About the service: Liberty Lodge is a residential home providing nursing and personal care to 3 people with mental health needs at the time of inspection.

People’s experience of using this service: People told us they felt well supported by kind and caring staff and were empowered to make choices about their daily lives. Staff supported people to be as independent as possible, to access health care when needed and to maintain links with friends, family and the local community. People were treated with dignity and respect.

The environment was clean, tidy and well maintained. Regular checks of the building and equipment were done to keep people safe. However, people were not protected against the risk of Legionella disease as checks on water temperatures were not carried out and there was no recent risk assessment to see if this was needed. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff received appropriate training and support to enable them to carry out their roles safely, including managing medication. There were enough staff to keep people safe. Agency staff were not used as staff from 2 of the provider’s other homes were used to cover sickness or leave, meaning people were always looked after by staff they knew.

People had their needs and choices assessed and appropriate plans of care to meet their needs. People had up-to-date risk assessments and risk management plans.

The registered manager had processes in place to monitor quality and people’s satisfaction with the service, and responded in a timely way to meet people’s needs. However, the provider’s quality monitoring system had not picked up that a Legionella risk assessment was needed but had not been done. The service promoted learning for people and staff.

Rating at last inspection: Good (report published 18th August 2016).

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

Follow up: We will monitor the provider’s action plan to see how they are implementing the required improvements to bring the service back to a rating of at least Good. We will inspect again in future as per our re-inspection programme.

This inspection took place on the 28 July 2016 and was unannounced.

The aim of the inspection was to carry out a full comprehensive review of the service and to follow-up on the compliance action and recommendation made at the previous inspection in July 2015. At this inspection we found the provider had followed their action plan and improvements had been made in the required areas.

Liberty Lodge provides care and accommodation for up to five people who have mental health needs. There were four people using the service at the time of this inspection.

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 registered manager had taken action to review records about people’s care and undertook more robust assessments before people started to use the service. Care plans for people accurately reflected their identified needs and the associated risks to their health and welfare. People’s needs were regularly monitored and reviewed to make sure the care was current and relevant.

We found there were improvements with the ways medicines were managed. Medicines were managed, stored, given to people as prescribed and disposed of safely. There were systems for checking that people received their medicines correctly and that staff administered medicines safely.

People told us they felt safe at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. Risks to people’s health and safety were being well managed and the service encouraged people to take positive risks.

People were treated with dignity and respect and staff encouraged them to maintain and develop their independence. Individuals spoke positively about their experiences of the home. Staff understood the needs of the people who used the service and how they liked to be supported. We found that staff communicated well with people and with each other.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This is legislation that protects people who are not able to consent to care and support, and ensures people are not unlawfully restricted of their freedom or liberty. People at the service had capacity and the staff sought people's consent about arrangements for their care. Staff were trained in the MCA and DoLS and understood their responsibilities.

People were supported to keep healthy and were encouraged to maintain a healthy lifestyle. Their mental and physical healthcare needs were met and other professionals were involved when people became unwell or required additional services. The registered manager sought and took advice from relevant health professionals when needed.

The provider’s recruitment and employment processes were robust and protected people from unsafe care. People received support from staff who knew them well, and had the skills to provide the care they required. Staff received the necessary training to fulfil their role and had ongoing support and supervision from the registered manager.

People knew how to raise any concerns. Staff listened and acted on what people said and there were opportunities for people to contribute to how the service was organised. The views of people, relatives, health and social care professionals and staff were sought as part of the quality assurance process.

There was an open and inclusive atmosphere in the service and the registered manager showed effective leadership. Staff felt well supported and had confidence in the registered manager.

There were s

At our inspection on the 16 and 19 May 2014, we found that the provider's arrangements for staff recruitment were not robust. We took enforcement action and issued a warning notice as the provider had failed to comply with regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations. We carried out this inspection to check that the provider had taken appropriate steps to comply with the warning notice.

We met with the manager for the service, interviewed one member of staff and looked at records held by the provider for staff recruitment. We found that the processes for recruiting staff had been strengthened so that people using the service were not put at risk of receiving care from unsuitable staff.

At our last inspection of the service on the 19 February 2014 we identified serious concerns with the way medicines were handled and administered as well as with the current arrangements in relation to obtaining and recording of medicines. We also found not all medicines that had been prescribed were stored safely. We took enforcement action and issued warning notices to the provider and registered manager as they had failed to comply with Regulations 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010

We carried out this inspection to check that the provider had taken appropriate steps to comply with the warning notice. We found there had been improvements.

We found the service had ceased ‘double dispensing’ of medicines. This is when medicines are removed from their original packaging and placed in pill boxes. The service had introduced a new monitored dosage system. Our checks of the medical records of the one person using the service showed they were receiving all the medicines that had been prescribed to them by their healthcare professional.

