About the service: Poplar Lodge provides accommodation for up to nine people with primarily mental health needs. Some people had additional learning needs. At the time of our inspection eight people were using the service. The service was made aware in our previous inspection that the provision of mental health needs had not been added to their registration.

People’s experience of using this service:

Staff had documented people’s personal risks. However, these were not always up to date and/or accurate leaving one person at risk of a serious health condition.

Since our last inspection improvements to care plans had been initiated, although there were some plans which needed further revision.

Audits to measure the effectiveness of the service lacked rigour. This meant people were at risk of receiving poor quality care.

Cleaning was ongoing in the home to reduce the risk of cross infection. The manager told us night staff were required to carry out cleaning. However, we found some areas of the home required deep cleaning. The local Infection Prevention and Control team had visited the service and found areas for improvement. In a meeting with local authority representatives the provider agreed to employ a cleaner.

Menu planning did not always consider specific dietary needs. The manager had brought into the service cook books to diversify menus. We made a recommendation about the service reviewing the menu choices on offer.

Regular ‘residents’ meetings’ had lapsed and people had not had the opportunity to give their views about the service.

People were supported by staff to attend activities outside of the home. We found improvements were required to further engage people in meaningful activities.

The temporary manager was in place and they were responsive to issues we raised during the inspection. Staff were willing to learn and make changes.

Changes were in progress to improve the fabric of the home. The kitchen had been refurbished and downstairs had been redecorated. Further work was required upstairs to improve the décor. Regular checks were carried to ensure people lived in a safe environment.

Pre-employment checks were carried out to ensure staff were suitable to work in the home. Sufficient staff were on duty. Start times for staff were staggered to support people.

Staff were not always supported through training defined as mandatory by the provider and supervision. The service had welcomed additional training from other professionals. Staff felt they had been able to improve service delivery due to their recent training.

People were supported with their health by staff who had regular contact with other healthcare professionals to discuss people’s conditions and seek advice.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

People were happy with the support they received from staff. Staff treated people with kindness and respected people. They enabled people as far as possible to be independent.

A complaints procedure was available. No complaints had been made since our last inspection.

Rating at last inspection: At our last inspection we rated this service as requires improvement. (Report published 1 November 2018). This service has been rated Requires Improvement at the last two inspections.

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

Improvement Action: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: This is the third time the service has been rated as requires improvement. We will continue to monitor the service through the information we receive and discussions with partner agencies. We will be speaking to the provider about their next steps to improve the service to an overall rating of Good. We have rated

We conducted the focused inspection from 21 to 27 September 2018. It was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We carried out an unannounced comprehensive inspection of this service on 3 April 2018 and rated the service to be Good. On 13 and 23 February 2018 we completed a focused inspection and reviewed the domains safe, effective and well-led. We rated the service as requires improvement overall and in these three domains. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment; the need for consent; staffing; and having good governance systems in place.

After inspection in February 2018, we received continued concerns from Durham local authority in relation to the operation of the service. As a result, we undertook a focused inspection to look into those concerns. We reviewed the domains safe and well-led.

Poplar Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Poplar Lodge provides care and accommodation for up to nine people who are living with a learning disability and who may have an offending history, so may present a risk of harm to others. On the day of our inspection there were eight people using the service.

The service has a registered manager in place. 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 found that the registered manager had been diligently trying to make improvements but was not supported by the provider to achieve effective changes to the service. They had proactively sought advice from forensic mental health specialists and sourced training for staff in this field. However, further training was required to ensure staff and the registered manager were equipped with the skills needed to complete risk management plans for people with forensic histories and complex behaviours.

At the previous inspection and again at this one, staff reported that the provider ran services in Whitley Bay for people with similar needs. Previously the regional manager had stated that they would ensure the Poplar Lodge team could work with staff from these units to enable them to develop their skills in this field. We found that other than a staff member being deployed from one of the units to work as care staff member, no one from these units had offered or been asked to provide support to staff and assist them develop their skills.

The manager had closely listened to external professional’s views about how to develop the care records and had since our last inspection rewritten people’s care records at least six times. We found that the care records were more informative and were written in a person-centred manner. However, the risk management plans needed to demonstrate what the current risks were and highlight how long ago historical risks were last present. They also needed to show how staff monitored people’s behaviour and identified trigger behaviours or potential re-emergence of risk and provide detailed evidence of what action was being taken to reduce risks.

