We conducted an inspection of Fradel Lodge on 27 June 2017. Fradel Lodge is a supported living service providing personal care and accommodation for adults with mental and/or physical health needs within the orthodox Jewish community. There were 21 people receiving personal care when we visited. At our last inspection on 19 and 24 May 2016 we found that the provider was in breach of regulations in relation to consent and notifications. At this inspection we found improvements had been made in these areas and the provider was no longer in breach of these regulations.

There was a registered manager at 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 provider was meeting the requirements of the Mental Capacity Act 2005. Mental capacity assessments were in place to demonstrate that where people could not consent to their care, decisions were made appropriately in their best interests. Care staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005.

Quality assurance systems were thorough. The manager completed various audits and took action to implement required changes as a result of the last Care Quality Commission inspection. We saw evidence that feedback was obtained from people using the service and the results of this was positive. Notifications were submitted to CQC as required.

Procedures were in place to protect people from abuse. Staff knew how to identify abuse and knew the correct procedures to follow if they suspected abuse had occurred. Safeguarding matters were reported to the CQC as required.

We saw evidence of logging of accidents and incidents and evidence of investigations and further analysis into the causes of accidents and incidents. We saw consequent further action was taken as a result to mitigate risk.

Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or where the person’s care needs had changed.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

People were supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs and to access a range of healthcare professionals.

People using the service and staff felt able to speak with the manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

We conducted an inspection of Fradel Lodge on 19 and 24 May 2016. Fradel Lodge is a supported living service providing personal care and accommodation for adults with mental and/or physical health needs within the orthodox Jewish community. There were 21 people receiving personal care when we visited. At our last inspection on 29 January 2014 we found that the provider was meeting all of the regulations we checked.

There was a registered manager at 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.

Procedures were in place to protect people from abuse. Staff knew how to identify abuse and knew the correct procedures to follow if they suspected abuse had occurred. However, safeguarding matters were not reported to the CQC as required.

We saw evidence of logging of accidents and incidents, however, we did not see consistent evidence to demonstrate investigations were always conducted into accidents and incidents.

Staff had completed medicines administration training within the last year and were clear about their responsibilities.

Risk assessments and support plans contained clear information for staff. All records were reviewed every month or where the person’s care needs had changed.

The provider was not meeting the requirements of the Mental Capacity Act 2005. We saw examples of documentation being signed by next of kin without them having the legal authority to do so and one person’s liberty was being unlawfully deprived. However, care staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service and their relatives were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision. There were enough staff employed to meet people’s needs.

People were supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs and were supported to access a range of healthcare professionals.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

Quality assurance systems were not consistently thorough. The registered manager completed various audits, but these did not identify the issues we found in relation to consent. We saw evidence that feedback was obtained by people using the service and the results of this was positive.

We found two breaches of regulations in relation to consent and notifications. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with five people using the service and the relative of another person. We also spoke with care workers, a registered general nurse employed as a care co-ordinator and the scheme manager. People using the service told us they were happy with the quality of their personal care and support. One person using the service said, "it's fine, the care workers are helpful and polite when they help me to have a wash and get dressed. They are nice and look after me well." Another person told us, "the staff are fantastic and very friendly. I prefer to have a male care worker and that is what I always get."

People using the service told us they were always asked for their consent before staff provided personal care and their views were listened to.

People's personal care was planned, delivered and monitored in a way that was intended to ensure their welfare and safety.

There were systems in place to ensure that people received safe and appropriate support with their medicines, in accordance to their assessed needs.

People told us there were sufficient staff available to provide their personal care in a manner that felt thorough and not rushed.

The provider regularly checked upon the quality of the service and acted upon people's views in order to make improvements.

We spoke with three people using the service and the relatives of three other people. People using the service and their relatives described it as being “wonderful” and “excellent”.

People told us they were well cared for and provided with an individualised service. One visitor told us they called in every day at different times and felt reassured their relative was happy and comfortable. They told us the standard of care was high and the staff were kind and helpful.

The care needs of people using the service were assessed and recorded in their care plans. Risk assessments had been carried out in order to ensure people’s safety.

We found that staff were provided with training and support. Staff told us they enjoyed the training programme and were offered opportunities for professional development.

People using the service and their representatives were asked for their views about their care and they were acted on.

People we spoke with told us they were happy at Fradel Lodge. We observed that people were well cared for, and supported to maintain their independence.

There were suitable arrangements to involve people in decisions about their care and support, and their needs were regularly reviewed.

There were sufficient care workers on duty at the time of our inspection, and the staff members we spoke to told us they felt supported in the service.