We inspected the service on 20 November 2018. The inspection was unannounced. Britannia 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. On the day of our inspection 10 people were using the service.

At our last inspection on 10 June 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good but there had been a deterioration in ‘effective’ which was rated as ‘requires improvement’. 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.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for and these were monitored for any changes. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Staff knew what to do in the event of an accident but there had not been any accidents in the last 12 months.

The service had deteriorated to ‘requires improvement for ‘effective’. People did not have access to the first-floor bathroom and the ground floor bathroom was in need of some refurbishment or repair to the floor covering. The registered manager had identified these shortfalls and was planning the work required. Staff received the training and support they required to meet people’s needs. People were supported with their nutritional needs. The staff worked well with external health care professionals, people were supported with their needs and accessed health services when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind, compassionate and treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and made sure that emotional support was provided.

People continued to receive a responsive service. People’s needs were assessed and planned for with the involvement of the person. Care plans were in place for each identified need. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaint procedure and action had been taken to learn and improve where this was possible.

The service continued to be ‘well led’. People and staff felt supported by and had confidence in the registered manager. There were systems in place to monitor the quality of service provision and these included seeking the views of people and staff. There was an open and transparent and person centred culture at the service.

Further information is in the detailed findings below

The Inspection took place on 10 and 13 June 2016 and was announced.

Britannia Lodge is registered to provide accommodation and personal care with nursing for up to 15 persons who may be living with mental health problem. There were 11 people living in the service at the time of the inspection.

There was a manager in post who was in the process of registering. 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.

At the last inspection in June 2015 we had concerns about the risks to people’s health and safety, the condition of the premises, medication practice, the food supply, people’s healthcare and staff support. We were also concerned about people’s assessments, care plans and the quality of the service. At this inspection we found that many improvements had been made in all areas and the new manager had put in place a system for monitoring the quality of the service on a regular basis.

People now received safe care and support in a way that ensured their happiness and well-being. There were enough staff who had been safely recruited, were well trained and supported to meet people’s assessed needs. People received their medication as prescribed and there were safe systems in place for receiving, administering and disposing of medicines. Staff knew how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had care plans and risk assessments in place to ensure people were cared for safely.

The manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed.

People had a sufficient choice of food and drink to meet their individual needs and to keep them healthy. People’s care needs had been assessed and their care plans provided staff with the information they needed to meet people’s needs and preferences and to care for them safely. People’s healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed. Staff were kind and caring and knew the people they cared for well. They ensured that people’s privacy and dignity was maintained at all times. People expressed their views and opinions and they participated in activities of their choosing. People were able to receive their visitors at any time and their families and friends were made to feel welcome. Where people did not have friends or family to support them advocacy services were available. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People’s concerns or complaints were listened to and acted upon. There was an effective system in place to assess and monitor the quality of the service and to drive improvements.

We spoke with six people using the service, staff and a visiting relative. Comments included, “It’s nice here.” “The food is nice.” One person told us the manager was, “Good.”

We looked at three care plan files and found that people’s individual needs had been considered and plans detailed the support required. We found that people’s capacity to consent to care and treatment was assessed and recorded.

We found there were systems in place to ensure that the premises were safe and suitable for people using the service.

We found that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

There were systems for people using the service and others to raise any concerns, complaints or compliments they had and staff took appropriate action as required.

People we spoke with told us that they were able to make decisions about how they were supported. One person told us that they have meetings with staff very regularly to discuss any issues and to plan events.

People we spoke with told us that they were well cared for at Britannia Lodge. One person said ‘’We are very well looked after here. I have no complaints about anything.’’

Two people we spoke with told us that they felt safe at Britannia Lodge.

People we spoke with told us that there were enough staff available to support them.

People we spoke with told us that they were able to make choices and decisions about the day-to-day support they received. Two people told us that they were not involved in planning their care and one person told us that they met regularly with the manager to talk about their care and ‘’how they were doing.’’

People told us that they were well looked after at Britannia Lodge.

People we spoke with told us that they felt safe living in Britannia Lodge

People we spoke with told us that there were always enough staff available to assist and support them for their day-to-day needs. Three people told us that staff were available to take them out shopping, to the seafront and cinema whenever they chose to do so.

One person told us ‘’The manager here is the best ever, he is always here when I need to talk to him and all the staff are great.’’

People we spoke with told us that they were able to speak with staff and make changes to the service. One person told us ‘’We can share ideas and when we ask for changes the manager sorts this out quickly.’’

This inspection took place on 15 and 16 June and 9 July 2015.

Britannia Lodge provides care and accommodation with nursing for up to 15 people who have mental health difficulties. There were eight people living in the service on the last day of our inspection.

Improvements were needed as appropriate actions had not been taken to safeguard people against risks to their health and safety which included the premises, medication practice, cleanliness and the quality of the service.

People did not always receive the food of their choosing to help them maintain a healthy balanced diet. Their healthcare needs had not been consistently met because follow up actions and appointments were not clearly recorded with next steps.

Care plans had not always been updated to meet people’s changing needs. Assessments did not always contain all of the relevant information so people may not always receive care that is responsive to their individual needs.

The quality monitoring system was not effective because the service had not independently recognised and remedied the problems that we identified at this inspection.

The staff and manager demonstrated a good knowledge of how to safeguard people and guidance was available for staff to refer to if necessary. The recruitment process was thorough and there were enough staff on duty to meet people’s needs.

People received their care from staff who had the knowledge and skills to support them. The manager and staff had a good understanding of how to support people to make every day decisions and had applied the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) appropriately.

Staff were kind, caring and respectful and treated people with dignity. People and their relatives were kept involved and people using the service had participated in regular meetings. People were aware that advocacy services were available if needed.

Overall people had participated in a variety of activities both inside and out of the home and were able to follow their individual interests and social activities. They were encouraged and supported to maintain their relationships with their families and friends. There was a system in place to deal with any complaints or concerns.

There was no 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. A new manager had been in post since 11 May 2015 and was in the process of applying to be the registered manager.

People felt the manager was approachable and supportive and had a good understanding of the needs of people living with mental health needs. Staff worked well together and communication had improved, regular staff meetings offered staff the opportunity to discuss ways of improving practice.

Personal records were safely stored and there was up-to-date guidance on the service’s password protected computer system.