We spoke with the local neighbourhood police who were very positive about recent developments at the home and found staff had developed their skills around managing behaviours that challenge. This had led to a much lower call out rate for police assistance.

We found that improvements were needed around the management of topical medicines. One person showed us topical medicines they had been prescribed in Januar

This focused inspection of Poplar Lodge took place on 13 and 23 February 2018. It was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on 3 April 2017 and rated the service as ‘Good.’

We completed this focused inspection, as we were aware the placing authority had recently raised concerns about the operation of the service. In January 2018, the local authority commissioners discussed their concerns around the way potential risks for people were managed.

Poplar Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Poplar Lodge provides care and accommodation for up to nine people who are living with a learning disability and who may have an offending history so may present a risk of harm to others. On the day of our inspection there were eight people using the service.

The service has a registered manager in place. 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 found staff needed to receive training around meeting the specialism the service was designed to deliver, for instance completing risk management with people who have an offending history and understanding the use of the Mental Health Act 2983 (amended 2007) in the community.

Also staff needed to be supported to understand the actions they were able to take to ensure people were safe when going out independently. They needed to be more proactive and find out if people were subject to any court restrictions, Ministry of Justice conditions or Community Treatment Order conditions. Although some links had been formed with the local Protection of the Public Unit at present no information was available to assure staff that the courts had not imposed additional restrictions when sentencing people. Also no information had been gathered in respect how the police dealt with any incidents.

Staff knew the people they were supporting but the care records did not reflect this knowledge. Also the records did not provide evidence that could be used to support staff to fully understand people’s histories, the impact of their learning disability or mental health needs on their behaviour, be able to contextualise and formulate risk profiles for people or determine what restrictions were in place. For instance one person had an electronic tag fitted but we could not determine why, what conviction had led to this and what requirements the Court expected the person had to adhere to. The person told us they were subject to a curfew but staff also thought the tag might offer them safeguards if the person became violent again but were unclear as to how this worked.

The care records contained no information about people’s capacity and no MCA assessments had been completed. We found people were required to only go out when accompanied by staff but neither a ‘best interests’ decision or formal agreement from the individual for this arrangement was on file. Staff we spoke with did not know if people had DoLS authorisations in place or when they were subject to restrictions via legal processes such as conditional discharges and court orders what were the conditions of these orders.

Although the registered manager had been completing audits these had not picked up issues we highlighted, for instance the lack of ‘as required’ protocols for medicines, the uninformative care records, the lack of robust risk management plans and that staff had not received specific training to enable them to work in this specialism.

People wer

This inspection took place on 3 April 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Poplar Lodge provides care and accommodation for up to nine people who have a forensic learning disability and may present a risk of harm to themselves or others. On the day of our inspection there were eight people using the service.

The service had a registered manager in place.

We last inspected the service in December 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

People told us they felt safe. Staff we spoke with were knowledgeable about safeguarding procedures and external professionals raised no concerns regarding people’s safety or how the service managed public protection considerations. We saw information about how to keep people safe was clearly displayed.

People who used the service and staff we spoke with told us that there were enough staff on duty to keep people safe and meet people’s needs and we found this to be the case.

There were policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Individual care plans contained risk assessments which were reviewed regularly. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. Staff liaised regularly with a range of external agencies and professionals to keep people safe and meet their needs.

Staff had received a range of training, including mandatory courses such as safeguarding, fire safety, infection control and food hygiene as well as specific training to meet people’s needs, such as Positive Behaviour Support (PBS) and challenging behaviour awareness.

There was a regular programme of staff supervision and appraisals in place, as well as regular staff meetings.

The service encouraged people to maintain their independence. People were supported to be involved in the local community and access regular activities.

There was a system in place for dealing with people’s concerns and complaints. People we spoke with knew how to complain and felt confident that the staff or registered manager and provider would respond and take action to support them. Complaints were treated seriously and responded to appropriately by the registered manager.

People were encouraged to choose healthy food options and helped in the kitchen regularly. People confirmed they had a choice of meals and were involved in menu planning.

Detailed care plans were in place which had regard to people’s medical and personal needs, life histories, preferences and risks. Staff demonstrated a good knowledge of people’s needs and we saw people were involved in regular reviews of care plans and risk assessments.

