Priory Lodge is registered to provide accommodation and personal care for up to 19 people. The service accommodates adults and people aged over 65 who have a variety of long standing mental health problems. There were 18 people living in the service when we inspected on 15 November 2018. The inspection was unannounced.

Priory 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. Priory Lodge provides people with single or a shared room in an adapted building close to the centre of Colchester. At our last inspection of the service in January 2018, we rated the service as ’Requires Improvement’ overall but as inadequate in the key question of Well Lead. This was because we found deficiencies in the way the service was managed. We found that the provider was in breach of a number of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we took enforcement action cancelling the registered managers registration as we had concerns about their competency. The registered provider sent us an action plan setting out the steps they would take to address the concerns we raised. At this inspection we found that significant improvements had been made and the service was no longer in breach of the regulations. As a result, we have made a decision to remove the service from special measures. However, the overall rating remains ‘Requires improvement’ as further work is still needed in some areas to imbed some of the changes that have been made.

At this inspection the service did not have a registered manager. A new manager had been appointed but had not yet applied to register with CQC. 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.

Management and staff were clearer about how to keep people safe. The acting manager exercised greater scrutiny over accidents and incidents. Hazards were identified and managed. Equipment was serviced and checked to ensure it was safe to use. The service was clean and there were plans to adapt the building to improve the management of laundry and washing of equipment such as commodes. Since our previous inspection, the accommodation had benefited from general updating and more regular maintenance. The garden had been landscaped which meant that it more accessible to people. Communal areas were comfortable and homely.

Safeguarding was understood by staff and we saw that the acting manager followed the correct procedure when concerns were raised. Peoples medicines were safely managed.

There were sufficient staff available to support people and there were arrangements in place to check on staff suitability as part of the recruitment process. Staff had access to a range of training to equip them with the skills they needed to meet the needs of people using the service.

The Mental Capacity Act (MCA) 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The registered manager understood their responsibilities but some of the documentation regarding decision making could be strengthened.

People had choice of meals and access to health care and were supported to lead healthier lives.

People told us that they were happy living in the service and that they had a good relationship with staff. Care staff were caring and knew people well.

Opportunities to participate in activities had significantly improved since the last inspection. People regularly accessed the community as well

On the 29 January 2018, we carried out an unannounced inspection at Priory Lodge Residential Home. We returned to the service on the 12 March 2018 to carry out additional checks of the Well Led domain and meet to discuss concerns with the provider and registered manager.

During an unannounced inspection in November 2016, we found breaches in Regulation 11, 12, 17 and 18 of the Health and Social Care Act 2008. The provider submitted an action plan to demonstrate how they would improve these areas of concern and during this recent inspection; we found that some improvements had been made.

However, the service was found to be in breach of Regulation 7, 9, 12, 13, 15 with a continued breach in Regulation 17. In addition, the service was also in breach of Regulation 18 of the Registrations Act 2009 for none reporting of other incidents to the commission.

Priory lodge residential care home 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, both of which we looked at during this inspection.

The care home accommodates up to 19 people in one building who are adults of working age and over 65, living with a variety of long-standing mental health problems. At the time of inspection, 17 people were living at Priory lodge.

At the time of inspection a registered manager was in place at the service, however we had concerns about the fitness to practice of this manager. Further meetings demonstrated that the registered manager lacked the competency and skills to ensure that the service was managed in line with the Health and Social Care Act, 2008. This is a breach of regulation 7 of the Health and Social Care Act, 2008, Registered manager requirements.

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.

Whilst we found that the service had improved in areas of concern previously found, we found the service required improvements in additional areas under each domain and the rating for the well-led domain was inadequate. The registered persons were not aware of their responsibilities to report safeguarding concerns to the relevant stakeholder, including the commission. This was a breach in regulation 18 of the registrations act, 2008.

The registered manager did not carry out robust investigations into incidents and accidents. They did not use information available to them to assess for and mitigate identified risks to people. This meant people were at risk of abuse and improper treatment. This was a breach in regulation 13 of the Health and Social Care Act.

There were insufficient infection control practices in place to safeguard people from risk of infection. When recommendations had been made by external companies, they were not always acted on. This was a breach in regulation 15 of the Health and Social Care Act.

During the inspection in November 2016, we found that the management of medicines needed improvement. We found that in this area there had been improvements and that medicines were managed safely and in line with best practice guidance.

Staff had previously not always been inducted in a safe way. We found that the HR/ Training manager had made significant improvements in this area.

The HR/ Training manager ensured that all new staff received a thorough induction, mandatory training, regular training updates and additional training to support them to meet peoples changing health needs. Staff were supported to undertake outside learning and given regular supervision.

Nutritional and fluid needs of people were met, and a choice of food was available. Where people needed additional support from othe

This unannounced comprehensive inspection took place on 1 September 2016 and 07 September 2016. Priory Lodge provides accommodation and care for up to 20 people. At the time of our inspection 19 people were being accommodated.

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.

