We carried out this unannounced inspection on the 27 and 28 September 2017 and arranged to return on the 06 October 2017 to complete the inspection. Wilson Lodge provides care and support for a maximum of 36 people who are living with mental health conditions. There were 29 people living at the home at the time of the inspection. There is a registered manager in place. 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 inspected Wilson Lodge in 09 and 10 December 2016 and found improvements were required in the environment as it did not consistently provide people with a safe and comfortable place to live. Improvements were also required in the checks and systems to ensure the safety and quality of the service. The provider documented the action they would take in a plan. We inspected again on 7 June 2017 to check improvements made against the plan. We found some improvements had been made, however some people told us they felt unsafe in their home and we found there were no robust procedures or processes in place to ensure people were protected.

This inspection identified that the plan had been somewhat effective; some improvements had been achieved. However, improvements were still required in some areas.

People now told us they felt safe living at the home and with the support of staff. However, we found incidents of a safeguarding nature had not been routinely identified and reported by staff. Some staff were unclear about when to report concerns, therefore we could not be assured that all incidents had been reported as required to support people stay safe.

Some improvements to the premises had been completed but further improvements were required in a timely way. We found two toilets where a strong odour was present; relatives and staff told us this needed addressing. We also found some remedial work in the bathrooms that was still in process or where equipment had been ordered but had not yet been fitted.

People and staff told us there were enough staff to meet their needs and we saw people’s needs met in a timely way. People said staff supported them to take their medicines when needed and we saw there were systems in place to monitor medicines administration.

Staff had a good knowledge about the people they supported and told us they received the right training for their role.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). Staff sought the consent of people before providing care and they could choose the support they received.

People were happy with the choice of food they received. People were supported to access health care professionals and staff were responsive to the advice received in providing care.

People told us staff were caring and we saw people were comfortable around staff providing care. Relatives told us people had developed good relationships with staff. We made observations that people’s privacy and dignity was maintained by caring staff.

People received care that met their individual needs. People were supported to enjoy various activities both within and outside the home. People told us they enjoyed the support of staff in activities and relatives and staff told us this support had improved and people were now enjoyed more activities.

Relatives said communication was good and staff and the registered manager was available to them. They said staff listened to them and they felt confident they could raise any issues should the need arise.

People, relatives and staff told us improvements in the service had been made. Since our last inspection checks and audits had been introduced by the registered manager. The governance

We carried out an unannounced comprehensive inspection of this service on 30 November and 01 December 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider developed an action plan to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that they had not met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

The home is registered to provide personal and nursing care with accommodation for up to 36 people who have needs relating to their mental health. At the time of our inspection there were 26 people living at the home. The home has a registered manager and they were present throughout our inspection. 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 we spoke with did not all feel safe at Wilson Lodge. People shared examples with us of times they had felt scared or when their personal belongings had been taken. The registered manager’s initial response to these concerns was not robust to protect people using the service. Since our inspection we have been informed action has been taken.

Although parts of the home had been redecorated to reflect people’s tastes and choices, people did not always live in a safe or clean environment. The work undertaken to ensure that bathrooms were clean, free from odour and that the floors protected people from the risk of slipping and falling had not been adequate. Specific tests and examinations of the passenger lift and other equipment, including the supported bath were not all completed as required by lifting regulations.

Some areas of the home had been re-decorated and we saw these areas appeared improved. Some bedrooms had been redecorated and the work completed reflected people's tastes and choices.

The governance systems in place had not been fully effective at achieving the improvements required. Improvements were needed to the cleanliness, comfort and safety of the premises, and to ensure systems that would monitor the safety and quality of the service were in place and being effective. Actions the registered provider told us they would take had not all been undertaken. The registered provider’s action plan relating to these areas had not been kept under review and updated as required. The plans and improvements made by the registered provider and the registered manager’s employed over that period have not resulted in adequate, timely or sustained changes to ensure people’s safety at Wilson Lodge.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out this unannounced inspection on the 30 November and 01 December 2016. Wilson Lodge provides care and support for a maximum of 36 people who are living with mental health conditions. There were 29 people living at the home at the time of the inspection. The registered manager retired shortly before our inspection. A new manager had been appointed and was in the process of applying to register with the Care Quality Commission. This manager was present throughout our inspection. 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 Wilson Lodge in December 2015. At that visit we found improvements were required in all areas of the service, and we identified that there were five breaches of legal regulations. After the inspection we met with the registered provider and registered manager, and they told us what they would do to see the service improve. They documented the action they would take in a plan. This inspection identified that the plan had been somewhat effective. Improvements were evident in all areas of the service, however the environment did not consistently provide people with a safe and comfortable place to live, and the systems to ensure the safety and quality of the service(we also call this governance) were not entirely adequate.

