We carried out an announced inspection of the service on 9 December 2016. Bridle Lodge is registered to provide accommodation and personal care for up to five adults living with a learning disability. At the time of the inspection there were five people living at the home.

On the day of our inspection there was not a registered manager 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 2008 and associated Regulations about how the service is run. We checked our records and did not find an application in place for a person to become registered to manage this home. We have raised this with the current manager and they have agreed to take action to address this.

During our previous inspection on the 30 September 2016 we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The issues related to limited staff competency checks, gaps in people’s medicine administration records (MAR), stock levels of medicines not being correct and protocols for the use of ‘as needed’ medicines were not always in place where needed. ‘As needed’ medicines are not administered as part of a regular daily dose or at specific times. During this inspection we checked to see whether improvements had been made. We saw they had, with all aspects of people’s medicines now being appropriately managed.

People told us they felt safe living at the home. People were supported by staff who could identify the different types of abuse and who to report concerns to. Assessments of the risks to people’s safety were in place and regularly reviewed. Emergency evacuation plans were in place, but the business continuity plan needed updating. There were sufficient numbers of suitably qualified and experienced staff in place to keep people safe. Safe recruitment processes were in place.

Staff were well trained, received regular supervision and felt supported by the manager. The principles of the Mental Capacity Act 2005 (MCA) were considered when supporting people. People received the food and drink they wanted and were supported and encouraged to follow a healthy and balanced diet. People’s day to day health needs were met effectively by the staff.

People and relatives felt the staff were kind and caring and treated them with respect and dignity. People were involved with decisions made about their care. Information was available for people if they wished to speak with an independent advocate. People were supported to live as independently as they were able to and staff respected people’s privacy. There were no restrictions on people’s friends and family visiting the home.

People were supported to take part in the activities that were important to them. People’s care records were person centred, focused on what was important to each person and provided staff with relevant information to respond to people’s needs. Complaints and concerns were managed in line with company policy.

People, staff and relatives spoke highly of the manager. The manager welcomed people’s views on developing the service. Staff understood their roles and responsibilities. Robust quality assurance processes were in place.

We carried out an unannounced inspection of the service on 30 September 2015. Bridle Lodge is registered to accommodate up to 5 people and specialises in providing care and support for people who live with a learning disability. At the time of the inspection there were five people using the service.

On the day of our inspection there was a registered manager in place, however they were not present during the inspection. 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’s safety was placed at risk because there were not appropriate processes in place to always manage people’s medicines in a safe way.

Staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. People’s freedom was maintained and regular assessments of their safety were carried out. Accidents and incidents were investigated, reviewed and then measures put in place to reduce the risk of them occurring again. Regular assessments of the environment people lived in and the equipment used to support them was carried out and people had personal emergency evacuation plans (PEEPs) in place.

People were supported by an appropriate number of staff. Appropriate checks of staff suitability to work at the service had been conducted prior to them commencing their role.

People were supported by staff who completed an induction prior to commencing their role and had the skills needed to support them effectively. Regular reviews of the quality of staff members’ work were conducted.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The deputy manager was aware of the principles of DoLS and appropriate applications had been made.

People were supported to make decisions for themselves and staff respected their decisions. People were supported to follow a healthy and balanced diet. People’s day to day health needs were met by the staff and external professionals. Referrals to relevant health services were made where needed.

Staff supported people in a kind and caring way. Staff understood people’s needs and listened to and acted upon their views. Staff responded quickly to people who had become distressed.

There was a lack of recorded evidence in people’s support records which showed people had contributed to decisions about their care and support. However people told us staff spoke with them and respected their views. Due to the involvement of people’s relatives with decisions about the care people were not provided with information about how they could access independent advocates if they wanted to access one. Staff understood how to maintain people’s privacy and dignity and treated people with respect. People’s friends and relatives were able to visit whenever they wanted to.

People’s support records were not always appropriately reviewed to ensure they reflected people’s current support needs. Other records such as health action plans which were no longer in use had not been removed which could lead to inconsistent care and support being provided. Some relatives felt involved when decisions were made about their family member’s care whilst others did not.

People’s support records were written in a person-centred way and staff knew people’s likes and dislikes and what interested them. People were encouraged to do the things that were important to them and they were supported to take part in activities individually and collectively with the people they lived with. People were provided with the information they needed if they wished to make a complaint.

People’s relatives gave mixed feedback about their views on how the home was managed. Some relatives expressed concerns that on occasions staff spent time talking with each other rather than supporting their family members. However no formal complaints had been raised so the provider was unable to investigate these concerns. The opportunity to provide anonymous and formal feedback had not been requested from people or relatives since 2012; however ‘Core Team Meetings’ were in the process of being set up to gain people’s views.

There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided although they were not always effective. The management team ensured their requirements under their CQC registration were met.

You can see what action we have told the provider to take at the end of this report.

During the inspection we spoke with two people who used the service and asked them about their experience of living at the home. We also spoke with two relatives. We carried out a tour of the building and reviewed records relevant to the running of the service. We observed staff interaction with people throughout the home. We spoke with the registered manager, a team leader and two support workers.

