This inspection took place on 9 May 2017 followed up by phone calls to relatives on the 12 May 2017. The service was last inspected on 26 March 2015 and the service was rated Good overall with requires improvement in Safe. This was due to risk assessments not being in place.

Hinton Lodge provides support for up to four people who have mental health needs or learning disabilities. At the time of our inspection one person was in hospital and three people were using the service.

At this inspection we found risks to people arising from their health and support needs as well as the premises were now assessed, and plans were in place to minimise them.

There were systems in place to ensure that people received their medicines as prescribed.

There was enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role. Staff received effective supervision and a yearly appraisal.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS).

People were cared for by staff that were trained in recognising and understanding how to report potential abuse. Staff felt confident to raise any concerns they had in order to keep people safe.

People enjoyed a good choice of meals and were supported to maintain a healthy diet.

The service worked with external professionals to support and maintain people’s health.

The interactions between people and staff showed that staff knew the people well.

Care was planned and delivered in way that responded to people’s assessed needs. Care plans contained detailed information about people’s personal preferences and wishes

Staff showed us that they knew the interests, likes and dislikes of people and people were supported to enjoy various activities. We saw that staff ensured that they were respectful of people's choices and decisions.

Relatives said they were not involved in reviews of people's care but said staff listened to them. Relatives and staff felt confident they could raise any issues should the need arise and that action would be taken as a result. The service had a clear complaints policy that was applied when issues arose.

The registered manager was a visible presence at the service, and was actively involved in monitoring standards and promoting good practice. The service had quality assurance systems in place which were used to drive continuous improvements.

Further information is in the detailed findings below.

We inspected Hinton Lodge on 26 March 2015. This was an announced inspection. We informed the provider at short notice (the day before) that we would be visiting to inspect. We did this because the location is a small care home for people who are often out during the day; we needed to be sure that someone would be in.

Hinton Lodge is located in Guisborough and provides personal care and support for up to four people who have learning disabilities and mental health conditions. All rooms are for single occupancy and have en suite facilities. It is situated close to the centre of Guisborough and has easy access to shops, local amenities and public transport. The service provider is the long standing Miltoun House Group, which became a limited company and re-registered as Marran Ltd on 31 December 2014.

The service has a registered manager, who has been registered with us in respect of the service’s new registration since 08 January 2015. Prior to this they were registered as manager for the service’s previous registration. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and action to take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

The service’s fire risk assessment had not been reviewed since 2011. We saw that some risk assessments were in place in relation to people’s health, crossing roads and falls. Risk assessments detailed some measures to keep people safe, however required further development. Some of the care plans included comments about relevant risks, but this was not part of a robust and formal risk assessment process that fed into the development of people’s care plans and supported them in positive risk taking. The registered manager assured us that people were safe. However there was a potential risk of people not being kept safe because the provider had not identified, assessed and managed risks relating to the health, welfare and safety of people who used the service.

Staff told us that they felt supported. There was a regular programme of staff supervision and appraisal in place. Records of supervision were detailed and showed the registered manager worked with staff to identify their personal and professional development.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. There was enough staff on duty to provide support and ensure that their needs were met. Staff were aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people.

People’s nutritional needs were met, with people being involved in shopping and decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted. Staff told us that they closely monitored people and would contact the dietician if needed. However, staff did not complete nutritional assessment documentation.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Assessments were undertaken to identify people’s health and support needs. Person centred plans were developed with people who used the service to identify how they wished to be supported.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.

The provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.