The inspection took place on 07 March 2017. The inspection was unannounced.

Star Care Lodge is registered to provide accommodation with nursing or personal care for up to 13 people. There were five people living at the home on the day of our inspection. One of those people was staying away from the home on the day of our inspection.

Star Care Lodge supported people who had mental health issues. Most people had lived at the home for less than two years. People had varying care and support needs. Some required more support than others but most people were quite independent, able to go out alone and requiring prompts to attend to personal care needs.

Star Care Lodge was quite spacious with plenty of communal areas for people to spend time together if they wished. Situated in a residential area close to Gillingham town centre and opposite a park, the home had an enclosed, private back garden with furniture to sit out on when the weather was fine.

There was a registered manager based at the service. 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 last inspected this service on 12 December 2015 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 12, Safe care and treatment, Regulation 17, Good governance and Regulation 18, Staffing. The provider had failed to manage people’s medicines safely. An effective quality assurance system was not in place. The provider failed to provide staff with appropriate support, training and professional development through supervision and appraisal systems. We asked the provider to take action to meet the regulations. At this inspection we found the provider had made all the necessary improvements to address the breaches from the previous inspection.

Following the last inspection the provider sent an action plan detailing the action they planned to take to improve in order to meet the regulations. We found evidence that the provider had addressed all the areas in their action plan to improve the service provided.

Medicines were now managed safely. All medicine administration recording systems were kept in good order by staff. The ordering, storage and returns of medicines were managed and documented well.

The registered manager now had a good system in place to ensure she met with staff on a regular basis to carry out one to one supervision. Staff were supported to increase their skills through the training required to be able to meet the needs of people living at the service. Staff were managed well and had the opportunity to engage in their own personal development.

The registered manager and the provider had developed a robust quality monitoring system to ensure the quality and safety of the service provided. Feedback was sought from people, their family members or friends, staff, and others involved such as health and social care professionals, to gain their views of the service. The registered manager and the provider used the information gathered to make improvements to Star Care Lodge and the service they provided.

The provider and registered manager had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the provider’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager and these would be acted on. Staff knew they could go outside of their organisation and raise concerns with the local authority safeguarding team if necessary.

Risks were assessed and managed well. Individual risks were identified and control measures were in place to help to keep peo

The inspection was carried out on the 14 December 2015, 6 and 11 January 2016. The first day of inspection was unannounced. The inspection was carried out over a number of days as the registered manager was unavailable in December 2015.

Star Care Lodge offers accommodation, care and support for up to 13 people with a mental health diagnosis. The accommodation provided was in a large double fronted house with a communal living area, dining rooms, bedrooms and communal bathrooms. People had access to a large, well maintained communal garden. There were six people living in the service at the time we inspected.

There was a registered manager employed at the service. 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.

People told us they felt safe in the service. Relatives also said they thought their relatives were safe and care provided appropriately.

People were not always protected from the risks associated with medicines management. The service was not using the Medicines Administration Records sheets provided by the dispensing pharmacist, which could lead to medication errors. Accurate stock levels were also not being maintained.

Risks to people had been identified but not expanded upon or detailed how to mitigate risk. In between inspection days the registered manager had put in place more detailed risk assessments which provided good information on how to mitigate risk.

There were safeguarding policies in place and staff and the registered manager were fully aware of their responsibilities in reporting safeguarding incidents and what the procedures were for this.

Recruitment practices were not always robust. The provider sought references and DBS checks but they did not always explore gaps in employment history. We have made a recommendation about this.

The registered manager told us that they did not have methods in place to determine the amount of staff needed to care for people living in the service, however, we saw that there adequate staff to support people at the time of inspection

People had been involved in planning their care and this was being reviewed on a regular basis.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. The registered manager and staff had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Care plans evidenced that people’s capacity was taken into account and how this affected the care they received from the service.

Whilst some staff had received supervision and appraisals, these were not always recorded and some staff had not received any supervision or an annual appraisal.

Staff had received training to meet people’s needs and training considered mandatory by the provider was up to date however staff had not received training specific to people with mental health needs.

People had access to GPs and prompt referrals were made for access to specialist health care professionals. People were supported to maintain a healthy diet and had free access to food and drink throughout the day.

Staff knew people living at the service very well. There was a key worker system in place which people said they liked. We heard staff engaged in meaningful conversations with people and they spoke to them with kindness and consideration.

Staff respected people’s privacy and dignity and relatives told us that the manager’s office door was always shut for private conversations.

People were actively encouraged to be independent. People and relatives told us how they had become more confident in accessing the wider community since they had been living in the service.

There was a complaints policy and procedure in place that was in a format appropriate for people living in the service. There was a service user guide available for people setting out what they could expect from the service.

The registered manager only made changes and improvements when they had been identified by outside agencies. For example, on the first day of inspection we found care plans were not expansive enough to support people. On the second day of inspection the registered manager had improved the care plans and the pre-admission assessments clearly fed into these. We have made a recommendation about this.

People’s likes and dislikes were recorded in an “It’s about me” book and people had signed in agreement to these. In some cases people had declined to sign. The service respected people’s choice about this but continued to work with people and encourage them to do so. People were able to participate in activities of their choice.

The registered manager did not have any quality assurance systems in place to monitor the service and identify areas for improvement. Recording in documentation was not consistent in the daily notes or care plans.

The registered manager was aware of their role and responsibilities to people living in the service and staff. Staff were positive about the registered manager and the support they gave them.

The registered manager was studying for a Leadership programme with Skills for Care. They had established links with local outside agencies. People had accessed these agencies and sort support from them because of these links.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.