During the inspection we focused on these five key questions; is the service safe, effective, caring, responsive and well-led?

This is a summary of what we found –

Is the service safe?

We viewed the support plans of each of the five people who used the service and saw that they and/or their relatives where appropriate, were involved in decisions relating to their care. Changes to care and support were documented and the names of people involved in these decisions appropriately recorded.

People received care and support in an environment that was safe and the home was clean and tidy. However we did note that whilst there were emergency evacuation procedures in place for the whole home, each person did not have a personal emergency evacuation plan that was written appropriate to their needs. The manager told us they would rectify this immediately.

Support plans contained detailed information and guidance for staff to enable them to provide care and support that met people’s needs and kept people safe. The support plans were written in a way that respected people’s wishes and beliefs and encouraged independent choice and thought wherever possible.

We saw there were appropriate procedures in place for the safe handling, storage and administration of medicines. Records indicated people received their medication at the correct time and by appropriately trained staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. The registered manager could explain the procedure for submitting an application, should one be required.

A relative of a person who used the service told us, “I have no worries whatsoever, they are well looked after. There is a very calm and relaxing atmosphere around the home.”

Is the service effective?

Staff spoken with had a good knowledge of people’s needs. They could explain the care and support each person who used the service required and how they ensured that the support was effective.

Support plan records showed people’s needs were assessed. Risk assessments were conducted and reviewed regularly.

We saw there was a variety of nutritional food and drink available. We saw people were encouraged to choose healthy options wherever possible. Support plans showed that external professionals such as dieticians and GP’s had been consulted where there were concerns over a person’s weight. Recommendations made by these professionals had been recorded in the support plans, put into action and results of improvements recorded.

A relative we spoke with told us, “The food is good, plenty of choice although I do wish my son would eat more vegetables.”

Is the service caring?

We observed staff interact with people. There was a calm and friendly atmosphere. People who used the service were well presented and staff took the time to listen and to talk with them. We saw one person watching a movie with a member of staff. It was evident that they had a good relationship.

A person who used the service told us, “I love it here, they (staff) look after me.”

Is the service responsive?

We saw staff had received training on how to support a person with specific needs.

We saw regular communication with relatives and staff ensured that concerns relatives may have about their family member were addressed.

We looked at records which confirmed that people’s interests, beliefs and needs had been recorded and identified and staff responded positively to these.

Is the service well-led?

The registered manager had effective processes in place to regularly monitor the quality of the service provided and whether people’s needs were being appropriately met. We saw regular audits of support plans, the environment and people’s finances.

People’s views were welcomed and acted on. Staff spoken with told us they felt able to raise any issues they had with the registered manager. They told us they felt supported and their views were respected.

There had not been a survey conducted during 2013/2014 that took account of the views of people who used the service and their relatives. The registered manager told us that this will be conducted shortly and the results used to improve the quality of the service.

Staff spoken with were aware of their roles and responsibilities and support plan records showed which people were to be consulted with when decisions about a person’s care were being discussed.

Staff and relatives of people who used the service spoke positively about the manager. A support worker told us, “The manager is incredible, best I’ve worked for.”

During this inspection there were five people using the service. We spoke directly with two people who used the service and two relatives. We also spoke with three care staff and the registered manager.

We saw that people were involved in making decisions about their care and their views were taken into account and acted upon. One person who used the service told us, “I get choices all of the time, the staff are very nice.”

We saw that the building was safe, clean and adequately maintained. A relative of a person who used the service told us, “The building is great and they have a lot of room.”

We found that staff were knowledgeable, well trained and supported in their role. A staff member we spoke with told us, “I have done a lot of training and it all helps me to work with people.”

We looked at the provider’s maintenance of records and found that they were adequately maintained and met people’s needs.

We carried out this responsive inspection because we had concerns that this service had not been visited since August 2011.

We saw a mixed picture of the care provided.

People who use services had limited verbal communication skills but were able to express themselves using simple yes and no answers. We gathered evidence of people’s experiences of the service by talking with three staff members. We also looked at surveys received from four relatives and talked with two of these relatives. We also spoke with a social care professional so that we could understand the experiences of people using the service as we needed to see if there hade been any recent issues with the home. There were none that that they were aware of.

Two people told us they felt safe here. One person told us, “It is nice outside and I like being outside.” Another person told us, “I go outside often” and pointed to the window.

Comments from one relative included, “We have a major input into the care of our relative as it is on a shared basis. However we would like to have planned reviews with the home also. We would like our relative to have more visits to the cinema but because it has to be booked in advance it does not happen as often as we or our relative would like.”

One relative told us, “I have noticed that drinks are provided but there does not seem to be any choice offered as to what my relative would like. Sometimes we feel that our relative seems to do the same things and are not given that much choice or variety.”

Two relatives told us they had been to reviews in the past and have had more than one meeting. They told us they could raise concerns at the meetings. Both relatives told us they were not sure if their concerns were acted on.