About the service: Kingly Lodge provides accommodation for up to five adults with acquired brain injuries and neurological conditions. The staff team includes a dedicated team of occupational therapists to assist people with their support and rehabilitation. There were three people using the service at the time of our visit.

People’s experience of using this service:

•Whilst people received their medicines safely and as prescribed by their GP, the completion of the medicine administration records and the providers protocol for medicines prescribed ‘as and when required’ needed attention.

•The providers auditing and monitoring processes had not identified issues regarding the temperature of the hot water being delivered at the service.

•It was not always evident sufficient numbers of staff were deployed throughout the day to meet the needs of the service and the people using it. We recommended staffing numbers be revisited.

•People felt safe living at Kingly Lodge and with the staff team who supported them. The staff team knew what actions to take should they feel people were at risk of avoidable harm.

•Risks associated with people’s care had been comprehensively assessed and plans of care were in place for the staff team to follow.

•The staff team were experienced and knowledgeable and felt supported in their role.

•People were treated with kindness and compassion and their privacy and dignity respected.

•Support from relevant healthcare professionals was sought when required and people were supported to eat and drink well.

•People were provided with a clean and comfortable place to live and there were appropriate spaces to enable people to either spend time on their own, or with others.

•People had individual activities schedules. They were supported to follow their interests and hobbies and to participate in social activities with others.

•A formal complaints process was displayed and people knew who to talk to if they had a concern of any kind.

•People were supported to have the maximum choice and control of their lives and staff supported them in the least restrictive way possible; the polices and systems in the service supported this practice.

•The staff team supported people to make decisions about their day to day care and support and always obtained people’s consent to their care. They were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected.

•People had the opportunity to have a say and to be involved in how the service was run.

•The management team worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

•Lessons were learned and improvements to the service were made when things went wrong.

More information is in the detailed findings below.

Rating at last inspection: Outstanding - last report published 17 June 2016.

Rating at this inspection: We found evidence to demonstrate and support the overall rating of Requires Improvement.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated requires improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was an unannounced comprehensive inspection that took place on 17 March 2016.

Kingly Lodge is a care home registered to accommodate and provide rehabilitation for up to five people who have a mental health diagnosis. The home is located on three floors. Each person had their own bedsit with kitchen facilities. The home had a communal lounge, kitchen and dining room where people could spend time together. At the time of inspection there were 5 people using the service.

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.

We received very positive feedback about the service. Comments from people included, “I am happy to be here”, “It is like a family”, and “I feel really wanted here.”

People received care and support that was extremely responsive to their needs and preferences. Care plans provided detailed information about people so staff knew exactly how they wanted to be supported in a personalised way. People were supported as individuals and encouraged to maintain their independence in ways that were important to them. A wide and varied range of activities were on offer for people to participate in to support their rehabilitation in a meaningful way. People were encouraged to pursue their interests and hobbies and to have holidays.

People actively participated in developing their care and rehabilitation plans. People were encouraged and supported to develop and maintain relationships with people who mattered to them.

People were protected from the risk of harm at the service because staff had undertaken training to recognise and respond to safeguarding concerns. They had a good understanding about what safeguarding meant and how to report it.

There were effective systems in place to manage risks and this helped staff to know how to support people safely. Where people displayed behaviour that was challenging the training and guidance given to staff helped them to manage situations in a consistent and positive way that protected the person, other people using the service and staff.

The building was well maintained and kept in a safe condition. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

People’s medicines were handled safely and were given to them in accordance with their prescriptions. People’s GPs and other healthcare professionals were contacted for advice whenever necessary.

There were enough staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Staff received appropriate support through a structured induction and regular supervision. There was an on-going training programme to provide and update staff on safe ways of working.

People were supported to maintain a balanced diet where they were supported with eating and drinking. Where monitoring was required for health purposes this was in place. We saw that people were able to choose their meals and were involved in making them.

People were supported to make their own decisions. Staff and managers had a full and up to date understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We found that appropriate assessments of capacity had and DoLS applications had been made. Staff were acting in accordance with DoLS authorisations. Staff told us that they sought people’s consent before delivering their support.

People were involved in decisions about their support. They told us that staff treated them with respect.

People and staff felt the service was very well managed. The service was well organised and led by a registered manager

For this follow up inspection we did not speak with people using the service. We referred to medication records and we spoke with a member of staff.

The provider had taken the action we had requested following our previous inspection. Arrangements for recording the administration of medication had improved and daily audits were completed to check that this information was complete.

During our inspection we spoke with one of the people using the service and with three staff.

The provider had arrangements in place to assess whether people had the capacity to make decisions in relation to the care and support they received.

Support was provided to help manage and monitor people’s nutritional needs. Assessments had been completed to help indentify any risks and explain how these were to be managed. People’s independence was promoted as, where appropriate, they were supported to plan and prepare their own meals.

When we reviewed records relating to the administration of medication we found that the process was not as reliable as it needed to be. It appeared medication had not always been given when it should have.

Formal recruitment processes were followed and appropriate checks taken up before any formal job offers were made to new staff. Staff we spoke with confirmed that they received support from senior staff and colleagues and received appropriate training to support them in their roles.

During our inspection visit we spoke with the five people who used the service. They all told us that they were satisfied with the support they received at Kingly Lodge.