The premises had not been as well maintained as they should have been. People could not be confident they would consistently have enough hot water to bathe or shower. At the time of our inspection records were not available to show that checks had been undertaken as frequently as required to ensure equipment and facilities were in good order and safe to use. You can see what action we have required the provider to take at the back of this report.

People told us they felt safe living at the home. Staff we spoke with had knowledge of possible signs of abuse and could describe the action they would take in reporting any concerns. There were enough staff available to meet people’s requests for support.

Risks people faced had been identified and measures had been put in place to minimise the risk for the person. Staff we spoke with were aware of how the risks should be managed, and the systems in place to monitor the risks were effective.

People received their medicines safely and there were systems in place to monitor medicines administration.

Staff told us they had received sufficient training although records showed some staff training was now overdue. Our observations of staff working with people showed that staff were skilled and knowledgeable in meeting people’s needs.

Staff had the knowledge they needed to work in line with the principles of the Mental Capacity Act (MCA) 2005. Staff described how they supported people with making choices and gaining consent. The advice of appropriate professionals had been sought when people needed to make complex decisions.

People had access to regular healthcare and specialist advice was sought from healthcare professionals when needed.

People were happy with the provision of meals and drinks at the service. The quality of food had improved and people had greater access to a range of drinks and snacks.

People were happy with the care provided and told us that staff were kind and caring. People had been involved in planning their care to meet their individual needs and care was reviewed with people to ensure people were still happy with the care they were receiving. Staff enjoyed working at the home and knew the people they supported well.

People were treated with dignity and respect and were encouraged to remain independent.

The opportunity to undertake interesting activities both inside the home and in the local community

The inspection took place on 18 November 2014 and was unannounced. At our inspection in June 2014 we found that there had been improvements since a previous inspection but these had not been enough and further breaches of the Regulations were identified. We received a reply from the provider to indicate that action would be taken to address the issues raised. At this inspection we found that improvement has been slow. Plans were in place but further action will still be needed to meet all Regulations and to ensure that people receive a consistently good service.

The home provides accommodation and nursing care for up to 36 people who experience enduring mental health conditions. At the time of the inspection 27 people were living in the home. The home had two floors with the communal areas being on the ground floor. The building was accessible for people who have physical disabilities.

There was no registered manager at the time of our inspection. 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 previous registered manager had left prior to the inspection and the new manager had submitted a valid application to be registered with us.

Before the inspection concerns were raised about the cleanliness of the home and lack of staff to carry out cleaning. We decided to look at the management of infection control in the home. We found that the maintenance of cleanliness of areas of the home and equipment used by people was not sustained throughout the day. There were not sufficient systems to manage the control of infection in the home and this put people at risk of acquiring an infection.

The new manager had identified that the system used for the administration of medicines was not time effective and had led to errors. They had planned that a new system of dispensing medicines would be implemented within three weeks of our inspection. However, the audits of medicine at the time of the inspection were not robust enough to identify errors. The information about when as required’ medicine was not clear and this could lead to inconsistencies about when medicines should be administered.

At previous inspections we found that the quality of training for staff was poor. At this inspection new staff told us that they had not had a recognised induction programme at the start of their employment. Although they had shadowed more experienced and qualified staff and they were knowledgeable about people who lived in the home, this did not mean they had the knowledge needed to deal with the complex situations that arose in the home. Although more detailed training was planned not all of this had been delivered. In addition due to the changes of manager and the nursing staff, staff had not received regular supervision and appraisals of their performance. This put people at risk of receiving inappropriate care and support.

People we talked with had some concerns about some incidents involving them and other people that lived in the home. We looked at this and found that the service had contacted health professionals who were involved with the relevant people and reviewed incidents to try and prevent these incidents from happening so as to keep people safe.

People told us and staff confirmed that people’s access to their money had improved. We saw that people were being helped to claim the benefits they were entitled to. We found the provider’s accounting for people’s money had improved and this helped to keep people financially safe.

People told us that there were enough staff to support them when they needed support. Staff told us that staff numbers had increased in line with people’s increasing needs. The manager told us they had recruited new staff and expected to be fully staffed with permanent staff by the end of November and this would help people receive a consistent service.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. We found that appropriate applications had been made and that the results of the applications were awaited. We did not see anyone being restricted from going out of the home and we found that people were offered opportunities to go out. Some people went out unsupervised.

People we spoke with told us they liked the meals. We saw that efforts were made to supply and prepare meals that people preferred and met their cultural, religious and health needs. The timings of food and drink tended to be set and this did not promote people’s independence.