Staff understood the principles of keeping people safe, but in practice these had not been followed. We found some risk assessments in place to meet their needs, but for some people relevant risk assessments were not found or up to date. This meant there were risks associated with people's care which staff were not aware of.

The environment had not always been maintained to a safe standard.

Sufficient recruitment checks had not been carried out before staff started work to ensure that they were suitable to work in a care setting.

Medicines were administered and stored safely. People were supported with their medicines but correct guidance was not in place when people were given medicines as needed (as and when required).

Staff had a basic knowledge of the Mental Capacity Act 2005 but this had not been properly followed or put into practice. This meant people did not have their mental capacity assessed and restrictions had been placed on people without their agreement or being in their best interests as authorised by proper processes.

There was a training programme in place for staff but this did not cover all the areas needed, which meant staff did not always have the knowledge to meet people's needs.

People enjoyed their meals and were offered a choice at meal times. People were supported to access a range of health professionals.

People did not always have their needs planned in a personalised way which reflected that their choices and preferences had been considered. This meant staff may not always have the best information on how to meet an individual's needs and preferences.

People were not always supported to engage in activities and individual interests were not always accommodated.

There were systems employed to monitor the quality of the service, but they had not effectively identified concerns which impacted on the quality of care that people received.

During this inspection we spoke with ten people who used the service. We also spoke with six members of staff including the manager and provider. We looked at four people’s care records and three staff files. Other records seen included: care plans and risk assessment reviews, complaints log, resident meeting minutes, accidents and incidents log, medication audits, staff rota, fire safety checks, maintenance logs, water temperatures, and safety checks on equipment.

We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service safe, Is the service effective, Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor’s book. This meant that appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access the service. The member of staff also went through the fire safety evacuation procedure, so we were aware of what to do in the event of an emergency.

People told us they felt safe, protected and their needs were met.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have needed to be submitted, we saw that policies and procedures were in place. The manager confirmed that relevant staff had been trained to understand when an application should be made, and how to submit one. This ensured that arrangements for safeguarding people were in place.

Records seen confirmed that staff were booked onto upcoming or had received training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and DoLS. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

People told us they received their medication as prescribed and intended. Medicines were correctly stored and disposed of and records seen were accurate. Staff received medication training and managed medicines in a safe way.

Records seen confirmed health and safety was checked in the service and equipment was maintained and serviced.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Records showed that staffing levels were based on the level of dependency and needs of the people who used the service.

Staff supervision and training was planned and delivered as required. This meant that staff had the support and skills to deliver care effectively.

Is the service caring?

Staff interacted with people who used the service in a caring, respectful and professional manner. People told us they were happy with the care they received and their needs were met. One person told us, “The staff are good. They can’t do enough for you, they are very attentive, kind, and all round decent people .”

Staff had a good understanding of the people’s care and support needs and knew them well.

Is the service responsive?

People's choices were taken in to account and listened to.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor, district nurses, mental health teams and chiropodists.

Is the service well-led?

There is not a registered manager at this service. The provider advised us that the manager of the service will be submitting their registration application to the Care Quality Commission

Staff told us they were clear about their roles and responsibilities and were supported and trained to meet people’s needs.

People's care records and risk assessments were accurate and up to date.

The provider had systems and procedures in place to monitor and assess the quality of the service provided. There were records to identify shortfalls in the service and how they had been addressed.

Feedback from people who used the service about their experiences was valued, taken into account and influenced the running of the service.

People told us that they were comfortable and at ease living at Priory Lodge. They also told us that they felt safe living there, and were confident that if they had any concerns they would be listened too and addressed.

Staff that we spoke with told us that they had access to a good range of training that provided them with the necessary skills to meet people's assessed needs.

People that we spoke with told us that they felt the staff who supported them understood their care needs well, and always supported them in a understanding and respectful manner.

People that we spoke with told us that they were comfortable living at Priory Lodge and felt safe being there. They told us that they felt well supported by the staff who they said were kind and caring. People told us that they could always talk to staff and always felt listened to.

People that we spoke with told us that they were happy with the accommodation provided and were particularly happy with their own rooms.

People that we spoke with also told us that the food provided was always good and that they were always provided with at least two choices from the menu.

People also told us that they liked the fact that they could come and go as they pleased to follow their own daily routines.

We spoke with three people living at the service. People said that the staff were "All OK" and that they "Knew what they were doing". They said that there is plenty to eat at the service. If they had a complaint, they knew who they would go to and they said that they felt their complaint would be listened to.

People told us that they were happy with the service and felt that staff supported them well.

Most people have lived at Priory Lodge for many years and told us that they are happy and comfortable living there. People told us that they felt well supported by staff who were kind and caring. People said that they could talk to staff and feel listened to.

People liked the accommodation provided and particularly liked the fact that they could have their own things around them and personalise their rooms.

People said that the food was always good and that they had choice.

People liked being able to come and go as they wished and follow their own routines. Some people however, who are unable to be as independent, felt that there could be more to engage in within the home.