This inspection took place on 23 November 2016. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. This service was last inspected on the 25 June 2015; we found the provider in breach of the following regulations: Regulation 11, Need for consent, Regulation 9, Person centred care, Regulation 12, Safe care and treatment, Regulation 18, Staffing and Regulation 17, Good governance. The registered provider was asked to send us a report saying what action they were going to take to achieve compliance. The registered provider sent us a report and told us all the action would be completed by 30 November 2015. We carried out this inspection to check whether the registered provider had completed these actions and that these actions had been embedded into service practice and sufficient improvements had been made.

We found the action taken by the provider had not been embedded into service practice and sufficient improvements had not been made. We found the service in continued breach for Regulation 9, Person centred care, Regulation 11, Need for consent, Regulation 12, Safe care and treatment, Regulation 18, Staffing and Regulation 17, Good governance.

Walkley Lodge is a care service that provides care for up to seven people. It is a listed building which has been converted into a home. At the time of our inspection six people were living at the service. On the day of the inspection one person was staying with their family. People living at the service had complex needs and had behaviour that may challenge others.

Since the last inspection the registered provider had appointed a new manager and they had registered with the Care Quality Commission on 21 July 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new regional manager had also been appointed to oversee the running the service.

We were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. Two people were able to share a small amount of their experience of living at the service. One person did not want to speak with us, but later in the day they were able to confirm they were happy living at the service and everything was “good”. Another person told us they did not have a lot of time to speak with us because they were interviewing applicants for a support worker post and they wanted to go out later. They told us they were happy living at the service.

We spoke with relatives of one person living at the service, they told us they were satisfied with the quality of care their family member had received. They also made positive comments about the registered manager and staff.

After the last inspection the registered provider told us they would take the following action to improve the service: ‘the evaluation of all risk assessment and care plans to be routinely carried out monthly or where changes in care needs occur’. Our findings during the inspection showed the action taken by the registered provider had not been embedded into service practice.

We looked at the risk assessments for people who had challenging behaviour. We saw that risk assessments needed to be more detailed, prescriptive and give staff clear guidance to staff on what to do if a person was getting agitated. It is important that consistent strategies are in place for preventing and reducing anxieties and when behaviour escalates.

We found the advice received from external healthcare professionals on the responsive supportive action that should be taken by staff when a type of behaviour was seen and heard had not been included in one person’s care plan.

This inspection took place on 25 June 2015. This was an unannounced inspection which meant the staff and provider did not know we would be visiting. This service was last inspected on the 9 April 2013.

Walkley Lodge is a care service that provides care for up to seven people. It is a listed building which has been converted into a home. At the time of our inspection six people were living at the service. Some people living at the service had complex needs and had behaviour that may challenge others.

There was a registered manager for this 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We were not able to speak with some people using the service because we were unable to communicate verbally with them in a meaningful way. From our observations we did not identify any concerns regarding the safeguarding of people who used the service. One person told us they felt safe and would speak to staff if they had any concerns. We found that daily records showed that people were not always treated with dignity and respect.

Some people had personalised their rooms and they reflected their personalities and interests. One person told us they were satisfied with the quality of care they had received and made positive comments about the staff. Another person used gestures to confirm that they were happy living at the service and that all the staff working at the service were nice.

Relatives spoken with told us they felt their family member was in a safe place. Our discussions with staff told us they were aware of how to raise any safeguarding issues.

Relatives spoken with were satisfied with the quality of care their family member had received. They told us they were fully involved in their family member’s care planning.

We found the provider had not ensured there had been effective leadership and management in place at the service to create and maintain a person centred approach culture. People’s care records showed that they were not actively involved, encouraged and supported to be involved in their care planning or that obtaining consent to their care planning was part of the process.

We also found the provider had not protected people who may be at risk, against the risks of inappropriate or unsafe care by having effective operational systems in place to review and evaluate care plans and risk assessments.

The provider had failed to put adequate arrangements in place to ensure the monitoring of incidents or untoward occurrences was maintained. This showed there was a risk that some people’s behaviour was not managed consistently and the risks to their health, welfare and safety were not managed.

We found the arrangements in place to ensure unexpected staff absence needed to be more robust to ensure staffing levels were maintained.

Recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by suitably qualified staff who had been assessed as safe to work with people.

We found the provider had failed to ensure that staff acted in accordance with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberties Safeguards DoLS.

The service had appropriate arrangements in place to manage medicines, so that people were protected from the risks associated with medicines. However, we found that the storage of medicines required improvement.

There was evidence of involvement from other professionals such as doctors, opticians and dentists in people’s care plans. People had a health action plan in place.

People’s nutritional needs were monitored so actions could be taken where required. However, we found records showed that people’s consent had not been obtained to support them with weight loss.

Staff told us they enjoyed caring for people living at the service. Staff were able to describe people’s individual needs, likes and dislikes.

We received mixed messages regarding the support staff received at the service. Staff told us they enjoyed working at the service. However, staff told us that staff morale was low due to the number of changes of managers at the service over the past 18 months.

We found there was not a robust system in place to ensure staff received all the training they required to meet the needs of people they supported.

We saw the service provided support for people to go on daytime activities, which included going shopping and going out for meals. One person told us they really enjoyed going on a recent trip to the seaside. People also had access to a sensory room at the service. We found the activities provided to some people could be improved by exploring different types of activities to see if people liked them.

The provider had a complaint’s process in place. However, we found an accessible format to reflect the communication of people living at the service was not on display.

We found that there were not robust arrangements in place to regularly seek people’s views so they could share their experience of care.

We found the records relating to people required improvement. We found examples of missed signatures or omissions within care plans. Although checks had been completed by the provider our findings showed that some of the checks were ineffective in practice.

We found five 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 the report.