People told us and records confirmed that people had access to appropriate health professionals such as GP, dentists and chiropodists. Health specialists in mental health care visited routinely and where a person’s health needs changed other specialists were consulted. This helped to keep people as well as possible.

People told us staff were caring and we saw some good interactions between staff and people. However, within the home, people spent significant amounts of time in the lounge without a staff presence and conversations tended to be had when people were being supported with a task.

Some people told us that they were unsure what freedom they had to control areas of their life such as getting up and when they could have drinks. Others told us that they could do what they wanted. Some staff were not clear about whether they should be giving people choices so some people remained confused about what they could and could not do or ask for.

People told us that they felt able to raise concerns with staff and the manager and raised no concerns with us. Staff told us that they could raise concerns with the management and that they would be listened to and action taken. Details of any dissatisfactions and the action taken were recorded. The capturing of dissatisfactions helps to ensure the home improves. People and staff told us that they had meetings with the management, where their views were taken into account and this was an improvement on findings at previous inspections.

This was a follow up inspection. At our last inspection in October 2013 we found that the service was not compliant with regulations we looked at. We wanted to see what progress had been made to become compliant. During this inspection we spoke to seven people who used the service and we looked at five sets of care records. We also spoke to two visitors and 12 members of staff. During the inspection we reviewed documents associated with the running of the service.

We found that people did not experience care, treatment and social welfare that met their needs. People did not get their social needs met and no support have been provided to plan or improve people’s independence. One person told us “I would love to go to the shops, but I am not allowed a walking aid (which the person felt they needed).” People did not have an opportunity to be part of their local community.

Controls and restrictions in place to protect people were excessive and denied people their rights. Arrangements in place for people to go out or to leave the service compromised their liberty. We found that arrangements in place for people to access their own money and for them to spend it as they wished on goods, such as toiletries were restrictive and prevented people from exercising choices that they were entitled to make. People commented on this and one person said: “They don’t give me enough money.”

People were cared for by sufficient numbers of staff when in the home, but staffing levels were not adequate to provide support to people who wished to go out into the community or for people to receive one to one support.

The provider had failed to undertake monitoring of the quality of the service to ensure people were satisfied or receiving positive outcomes. The provider also failed to gain the opinions of people using the service, their relatives and staff. Both staff and people told us that they felt excluded from decisions made about the service. This meant the provider missed the opportunity to act on suggestions which could have had a positive impact on the well-being and outcomes for people using the service.

Following this inspection we met with the provider to discuss the gravity of the non-compliance. The provider told us as a result of the inspection they had commissioned the support of a consultant service and other changes which would have a positive effect for the people using the service. We will schedule inspections in a short timescale to determine if changes have occurred as detailed by the provider.

During this inspection we spoke to eight staff this included senior staff and the registered manager. We looked at supporting documents and inspected the premises.

People experienced care and treatment from staff that were not trained to recognise and report abuse or suspected abuse. The provider and manager had not taken adequate steps to provide the training to all the staff as had been previously planned and a high number of staff had still not received the necessary training. We saw and noted in records that people received care and support on occasions that was inappropriate and staff did not recognise that the support provided placed people at the risk of harm. The lack of staff awareness meant that the people’s well-being was at risk and they were not adequately protected.

People who use the service were not protected against risks from unsuitable floorcoverings in the home. The provider had undertaken some of the most urgent works found at our last inspection. However, more maintenance work was identified on this inspection. The plan the provider had in place detailing action to address refurbishment and maintenance issues was due for completion by June 2014.

People received care and treatment from staff who were being supported in their roles. Staff received one to one time with their line manager. This enabled them both to identify areas of excellence and areas where more support was needed. This meant that people were supported and cared for by staff who were supported in their roles.

The system in place to monitor the quality of the service delivered to people had not been effective and when deficits had been identified inadequate action had been taken to ensure that people using the service were consulted with and involved in suggesting how the quality of the service could be improved. This meant that people were not always benefiting from a service that managed the risks to their health welfare and safety and involved them through arrangements to seek their views and opinions.

Where the commission had concerns that people were at risk of receiving inappropriate care and treatment we have shared this information with the local authority.

People’s health, care and welfare needs were met by the provider. People’s mental and general health needs were identified and plans of care were written and delivered for each person. The service was responsive to meeting people’s short and long term needs. Activities were limited but people felt they had enough to do.

People were not adequately safeguarded. The provider was aware that its staff team needed additional training but had failed to provide it for them. This meant that staff may not be able to recognise signs of abuse and know how to report them.