We found that people received their medicines safely and there were clear guidelines in place for staff to follow.

We found that the building was clean, appropriate for people’s needs and had ample outdoor space that had been meaningfully adapted to encourage people’s interests in horticulture and other outdoor activities. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety requirements were met. We saw that audits of infection control practices were completed.

Senior carers and the registered manager used a range of quality audits to scrutinise the service. The registered manager also regularly invited people to give their opinions on how well the service was performing.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to notif

Poplar Lodge provides care and accommodation for up to nine people. The home specialises in the care of people who have a forensic learning disability and supported men with a range of criminal offences. Some people who used the service were detained under the Mental Health Act 1983. On the day of our inspection there were nine people using the service.

The home did not have a registered manager in place as the registered manager had recently left the service. 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. A new acting manager was in post and was in the process of registering with CQC at the time of our inspection.

The provider had policies and procedures in place for recognising and reporting abuse. We spoke with two members of staff about keeping people safe. Staff we spoke with were able to describe to us the different types of abuse and how to report any suspicions they may have.

We looked at the care plans of four people who used the service and found where a risk had been identified an appropriate risk assessment was carried out and included in the care plan. Risk assessments identified the potential risk, the likelihood of it happening and action to be taken in order to best mitigate the risk.

An ‘Infection Control Inspection’ inspection carried out by the Clinical Commissioning Group Infection Control Team in April 2014 revealed some areas that needed improvement in the home. We saw that some of the work had been carried out but there were still some areas that needed further work. For example we saw there was a supply of liquid soap and paper towels in bathrooms, seating had been replaced and the bathrooms had been decorated with new showers and shower curtains, however, there was still work required to replace bathroom flooring and the shower enclosure. We were told by the acting manager the remaining work was expected to be completed by the end of February. In addition to this a cleaning rota had been put in place and infection control training has been booked for all staff to ensure they are up to date with the most recent legislation.

We saw robust recruitment and selection processes were in place. We looked at the files of three staff, the most recent member of staff employed, and two others who had worked in the home for several years. We found appropriate checks were undertaken before people started work. Staff files included evidence that pre-employment checks had been made including written references, Disclosure and Barring Service (DBS) checks, and evidence of their identity had also been obtained.

The home had an appropriate medication policy in place. We saw staff who dispensed medication had received training in the management and storage of medicines. We looked at the medication administration records (MAR) and found they were completed clearly and correctly.

Staff files contained evidence of regular supervisions and appraisals taking place. We saw where supervisions had taken place a detailed record was kept in staff files. We saw staff appraisals were carried out annually and a record was kept in personnel files

People who used the service had access to healthcare services like GPs, opticians, and podiatrists. In addition people received ongoing support from social workers and where appropriate, forensic mental health teams.

Everyone who lived at Poplar Lodge received care and support that was personalised to their individual needs. Care plans were in place for all the people who used the service.

Areas of risk were identified based on the persons individual needs and detailed risk assessments were formulated which were used to minimise potential risks. Risk assessments were regularly reviewed to ensure they were relevant and that there had been no changes.

Some of the medicines people were taking required regular tests be carried out to ensure that there were no adverse effects on people’s health. We saw reviews and tests were completed with the results logged in care files. Changes to medicines were made accordingly when necessary meaning people’s care was adapted to take account of their changing needs.

We saw the provider had a formal complaints procedure in place. We saw there was a record of complaints that had been made and evidence of investigations which had been carried out as part of the complaints procedure. People we spoke with were aware of the complaints procedure but they did not wish to make a complaint. We were told “I tell the staff if there’s anything wrong”.

We looked at the care records of four people who used the service. We saw care plans were comprehensive and person centred with a detailed pen picture included. All care plans included a full description of the individual, information relating to physical difficulties, addictions, medications and hospital admissions as well as preferred daily routine and social history.

We saw a notice board in the home providing people who used the service with information. This included access to support services and how to make complaints. We saw some of the people in the home had accessed advocacy services and advocates were in place.

We found there was a culture of positive reinforcement and reassurance with support being given by staff that were trained to deal with behaviour that challenged the service.

The provider had a quality assurance system in place which was used to ensure people who used the service received the best care.

After audits had been carried out we saw the acting manager used them to identify areas of concern and to put an action plan in place allowing for improvements to be completed. This meant the provider was working toward continuously improving the service.