We also found all medicines at the home were stored safely. Staff documented and recorded their checks of medicines in the home to give them assurance that people received their medicines as prescribed.

On the day of our inspection there were two people living at Liberty Lodge. We asked them both about their experiences of the care and support they had received from staff. One person told us, “Care is excellent and the staff are friendly and let me do what I need to do.” Another told us, “It’s ok here. My room is nice. I have my drawings to keep me busy.” We asked people whether staff asked them for their permission before carrying out any care or support. Both people told us that they did. They also told us they received their medicines on time.

However, although people were generally satisfied with the care and support they received we identified a number of concerns during our inspection.

We found there were no care and support plans in place for people using the service. This meant staff had no written guidance or instructions about how to look after the people they cared for. Risks to people’s safety and welfare were not routinely identified in a timely manner so that people’s safety was not being ensured when staff carried out any care or support.

We identified serious concerns with the way medicines were managed in the home. We found people were put at serious risk of harm as they did not receive all the medicines prescribed to them to manage their medical conditions. Medicines were not handled or stored appropriately. There were no appropriate records to show when medicines were ordered and received at the home.

People’s records were not accurate or fit for purpose. They did not contain the most up to date information about them which put them at risk of receiving unsafe or inappropriate care. Poor record keeping by staff was also identified, particularly in relation to people’s medical information.

The person who uses the service told us that their privacy, dignity and independence were respected. They had been actively involved in developing their care plans and they had regular meetings with their key workers. Staff had got better over the last two years and they knew how to make a complaint if they needed to.

‘Its ok’ and ‘a nice place’ were comments from the person we spoke to. They confirmed that they had their own key to the property and were able to have the food they liked.

A complaint was made to us by the individual currently using the service in the presence of the acting manager during our visit on the 24th November 2010. We asked the provider to investigate this issue using their complaints procedure.

We visited the service on the 23 and 24 July 2015. The first day of the inspection was unannounced and we informed the manager that we would be returning on the second day to complete our inspection.

The aim of the inspection was to carry out a full comprehensive review of the service and to follow-up on the three required actions made at the previous inspection in May 2014. Between September 2014 and March 2015 the home was dormant which meant there were no people using the service and we were unable to inspect the service during this period. At this inspection we found the provider had followed their action plan and improvements had been made in the required areas.

Liberty Lodge provides care and accommodation for up to five people who have mental health needs. There were five people using the service at the time of this inspection.

There was a registered manager who had worked at Liberty Lodge since February 2014. 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 manager had improved the arrangements for staff supervision and training to ensure that people received appropriate care and support.

She had also strengthened the arrangements to monitor the quality of the service. New audit systems had been introduced and regular checks were being carried out. People using the service, their relatives and staff were provided with more opportunity to share their views.

The environment was well maintained and decorated to comfortable standards. Since our last inspection essential repairs and redecoration had been carried out.

Although there had been improvements we found that the provider’s arrangements for assessing people’s needs were not always effective and this could place individuals at risk of receiving inappropriate care or treatment.

We also found that the service did not follow consistent safe practice for the recording and safe administration of people’s medicines. We have made a recommendation about the management of medicines.

People told us they felt safe living at Liberty Lodge. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They received appropriate safeguarding training and there were policies and procedures to support them in their role. Risks to people’s health and safety were being well managed and the service encouraged people to take positive risks.

People’s rights were protected because the provider acted in accordance with the Mental Capacity Act 2005. This is legislation that protects people who are not able to consent to care and support, and ensures people are not unlawfully restricted of their freedom or liberty. The manager and staff understood the requirements and took appropriate action where a person may be deprived of their liberty.

People were positive about their day to day lives and their experiences of the home. They told us that staff listened to them, were approachable and respected their choices.

People’s needs were regularly monitored and reviewed to make sure the care was current and relevant. The care records included guidance for staff to safely support people by reducing risks to their health and welfare. The manager and staff team were developing a more person centred approach to recording people’s care and support needs.

People were supported to keep healthy and the service made sure health and social care professionals were involved when people became unwell or required additional services.

There were effective recruitment and selection procedures in place to help ensure people were safe and being cared for by suitable staff.

People told us they were actively involved in decisions about their care and treatment. Staff showed understanding, patience and treated people with respect and dignity. People were encouraged to build and develop their independent living skills both in and outside the service. Individuals were supported to maintain relationships with their relatives and friends.

There was an open and inclusive atmosphere in the service and the manager showed effective leadership. Staff were clear about their roles and responsibilities and felt supported by her.

People were involved in reviewing and providing feedback on the care and support they received. The provider carried out regular audits to monitor the quality and health and safety of the service and to plan improvements. Where improvements were needed or lessons learnt, action was taken.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to assessing for the needs of people using the service. You can see what action we told the provider to take at the back of the full version of this report.