harm. They demonstrated they were aware of their role and responsibilities in keeping people as safe as possible though not all were sure of which agencies to report to if management had not acted appropriately to protect people.

The Commission had not been informed of situations of abuse to people which meant that monitoring action to prevent these situations could not be considered.

Staffing levels met people's needs.

We found people largely received their prescribed medication in a safe way by staff trained in medication administration, though this needed to be improved.

Detailed risk assessments had not always been undertaken to inform staff of how to manage and minimise risks to people's health from happening.

The provider supported staff by an induction and some on going support, training and development. However, comprehensive training had not been provided to all staff, although we saw evidence this had been planned for the near future.

The Mental Capacity Act (MCA) is legislation that protects people who may lack capacity to consent to their care and treatment. We found examples where the manager was not following this legislation, which informed us that people’s capacity to consent to specific decisions had not been assessed appropriately.

People received a choice of what to eat and drink and they liked the food provided.

People who used the service and relatives told us they found staff to be caring and friendly. Our observations found staff to be friendly and attentive to people’s individual needs.

Staff had read people's care plans so they were aware of how to provide care to people that met their needs.

People were encouraged to be as independent as possible. People had their rights respected in terms of privacy and dignity.

Activities were provided though provision was limited and needed to be expanded to include people's preferences.

Complaints had been followed up though the complaints procedure did not provide full information as to how to make a complaint.

The provider had internal quality and monitoring procedures in place. These needed to be strengthened to prove that necessary identified actions had been implemented.

The manager enabled staff to share their views about how the service was provided by way of staff meetings and supervision. Staff said management provided good support to them.

At this inspection, there had been a breach of Regulation 12 of the Health & Social Care Act 2008 Regulated Activities Regulations 2014, as people had not been protected from risks to their safety, including the risk of infection. You can see what action we told the provider to take at the back of the full version of the report.

People told us they liked living at Anita Jane’s Lodge and thought the care was good. One person said, “I can do most things for myself but if there’s anything I can’t do the staff help me.” Another person commented, “This is a special place where you feel safe and looked after. The staff are here for us day and night.”

During our inspection the evening meal was served in the dining room. The atmosphere was relaxed and convivial and people appeared to enjoy the meal as a social event. A variety of dishes were served, depending on people’s preferences, including curry, omelette, meatball bolognaise, and corn beef hash. People sat in small groups at pine tables. Music chosen by one of the people who used the service was played in the background.

People said they liked the premises which were clean and homely. One person told us, “It’s fine here, nice and comfy. We’ve got a big garden at the back and I like to sit our there in the summer.” Another person commented, “The staff are always cleaning. I think they do a good job.”

People told us they got on well with the staff. One person said, “The staff are always here for me and make me feel safe.” Another commented, “The staff look after me very well.” We observed that relationships between the staff and the people who used the service were warm and friendly. Staff told us they enjoyed working at Anita’s Jane’s Lodge and felt they were well-trained and supervised.

People told us they could choose their activities and daily routines. One person said, “I make choices about everything I do. I can watch telly in the lounge, or read in my room, or play scrabble with the staff, or go out – it’s up to me.” Another commented, “Sometimes I go to a day centre but sometimes I don’t want to go so I stay here. Staff told me it’s my decision.”

People said they thought the care the home provided was good. One person told us, “The staff look out for us and make sure we’re OK. They’re always there if we need them, night and day.” Another commented, “I go out whenever I want, I just have to tell the staff I’m going in case they’re worried about me.”

People told us they felt safe in the home and trusted the manager and the staff. One person said, “The manager is friendly and if I had a problem I would go to her and she would deal with it.” Another commented, “The manager is good and I’d tell her if anything was wrong, but if she wasn’t there I’d tell any of the staff.”

People said they had confidence in the manager and staff to take action if they had any concerns. One person said, “The manager is a very good worker and is friendly and helpful. If there are any problems she sorts them out quickly.”

People told us they liked the staff team and got on well with them. One person said, “If you need to talk you tell the staff and they see you straight away.” Another commented, “The staff are great, they are all friendly and kind.”

The people who use the service were consulted on all aspects of how the home was run. They contributed in one to one discussions with staff, group meetings, and through questionnaires issued by the service. One person told us, “I’m settled here and happy but if I want any improvements the manager will sort them out, she acts fast and is a hard worker.”

People told us there had been many improvements to the service since our last inspection. Comments included, “The food has improved – there’s more variety and it tastes better. They ask us now at residents meetings what we would like”, “They’ve been doing some decorating here and the place looks a lot better”, and, “This home is much better than before, the new manager is great and I have confidence in her.”

People said staff had been working on their care plans to improve them. One person said, “We have new care plans and the staff have been asking us questions and putting the answers in the care plans.” Another person commented, “My care plan is in the office. The staff showed it to me and asked me if I thought it was OK.”

People told us they felt safe in the home and trusted the staff team. One person said, “The staff are always asking us if everything’s ok and we’ve got to tell them if we’re not happy.” Another person said, “If I have a complaint I go to the manager but if she’s not there I can tell any of the staff.”