People received their medications as prescribed. Also medications which were prescribed to be given only in the event of people displaying certain symptoms were given appropriately and there was clear written direction for when to administer them and the expected effects. Records maintained for medications were clear and accurate. This meant that people were assured they received medications which met their care needs.

The premises were in need of refurbishment. The majority of the communal areas needed some maintenance work to be undertaken, or completed. The majority of the bathrooms and toilets needed attention to replace shower trays or flooring and other sanitary ware. Some external work had been completed in the last 12 months but some essential work had been postponed with no new dates for its completion. The lack of refurbishment or maintenance meant that some parts of the home were unsuitable for their designated use.

Staff were not supported to improve their skills as they did not receive supervisions and appraisals. This meant that the provider missed the opportunity to plan staff careers and test competencies.

Assessing and monitoring was not done fully and was not always effective. The provider had not effectively assessed the premises, staff files or finances.

The people living in this home had, on average, lived in the home for in excess of nine years. The staff turnover was negligible as most staff had worked there for more than five years making for a very stable environment.

We looked at three sets of care documents; spoke with three people who used the service, and three relatives as well as some of the staff delivering direct care and support.

People were given the opportunity to be involved in their care and had options of activities to take part in.

One visiting relative told us when asked about care and treatment, “They have done wonders for my relative”. We saw that care and treatment was planned and delivered in line with peoples needs. It was also updated in a timely manner.

The provider had identified that the vast majority of the staff were not up to date with safeguarding training. They had plans in place about how to address the training needs.

The provider had not fully met the requirements for the recruitment of staff. Some essential documentation was missing from personnel files.

Monitoring of the quality of service took place. Opinions were sought from people and their families about the care and support they received. Other opportunities to inform the service were not utilised.

People told us that they liked the staff in the home. That they were well cared for, and that the home was clean with plenty to do.

This unannounced inspection was undertaken on 01 and 08 December 2015. At our last inspection we identified that the registered provider was not consistently meeting the needs of people, and action was required to improve this situation. Following the inspection we met with the registered provider. They provided a written action plan and engaged consultants to help with the development of the service. This inspection found that significant improvements had been made, and further developments had been planned. However the registered provider was still not providing a service that was consistently safe, effective, caring, responsive or well led.

Wilson Lodge is registered to provide accommodation and nursing care for to up to 36 adults who are experiencing enduring mental ill health. At the time of our inspection 29 people were using the service. The registered provider had recruited a new registered manager since our last inspection, and they had commenced working at the home in January 2015  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 living at Wilson Lodge were not always safe. Incidents of unsettled behaviour when people had upset or harmed each other had not always been identified as ‘safeguarding’ matters, and this meant people did not always get the support they needed, or that the relevant organisations and people were informed.

People had not always been supported to move safely, and manual handling techniques that could cause people harm, and compromise their dignity were observed during the inspection.

People whose medicines were administered from a pre-packed dosette could be confident they would get all their prescribed medicines in the correct dose. People who needed creams and tablets administered straight out of a bottle or packet could not be certain these would be administered as prescribed.

People were supported by adequate numbers of staff, who had been trained to meet the needs of people they were supporting and about how to work safely. Checks were made on new staff before they were offered a position at the home, and new staff received induction to ensure they were confident and able to meet people’s needs.

People were offered nutritious food that was home cooked. People told us they mainly liked the food served. People did not have free access to drinks or snacks, and sometimes the gaps between meals for people who were unable to go out from the home to purchase snacks and drinks were too long.

People who were at risk of malnutrition were regularly weighed, but action was not taken promptly when their weight changed. People who had been assessed as needing extra food to help maintain their body weight did not always receive this.

People were supported to see a wide range of health and social care professionals. People’s health care conditions were not always well managed by the nursing staff, and records did not show they had always been updated or reviewed when people’s needs changed.

Individual staff showed kindness and compassion to the people they were supporting. However the routines and everyday practice in the home did not consistently value, empower or enable people.

The registered manager provided regular opportunities for people to provide feedback about their experiences of the service and to make suggestions for improvements or developments. Both discussions with people and records we viewed showed that this feedback was used in developing the service further.

People told us that they had been provided with new opportunities to undertake activities in the home and the local community. Our observations and discussions with people identified that these opportunities were isolated and that for most people, for large parts of each day there were no interesting or stimulating things to do.

The registered manager had a clear vision about how to develop the service. Feedback from people using the service, staff and visitors was positive about the registered manager’s attitude and practice. We had lots of feedback that supported our findings that this is a developing and improving service.

You can see what action we told the provider to take at the back of the full version of the report.