About the service: St Andrews Lodge is a home that provides rehabilitation and support for eight adults with mental health needs. It is situated in Colchester. There were eight people living in the service on the day of inspection.

People’s experience of using this service:

Systems were in place to monitor the quality of the service provision; however, these were not always effective in ensuring issues were identified or improvements were made and sustained.

Improvements were required to the service's governance arrangements to assess and monitor the quality of the service and ensure that action was taken as required.

Systems were not effective to check that people received their medicines as prescribed and where people received medicines ‘as and when required’ there was not always guidance in place for staff on when these medicines should be administered.

People, their relatives and staff were positive about the care provided at St Andrews Lodge.

Staff knew people well and had developed meaningful relationships with them. People were given choice and supported to develop daily living skills.

Staff were kind and caring and people were treated with dignity and respect.

People received effective care from staff who understood how to recognise and report issues of concern and potential abuse. Staff were recruited safely, were visible in the service and responded to people quickly.

There was a complaints system in place and people felt able to raise concerns which were addressed.

People could access the community and take part in a range of activities which promoted their wellbeing.

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's health was well managed and there were positive links with other services to ensure that individual needs were met.

People, their relatives and staff were positive about the deputy manager and felt they were approachable.

Rating at last inspection: Good (report published 29 September 2016)

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

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

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

St Andrews Lodge provides accommodation without nursing for up to 8 people who have complex mental health needs.

There were 6 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.

There were some procedures and processes in place to ensure the safety of the people who used the service. However, people did not have personal evacuation plans to guide staff on how to support them in the event of a fire. Water temperatures had not been checked to protect people against the risk of legionella or to check that thermostatically controlled valves were working correctly.

People were provided with their medicines when they needed them and in a safe manner. The manager had identified and was working on improvements to systems for administering as and when required medicines. This was to ensure this was being managed safely

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

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

People received care that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner.

People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

Staff were passionate about supporting and promoting the independence of those who lived at St Andrews Lodge.

Care and support was based on the assessed needs of each person and people were encouraged to pursue their hobbies and interests.

People’s nutritional needs were assessed and they were supported to eat and drink sufficiently.

There were processes in place that encouraged feedback from people who used the service and people were involved in making decisions about their care and support.

There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

Quality assurance audits were used to identify shortfalls and drive improvement in the service.

As part of this inspection we spoke with three people who used the service, three support staff and the registered manager. We found that the service provided safe care to people who used the service. The care was delivered in an effective manner that met the needs of those people who used it. Each person we spoke with, who used the service was very complimentary about the staff who supported them. One person told us that "They have helped me get back on my feet and I will always be grateful for that."

We found that the manager and staff offered an inclusive and consultative approach to people who have a range of complex mental health needs. We saw that staff worked tirelessly and passionately to guide, support and empower the people who used the services at St Andrews Lodge.

We found that people were protected from the risks of an unsafe environment because the service had effective methods to monitor the safety of the buildings and an effective maintenance programme in place.

We found that there were adequate levels of staffing providing the appropriate support to people. Staff were supported by an effective style of leadership which was responsive to the needs of the people who used the service. We also found

that there was an appropriate and effective system in place to monitor and review the service's performance.

We had conversations with three people living in the home and one relative who was visiting at the time of our inspection. People were very complimentary about the support they received in the home and described how staff helped them to develop their confidence and independence. One person said, “They cope with problems very well so no one comes to any harm.” Another person told us, “The staff take a lot of time to talk to you to check you understand.”

The relative we spoke with told us that there had been a “…massive improvement in the past year” in the person they visited. They were very happy with the range of activities during the week. However, they felt that the drop in staffing levels at the weekend meant that people had less opportunity to go out then. The provider told us that they were reviewing staffing levels at the weekend.

As part of this unannounced inspection we checked on the standards that were not met at our last inspection in July 2011. The areas needing improvements were staff training and quality assurance. We found that the provider had made improvements since our last inspection. Additional staff training had been given and good systems for auditing standards had been introduced. As a result we found that these standards were now met.

We carried out an unannounced visit to St Andrews Lodge on 12 July 2011. We had conversations of various lengths with five people living in the home. They told us that they were happy with the care and support received at St Andrews and did not have any complaints. One person said, “This is the best place I’ve ever been to. I feel safe here, there’s always staff around and I go out when I like.” Another person said “The staff are excellent.”

People said that there were a range of activities and outings every week and said that they could take part in whatever they wished. Some people went out by themselves. Those who needed to be accompanied by a member of staff understood the need for this and told us that they were happy with the arrangement. People generally made positive comments about the menu and the food. One person said that they would like more variety on the menu. However, another person told us “They make an effort to find things I like.” Two people told us that they could not think of anything they would like to change at the home.