The inspection took place on the 26 July 2018 and was unannounced.

April Lodge provides personal care in a supported living scheme for up to twelve people who have enduring mental health difficulties. The service is provided in two converted properties over two floors in the local community. 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. At the time of our inspection twelve people were using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service is required to and did have a registered manager. 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.

The service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

The service was caring. Staff cared for people in a empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner.

The service was well-led. The registered manager had suitable systems in place to assess and monitor the quality of the service provided.

The unannounced inspection took place on the 10 and 15 February 2016.

April Lodge provides personal care in a supported living scheme for up to twelve persons who have enduring mental health difficulties.

The service is required to and did have a registered manager. 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.

The service needed to improve their quality assurance systems. Systems were in the process of being adopted from sister services to achieve uniformity from the provider. The registered manager had been appointed to this existing service in November 2015 and actively supported the deputy manager, who was also new to their role, in the development and implementation of quality assurance systems. Although systems were in place to make sure that people’s views were gathered, analysis and action plans were not in place to make effective use of people’s views.

Staff delivered support effectively. People’s safety was ensured and care was provided in a way that intended to promote people’s independence and wellbeing. A robust recruitment process was in place and staff were employed upon completion of appropriate checks. Sufficient members of staff enabled people’s individual needs to be met adequately. Qualified staff supported people satisfactorily with the administration of their medications and the monitoring of their own health.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to apply such measures appropriately.

Staff supported people to ensure they received access to healthcare services when required. Staff also worked with a range of health professionals, such as social workers, community mental health nurses and GPs, to implement care and support plans.

People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. Staff were respectful and caring towards people ensuring privacy and dignity was valued. People were supported to carry out their own daily interests independently or achieve them with the assistance of staff, if requested.

Our inspection team was made up of one inspector. Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected issues identified in the initial needs and risk assessments. These were sufficiently detailed to allow care staff to deliver safe and responsive care.

The provider was able to demonstrate that improvements had been made to the recruitment process and the necessary checks were undertaken prior to a new staff member starting work with vulnerable people.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person who used the service told us, "We are a good team here."

Is the service caring?

People were supported by kind, committed and attentive staff. One person said, "Staff will always listen to me."

Is the service responsive?

People's needs were reviewed on a regular basis. Records confirmed people's preferences, interests and diverse needs had been recorded and care had been provided in accordance with people's wishes. We observed people who used the service undertaking various activities and going out in the local community.

Is the service well-led?

Staff had a good understanding of providing personalised individual care and the need to promote independence in the supported living environment. People who used the service were very happy with the care they received. One staff member told us they loved working at April Lodge.

Quality assurance processes lacked rigour and consistency. Not all of the records were readily available during the inspection and part of the care planning process recorded in the records was not understood by the staff. Therefore, the registered manager was not protecting the people who used the service and others against the risks of inappropriate or unsafe care. We have asked the provider how they plan to improve in relation to this.

At the time of our visit 10 people were using the service and we spoke with five people and two staff.

People told us that they were independent but that staff were available to prompt and motivate with care as required. Comments included, “It’s lovely.” “They [staff] try and sort things out for you.” “I like independent living, we can do more or less what we want.”

We found that the provider had systems in place to gain people’s consent to their care and to support people to access other services from providers/professionals.

We found that the provider had systems for people to be able to give feedback on the service and raise any issues. We found that responsive action was taken to any issues raised.

We found that some systems relating to staff recruitment and records needed improvement to ensure they were effective.

We spoke with nine of the eleven people who currently use the scheme. They all told us that the scheme was good. One person said, “They gave me good information about the service and they always ask me if I am happy with the care that I get from them.” Each person had given signed consent for the service to share information with others.

The level of support that people needed was minimal. The care plans showed and people who use the service confirmed that their support was mainly verbal prompts and reminders. People told us that they would not remember to take their medication without staff prompting or reminding them to do so.

There were risk assessments and management plans in place for any areas of identified risk. The care plans and risk assessments had been regularly reviewed. The daily notes were clear and detailed.

There was good information about safeguarding adults. Staff had received training and knew how to deal with any allegations of abuse. Supervision had not been carried out as often as stated in the service’s supervision policy and some training updates had not taken place.

The quality assurance system needs improving. Although people living in the scheme had been asked for their views each year no analysis of their views had taken place and the views of other relevant people had not been sought. This meant that any areas requiring improvement may have been missed.