About the service: Rectory Lodge offers both personal care and accommodation for up to 12 people who have mental health difficulties. At the time of inspection there were 12 people using the service.

People’s experience of using this service:

Staff knew how to keep people safe and received training for safeguarding and how to reduce the risks of harm from occurring. Risks to people's well-being and safety were assessed, recorded and kept up to date. People were supported with their medicines in a safe way.

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. People were supported to maintain good diet and access the health services they needed.

Training relevant to people's support needs had been undertaken by staff. The staff team felt involved in the running of the service and were supported by the registered manager. A complaints procedure was in place and people knew what to do if they had a concern of any kind.

Staff had built positive relationships with people living in the service. Care plans included clear guidance to staff on how to support people in the way they wanted.

There was an effective quality assurance system in place to ensure the quality of the service and to drive improvement.

Rating at last inspection: Good (report published 13 August 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The inspection took place on the 2 and 4 August 2016.

Rectory Road is registered to provide accommodation with personal care for up to 12 people with mental health needs. There were 12 people receiving a service on the day of our inspection.

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. The registered manager was supported by an assistant team leader to ensure the daily management of the service.

The service was safe. Staff were aware of their responsibilities to keep people safe and to protect them from harm and abuse. Risks to people were well managed and assessments were undertaken to keep people safe both within their own home and the local community. The registered provider had effective recruitment processes in place which ensured people were protected from the risk of avoidable harm. There were sufficient staffing levels to meet people’s needs. Accidents and incidents were recorded and monitored to identify and mitigate reoccurrence. People’s medicines were managed appropriately so they received them safely.

Staff had received appropriate training and supervision and were knowledgeable about their roles and responsibilities. Care plans were person centred and included information on people's preferences and routines. Care plans were regularly reviewed with people, and the people that mattered to them, were involved in the planning of their care. People were cared for by staff who knew them well. Staff shared information effectively which meant that any changes in people’s needs were responded to appropriately. People were supported to access health and social care professionals and services when required.

Staff were kind and sensitive to people’s needs and ensured people’s privacy and dignity was respected. People had positive relationships with staff and relatives said that staff provided compassionate care and were professional and caring. Relatives told us they were made to feel welcome when they visited.

People’s capacity to consent had been assessed. The registered manager demonstrated a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

The service had a number of ways of gathering people’s views which included talking with people, staff, visitors and relatives. There was an effective quality assurance system in place to monitor the quality of the service and to help ensure the service was running effectively, meeting people’s individual needs and working towards continuous improvement.

Our inspection team was made up of one inspector who answered our five questions. Below is a summary of what we found. The summary is based on our conversations with the manager, two staff, two people who used the service and from looking at records. Where it was not possible to communicate with people who used the service we used our observations to gather information.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic and well maintained. Staff had undergone a thorough recruitment and induction process and had also received appropriate training and guidance including safeguarding of vulnerable adults. We saw that the provider had taken the appropriate action to protect people from abuse. They had followed the correct process for reporting safeguarding alerts to the local authority safeguarding team and the Care Quality Commission.

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications had been submitted at this time, the provider was finalising several applications for submission. We saw that the provider had proper policies and procedures in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

The provider had displayed their complaint policy on the communal notice board alongside an easy read version. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew the people well.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Where this was not possible staff had sought the views from relatives and other health care professionals.

Is the service caring?

People were supported by staff who took time to explain things clearly to them and listen to their responses. They were able to do things at their own pace and were not rushed.

Is the service responsive?

Records confirmed people's preferences, interests, aspirations and spiritual needs had been recorded and care and support had been provided in accordance with people's wishes.

A health care professional who had completed the stakeholder survey said, “The service is very well run and responds quickly to people’s changing needs by involving the appropriate professionals.”

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We saw that the home ensured that the relevant health care professionals had been involved in assessing, planning and meeting people’s changing health needs.

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities and that they had received excellent support and supervision from the manager.

People we spoke with were happy with the level of care and support provided at Rectory Lodge. We heard one person say, "I like this place, I'm really happy, the people (staff) are nice and kind."

We found that since our inspection in January 2013 that the provider's arrangements for assessing and recording consent, and capacity to consent had improved. People were asked for their consent before support was being given. Where they lacked capacity assessments were completed.

We saw that people's care and treatment was planned and reviewed with their involvement, where possible. Risks to people's health, welfare and safety were identified and well managed. Our visit showed us that the service was safe, responsive and caring.

We saw that overall the premises were clean. We found that there were systems in place to ensure that people were protected from the risk of infection.

We found the provider had arrangements in place to protect people, staff and visitors against the risks of unsafe premises. These included having maintenance plans in place for repair and improvement of the premises.

Staff were selected and recruited in a way that ensured they were suitably qualified and fit for the job.

Records relating to people and staff were kept securely and disposed of in line with the Data Protection Act 1998. They contained accurate, up to date information.

We spoke with two people using the service who told us that the care was good and staff gave them support. They told us they felt able to let staff know if they had any problems.

We spoke with a visiting professional who told us, “It always seems really nice.”

We looked at three care plan files and found that people’s individual needs had been considered and plans detailed the support required.

We found that people’s capacity to consent to care and treatment was not

consistently assessed and recorded.

We spoke with four staff and found there were systems in place giving support and opportunities for personal development.

We found that the provider had systems in place to monitor the quality of the service.

We found that improvements had been made since our last inspection in 2009, in relation to medication records.