The inspection took place on 27 November 2016 and was unannounced. The service was last inspected in December 2015. At the last inspection, we had found that people were at risk of cross contamination, as the bathroom had not been adequately maintained. We had also found that there had been inconsistent monitoring of when staff had intervened or administered medicines if people became agitated.

Bathurst Lodge is a large detached house in a residential area of Gloucester. The service is registered to provide personal care for up to six people with learning and mental health difficulties. On the day of our visit, there were six people at the home.

There was a registered manager for the service. 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 staffs skill and approach in responding to behaviours that challenge in a caring way was variable .Some staff did not convey a patient caring manner when they supported those people. The remaining staff did convey that they were caring towards people and were patient in approach.

People spoke positively about the staff and the support given by them with their particular needs. People were treated in a polite way and staff spent plenty of time with people. There were positive and warm interactions between them. People approached staff when they wanted to talk with them .

Care plans were informative and set out for staff what actions were needed to support people with their range of care needs. Staff were aware of what was written in each person’s care records. They knew how to provide care that was flexible to each individual and met their needs. Care plans were reviewed and updated regularly. This was done so that they were up to date and reflected the current needs of people.

There were recruitment and training processes in place that helped to ensure that staff were properly checked and were knowledgeable to be able to support people effectively.

The staff told us they could address any concerns or raise any issues informally with senior staff and the registered manager. The staff had received formal supervision meetings and areas for improvement were properly addressed with them.

There were enough staff deployed at any time to meet people needs. Feedback from people and others involved in their care was positive. There were quality checking systems in place to monitor the service so that people received care that was personalised to their needs.

Staff spoke positively of the management of the service. They said that the registered manager and the deputy manager provided strong and supportive leadership. Staff said they saw them or the deputy manager every day. They also said they were always available and helped them whenever they needed support and guidance.

Feedback about the home from people and others involved in their care was positive. Regular reviews were undertaken to see where improvements were needed and the service could be further developed. There were systems in place to monitor the service to ensure people always received care that was personalised to their needs.

Staff spoke positively of the management structure of the organisation they worked for. They said that the senior managers and the registered manager provided strong and supportive leadership. The staff team told us they were particularly well supported by the registered manager, who spoke positively about their role. Staff said they saw them every day and they were always there and helped them whenever they needed support and guidance.

This inspection took place on 3 and 4 December 2015. The inspection was unannounced. Bathurst Lodge provides accommodation and personal care for up to six people with a learning disability and mental health difficulties. The home is situated at the end of a quiet residential street in its own grounds. It comprises of a lounge, dining room, kitchen, six bedrooms and two bathrooms. People have access to a secure back garden.

At the time of the inspection the service had 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.

People were at risk of cross contamination when using the home’s bathrooms as they had not been adequately maintained. This meant the bathrooms could not be effectively cleaned to prevent the spread of infections. You can see what action we told the provider to take at the back of the full version of the report.

Risk assessments and guidance were in place to direct staff when people were at risk of harm or abuse. However, there was inconsistent recorded monitoring of when staff had intervened or administered medicines if people became agitated. Staff worked with people to ensure their safety, however records were not in place to reflect the assessment and impact of environmental restrictions on people within the home such as locked doors.

Staff were knowledgeable about reporting any concerns or allegation of abuse. Staff had sought advice and support from other health care services when people’s health and emotional needs had changed. People’s care records reflected their health and well-being needs. The home catered for people’s dietary needs and preferences. They were encouraged to take part in the planning and cooking of meals. Staff had been trained to support people who required additional support with their nutritional intake.

Staff were kind and caring. They encouraged people to become independent and express their own decisions. Staff had sought the opinions of significant others such as their family and doctors when people could not make important decisions for themselves.

Adequate recruitment and training processes were in place to ensure that staff were suitably checked and knowledgeable to support people. Staff told us they could address any concerns or issues informally with senior staff and the registered manager; however they had not received formal supervision meetings. Any shortfalls in staff conduct were immediately addressed. There were sufficient staff to meet people needs.

The home valued people’s feedback and involvement in running the home. Their concerns and problems were immediately addressed. Quality assurance checks were in place to ensure people received a good service and remained safe in their own home.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We looked at the care files of three people who used the service. These files were comprehensive and up to date. The care plans and risk assessments were person centred and individual to each person and reflected their needs. People’s care had been reviewed on a regular basis.

The provider had a medication policy in place that was up to date and fit for purpose. Staff had been training to administer medicines and had their competencies checked every six months. The deputy manager told us that staffing had recently been increased to match the needs of the people who used the service. We were also told that with the current staffing levels, all people’s needs were able to be met. The provider’s quality manager told us that the home had not received a complaint since 2010. We noted however, that an effective complaints system was in place should the need arise.

We were able to speak to one person who used the service. They told us “I really enjoy living here, I like to help out around the home and there is lots to keep me occupied”. We also saw the satisfaction surveys and all the results showed positive results.

We looked at the care files for three people. We saw evidence of picture care plans which detailed what each person liked and disliked and their routines. The care plans and risk assessments had been reviewed in August 2012 and were appropriate for each person. One person required special medication to be administered on occasions. We saw a detailed protocol for the use of this and details of which staff had been trained to administer it. Behaviour management plans were up to date and had recently been reviewed.

Three relatives said that they would recommend the home and rated it as excellent in their satisfaction surveys.