About the service: The Lodge offers both personal care and accommodation for up to 24 people who have mental health difficulties. At the time of inspection there were 20 people using the service.

People’s experience of using this service:

People told us they felt safe living at The Lodge. Risks were managed safely and safe processes were in place. 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.

Staff were skilled, competent and able to fulfil their role. Staff told us they received supervisions and appraisals to enable them to review their performance. 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. There was a relaxed atmosphere between people and staff. Care plans were person centred and included guidance for staff in how people wanted to be supported. A range of activities were available for people to take part in.

Staff said the service was well-run and the registered manager was supportive. There was evidence of effective checks being carried out to assess and monitor the quality of the service provided..

Rating at last inspection: Good (report published 06 August 2016).

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

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.

This inspection took place on the 20 July 2016 and was unannounced. When we last inspected the service in February 2014 we found that the provider was meeting the legal requirements in the areas that we looked at.

The Lodge is a residential home in Maldon providing care and support to up to older 24 people, some of whom were living with dementia.

There was a registered manager in post. 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 were safeguarded from avoidable risk of harm and staff understood the process to follow to report concerns regarding people’s safety. There were risk assessments in place which detailed how people could be supported safely. People’s care plans were detailed, person-centred and included information regarding their backgrounds, preferences and how they could be supported effectively. These were subject to regular review with involvement from people and their relatives where possible. There was a key worker system in place for each person to have a point of contact within the staff team.

People’s healthcare needs were identified and met by the service and there was evidence of good links with healthcare professionals. The service took a proactive approach to managing people’s healthcare needs and had recently won an award for the prevention of urinary tract infections. People had enough to eat and drink and the food and drink on offer took into account their individual needs and choices. There was a programme of activities on offer for people. People were treated with dignity and respect and had opportunities to have their opinions and views heard. People gave their consent to receiving care and treatment.

Staff received a variety of training to enable them to carry out their duties effectively including some specialised training. They completed a thorough induction programme when they first joined the service and were subject to regular supervision and appraisal. The recruitment processes used to employ new staff were safe and ensured that staff employed had the skills, character and experience to meet people’s needs. There were enough staff to keep people safe and protocols in place in case of severe shortages or staffing issues. The manager held team meetings and sent out staff surveys to provide staff with an opportunity to provide their feedback and contribute to the development of the service. Staff understood the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DoLS) and these were applied correctly in practice.

There was a robust quality monitoring system in place for identifying improvements that needed to be made across the service. People, staff and relatives were positive about the management of the service and felt that the registered manager was supportive and approachable.

People who used the service and their relatives were happy with the care and support they received at The Lodge. We saw that people received care that had been assessed and reviewed on a regular basis. The service involved people and their families in their care arrangements. One relative told us: “I am very satisfied with the care provided and the communication is good. It makes me feel very involved.”

We found that staff were well supported as there was a system of supervision and appraisals in place. An ongoing programme of training assisted staff in increasing their knowledge and undertaking their roles effectively. The staff knew about their responsibilities in relation to the safeguarding of vulnerable adults and the reporting of abuse so that people were kept safe from harm.

We found that the service had made improvements in assessing and monitoring the quality of the service in all aspects of the service. Records of people who used the service and staff were kept securely and were located promptly as requested.

One relative told us: “We looked at three homes before this one and this was by far the nicest, not in terms of décor, but the feeling you got when you were here.”

During this inspection we found that improvements had been made to protect people against the risks associated with the management of medicines.

As the purpose of this inspection was to check that the provider was now compliant with regulations 10 and 13, we did not request information directly from people using the service on this occasion.

The provider did not protect service users against the risks associated with the unsafe use and management of medicines, by means of the making of appropriate arrangements for the recording, administration and safe keeping of medicines.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received.

During our inspection, we found that some improvements had been made. The recording and monitoring of people's nutritional needs was more detailed which supported their health and wellbeing. The required notifications were also being made to us in a timely way.

Some improvements had been made to the management of medicines. However, we found some discrepancies in the medicine audits that had been completed and found that systems for the effective assessment and monitoring of quality and safety at The Lodge were inadequate. Improvements were needed.

People were treated with dignity and respect and were well cared for. One person told us, “I like it here, can’t find anything wrong with it.” Another person told us, “People are nice.” However one person told us that staff spoke in a foreign language when providing them with care. People told us that they felt uncomfortable with this.

We saw that people were provided with care and treatment that met their individual needs. We identified that food and fluid charts were not completed with detailed information required. For example one entry was listed as, ‘Main meal.’ There was no reference to what that main meal was. Therefore did not provide enough information to support care needs of people.

We identified concerns in relation to the management and administration of medication. We found medication in the controlled drug cupboard that had not been returned to the pharmacy.

We found that staff had been appropriately recruited to their roles; they received induction to work in the service and received ongoing training and supervision.

People were aware of the complaints system in the service. Complaints and compliments information was clearly displayed in the public areas. People were encouraged to feedback about the service. We identified that the service has not reported incidents in accordance with the regulations to notify the Care Quality Commission of routine or unexpected events.

People that use the service told us that they felt well treated. They told us that the home gave them good information about the service it provided. People told us that meetings had taken place and that they discussed how the home was being run.

People told us that they felt well treated and that the staff listened to them. They said that they had a full assessment before moving in and that they were regularly asked about their care. People said that they felt safe living in The Lodge Maldon.

People told us that the staff gave them their medication. One person said they were happy with the way that staff did this. They told us that if it was left up to them they would forget to take it. They told us that the staff treated them well and were quick to respond if they needed help. People appeared very relaxed and happy in the company of staff.

People told us that they were happy with their rooms. They said that they contained everything they needed and that they had been able to bring things from home if they had wished. People told us that the home was kept nice and clean.

People that use the service told us that they liked the staff and that they seemed to know what they were doing. They said that regular meetings had been held where they discussed how the home was run. One person told us that the staff were always asking them what they wanted and how they wanted things done.