People said staff attitudes had improved and they had confidence in the staff team. One person commented. “The staff seem happier now and we’re happier.” Another told us, “We have some new staff and they’re very good and the other staff who have stayed on are good too.”

They also said staff now spent more time with them doing activities, talking to them, and encouraging them to get out and about. One person told us, “The staff are here for us now. All they used to do is clean, but now they do stuff with us.”

When we visited some of the people who use the service were out shopping or at day centres, others were in the home. We talked to one person in their room and others in the lounge and dining room where they were waiting for lunch to be served. People appeared settled in the home and the atmosphere was calm. Staff were busy but some took the time to chat to the people who use the service as they went about their work.

One person told us he like living at Anita Jane Loge because he could do what he wanted there. He said, “We get to go to bed when we want. I go to bed at 10pm but I can stay up till 12 or later if I like.” Another commented, “It’s alright here, there’s usually someone to talk to if I want that, but I prefer to keep myself to myself.” One person told us the home was ‘okay’ but ‘noisy at times’.

We talked to one person about safeguarding and they told us, “If a member of staff was rude I’d report it to the manager.” Another person told us they had experienced racism in the home from another person who used the service but this had not been effectively addressed by staff.

We observed staff interacting with the people who use the service. One member of staff was seen to treat them with respect, while another appeared indifferent to them. We talked to one person about the staff. They said the staff were ‘alright’ and as far as they knew they ‘never shouted at the residents’.

Please see previous report dated January 2012.

During our inspection we answered 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 we observed, the records we looked at, and what the people who used the service and the staff told us. During our inspection we talked with six of the people who used the service and five members of staff.

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

Is the service safe?

People told us they felt safe at Anita Jane’s Lodge. When we visited the home generally had a good atmosphere and people appeared relaxed and happy. One person said, “I’m accepted here and I can be myself. We all look after each other, residents and staff. It feels like home.”

There were enough staff on duty to meet the needs of the people living at the home, and the acting manager and other staff were available on call in case of emergencies.

One person did not have a care plan or risk assessment for an ongoing medical condition. A compliance action has been set for this and the provider must tell us how they plan to improve.

People told us they were satisfied with how staff managed their medication. One person said, “The staff put my tablets in a little pot then tip them in my hand and give me a glass of water to take them with.” Some medication records needed updating. A compliance action has been set for this and the provider must tell us how they plan to improve.

The acting manager and staff understood their responsibilities under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS). Where appropriate, applications had been submitted to the relevant authorities.

Is the service effective?

People were supported to be as independent as possible. Those who were safe to do so made their own hot drinks and snacks in the kitchen. One person told us, “I’ve been making bacon sandwiches with the staff when I want to, and I make my own tea all the time.”

The home had acquired a kitten at the request of the people who used the service. People introduced us to the kitten and told us how much they enjoyed looking after it. When we inspected people were playing with the kitten, taking it into the garden, and feeding and petting it.

We found improvement to some care plans and risk assessments, with evidence of regular reviews and updates. One person who used the service told us they had been involved in the review process and said this had been a positive experience as they could see how they had progressed and become more independent.

Is the service caring?

People got on well with the staff who worked with them in a warm and supportive way. One person who used the service said, “The staff are like family and always look out for me. There is only one word for them – excellent.” The staff team was established and some staff members had worked at the home for a number of years. This meant they had provided continuity of care and built up relationships of trust with the people who used the service.

Some people who used the service needed staff to support them when they left the home. Others were safe to leave the home on their own, but preferred to go out with staff. As this was their choice staff accompanied them on request. Records showed people had recently gone out with staff, on their own or in small groups, to two local parks, to cafes, and shopping.

Is the service responsive?

When we visited the home was undergoing major refurbishment. The people who used the service told us they were pleased with the changes and had been involved in choosing the new décor. One person said, “The owners have pulled out all the stops – it’s the most I’ve seen done to this home in years.” Another person told us, “With the painting the home’s looking better and it makes me feel alright.”

Although improvements had been made to parts of the premises, some areas were still in a poor state of decoration and repair. A compliance action has been set for this and the provider must tell us how they plan to improve.

One person told us they’d been helping to look after the home’s large rear garden. When we inspected they were in the garden with their keyworker digging flowerbeds and planting vegetables. They told us how much they enjoyed doing this.

Is the service well-led?

The acting manager had been running the home for two years. In May 2014 she submitted an application to CQC to become the registered manager. This was being processed at the time of our inspection. The people who used the service told us they had confidence in the acting manager. One person said, “She’s here for us and you can talk to her about anything.”

People had asked for an alternative to residents meetings which they said they didn’t find useful. These had been replaced with monthly one-to-one meetings when people met with their key workers to give individual feedback on the home. The acting manager said this approach gave everybody the opportunity to comment on the service and the results would be used to help ensure the home was run in the way people wanted it to be.

The home’s audits of care plans and risk assessments, and medication records had not always been effective as they had failed to identify some errors or omissions. A compliance action has been set for this and the provider must tell us how they plan to improve.