About the service: Lychgate House provides accommodation and personal care for up to 15 people who have mental health needs. At the time of inspection 14 people were living at the service.

People’s experience of using this service:

People living at Lychgate house at the time of inspection received care that was safe, effective, caring, responsive and well led.

The service had made a number of improvements following previous inspections in 2018 and 2017 where the service had been rated as requiring improvement.

People’s individual risks and associated needs were assessed and reviewed by a care team that incorporated the persons views and wishes, with expert advice from local mental health teams and other health and social care professionals.

Staff were recruited safely, had good understanding of safeguarding vulnerable adults, and had received training on specific areas of need and risk for the people living at the service.

Medicines were managed safely and given to people in a way that supported their dignity and encouraged compliance to manage their mental and physical health needs.

People were supported to maintain their mental and physical health with access to health appointments and reviews, including annual recommended health checks.

Staff had a good understanding of mental capacity and deprivation of liberties. People who lacked capacity had appropriate assessments in place that were revisited regularly and when needed. People were given information to help them make decisions about their care and treatment.

People living at the service and visiting professionals told us that staff were caring. We observed caring responses to people throughout the day, and the provider and registered manager role modelled a caring approach.

However, we did find peoples expressed desire for meaningful romantic relationship had not been appropriately discussed and explored and we have made a recommendation about this.

Care plans had improved and were person centred and interventions supported people to take steps to maintain their mental and physical health and achieve their ideal goals. However, access to the local community was infrequent for those who could not leave the home independently and we have made a recommendation about this.

People could express their views about the service, felt able to raise a complaint and were confident it would be resolved.

The registered manager had a positive approach to improving the service following previous inspections. They were constantly adapting, seeking advice and additional training and opportunities for staff from external professionals.

The registered persons had improved the systems in place to monitor the quality of the environment and the care people received. We observed these were being used effectivity.

Staff felt supported by the management team and people told us the registered manager and registered provider was a constant positive presence at the service.

Rating at last inspection: This service achieved a repeat rating of Requires Improvement at the last inspection. Report published on the 2 March 2018.

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

Follow up: We will continue to monitor this service in line with the current rating.

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

This inspection was completed on 26 January 2018 and was unannounced.

At our last inspection of the service on 5 July 2016 the service was rated as ‘Requires Improvement’. Breaches of regulatory requirements were evident for Regulation 9 [Person-centred care], Regulation 12 [Safe care and treatment] and Regulation 17 [Good governance].

Following the last inspection in July 2016, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well-Led’ to at least good. An action plan was received on 23 September 2016.

At this inspection we found that not all improvements had been made to meet the relevant requirements. This is the second time the service has been rated ‘Requires Improvement’.

Lychgate House is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Lychgate House accommodates up to 15 adults who have mental health needs. Lychgate House is a large detached house situated within a short distance of Colchester town centre and within walking distance of local amenities and facilities. The premises is set out on two floors with each person using the service having their own individual bedroom and adequate communal facilities are available for people to make use of within the service.

An effective robust system was not in place to assess and monitor the quality of the service. Quality assurance systems had failed to identify the issues we found during our inspection to help drive and make all of the necessary improvements.

Some aspects of medicines management required further development. Not all risks to people were identified and improvements were required to record how these were to be mitigated so as to ensure people’s safety and wellbeing. Improvements were required to ensure that people’s care plan documentation was accessible at all times, reflected all of their care and support needs and how the care was to be delivered by staff.

Staff had received regular training opportunities; however improvements were needed to ensure staff received appropriate training relating to the specific needs of people using the service. Minor amendments were required to ensure staff recruitment practices were in line with regulatory requirements. Newly employed members of staff received an ‘orientation’ induction but had not received an induction that was specific to their role.

People’s capacity to make day-to-day decisions had been considered and assessed. Where restrictive practices were in place, these were not clearly recorded to show these had been discussed and agreed with people using the service. Staff member’s understanding and knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act (MCA) 2005 were much improved. The Care Quality Commission had not been notified where [DoLs] had been authorised by the Local Authority.

People were protected from abuse and avoidable harm and people living at the service had no concerns about their safety and wellbeing. Staff described the management team as supportive and approachable. Arrangements were in place for staff to receive formal supervision at regular intervals and an annual appraisal.

People’s healthcare needs were supported and people had access to a range of healthcare services and professionals as required. Staff had a good relationship with the people they supported. People were treated with dignity and supported to maintain their independence where appropriate.

You can see what action we told the provider to take at the back of the full version of the report.

Lychgate House provides accommodation without nursing for up to 15 people who have mental health needs.

There were 14 people living in the service when we inspected on 5 July 2016. This was an unannounced inspection.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were not always provided with their medicines in a safe manner. Improvements were required around the recording and auditing of medicines, and as and when required medicines.

People’s health needs were generally met. However, some of the health monitoring was not always clear.

People were not always supported in accordance with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Some staff lacked awareness of what the Mental Capacity Act meant for people despite having received training. Mental capacity assessments had not been completed correctly.

Records were not always sufficiently detailed or respectfully written.

The service was at risk of isolation and the registered manager was not up to date with current best practice.

You can see what action we told the provider to take at the back of the full version of the report.

Procedures were in place which safeguarded people who used the service from the potential risk of abuse and staff understood the various types of abuse and knew who to report any concerns to.

There were sufficient numbers of trained staff to meet people’s needs and recruitment processes checked the suitability of staff to work in the service.

People were treated with kindness by the staff who knew them well and had good relationships with people who used the service.

A complaints procedure was in place and people’s comments and concerns were listened to.

There was an open culture within the service and staff understood their roles and responsibilities in providing good quality care to people.

We observed that staff were attentive to people’s needs and treated them with respect and dignity calling them by their name. We saw that staff sought people’s agreement before providing any support and assistance. We saw that the provider gave due consideration to people's capacity to consent, and that the provider had taken the relevant action to ensure that they complied with the Mental Capacity Act 2005.

We saw that staff were knowledgeable about people’s needs and promoted their independence. We found that they had a good understanding and awareness of people’s care needs and preferences. We saw that care plans and risk assessments were regularly reviewed and updated. One person told us: "The staff talks with me about my care and support.”

People told us that there were sufficient numbers of staff on duty to meet the needs of the people who lived in the service.

We saw that there was a complaints policy and procedure in place which was displayed in the communal area. The staff were able to explain the complaints procedure. People who used the service told us they were aware of how and who to complain to.

We gathered evidence of people's experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff.

During our inspection we spoke with two people who told us they liked living at Lychgate House. We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home.

During our inspection we saw that people received good care. One person living in the home told us they liked the food and the other said the home was lovely.

People with whom we spoke told us that they had been involved in the development of

their care plans. They also told us that they always attended any reviews of their care that were held.

People living in Lychgate House told us that they felt safe being supported by people who knew them and understood their needs well.