This inspection took place on 13 and 14 December 2017 and was unannounced. At the last inspection in September 2016, the home was rated requires improvement. At the last inspection we identified a breach of Regulation 9, person-centred care, as care plans did not fully reflect people’s preferences or meet their needs appropriately. At this inspection we found improvements had been made to care plans and the home was now meeting this regulation. However, we have rated this service as ‘Requires Improvement’ for a second time having identified three further 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.

Alness Lodge Limited is a ‘care home’ for up to 10 people with mental health needs. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People living at Alness Lodge Limited did not require nursing care.Throughout this report Alness Lodge Limited is referred to as Alness Lodge.

At the time of this inspection there were 10 people living at Alness Lodge, within the age ranges of 33 to 64 years. Alness Lodge is a large, detached house spread over two floors with parking to the front and a large garden area to the rear of the home. The home is situated in the Whalley Range area of Manchester, close to local amenities and public transport routes.

At the time of our inspection the service had a registered manager. 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 registered manager was absent from the service on the days of inspection however we spoke with them over the telephone and dealt with the deputy manager and the owner, who was at the home carrying out maintenance work and checks.

The cleanliness of the home was a cause for concern. Areas of the home were untidy or cluttered and there were recording gaps in all the cleaning schedules we checked. We saw no use of personal protective equipment by staff, such as aprons or gloves. We were not assured that the home was taking adequate measures to prevent and control the spread of infection.

We saw positive practice around how people were supported to manage their risks and move safely around the home. Examples of identified risks were around mobility, medicines, smoking and finances.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. However there was no evidence of any checks in place to ensure medicines were stored at a suitable temperature and there were no protocols for ‘as required’ medicines (PRN), as is good practice.

People’s health was monitored as required so appropriate referrals to health professionals could be made. People received regular reviews to check their prescribed medicines were suitable and this promoted good health.

There were enough staff to meet people’s needs. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role.

People were supported to make their own choices and decisions. Staff sought people’s consent before assisting them with support and people had signed to consent to their care. No one living at Alness Lodge had a Deprivation of Liberty Safeguard (DoLS) authorisation in place. People were able to go out independently and we saw people chose to come and go as they wanted to. Staff had received trainin

This inspection took place on 06 September 2016 and was unannounced. At the last inspection in October 2014, where we found the provider was meeting all the regulations we inspected.

Alness Lodge is a residential care home providing 24 hour personal care and accommodation for 10 people with mental health needs. The home is situated in the Whalley Range area of Manchester, close to local amenities and public transport routes.

At the time of our inspection the service had a registered manager. 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 found people’s care plans and risk assessments had not been reviewed in a timely way and we could not establish if the information was still relevant and up to date.

There were enough staff to meet people’s needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff told us they received training to be able to carry out their role. However, we noted some staff training had expired. Staff did have the opportunity to attend supervision, but this was not in line with the provider’s procedure. We recommend the provider determines what timescale are appropriate for staff training requirements and how often the management team should carry out staff supervision meetings.

Staff spoke highly of the management team and felt well supported by them. There were checks in place, though these were not always effective when monitoring the quality of service delivery. We saw the provider had procedures on how complaints should be managed if any were to be received.

Staff we spoke with could tell us how they supported people to make decisions but not all staff had received Mental Capacity Act (2005) (MCA) or Deprivation of Liberty Safeguards (DoLS) training. Staff demonstrated a good understanding of how to protect vulnerable adults.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. People’s health was monitored as required so appropriate referrals to health professionals could be made.

People’s privacy and dignity were respected. People engaged in a range of activities, both in-house and in the community. We observed interactions between staff and people were friendly and staff knew people well. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed. People were appropriately supported with their nutritional requirements.

We found a breach 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.

We carried out this inspection to check improvements that had been identified at our inspection in June 2014 had been made.

At the inspection carried out in June 2014 we saw some information was difficult to find in the care records we viewed and some information was not included within care plans. We also saw there was no evidence to demonstrate staff had received training in fire safety.

We also found improvements were required in the quality assurance systems at Alness Lodge. We found medication audits and care records audits were not documented, and incidents and accidents were not recorded to enable effective analysis to be carried out.

Following the inspection the provider sent us an action plan which showed us the manager would check medication administration records monthly, audit individual daily notes monthly and records of the audits would be kept to identify any trends. The action plan also showed us the manager intended to create an accident and incident file to monitor trends. In addition the action plan showed us care records would be updated to accurately reflect the needs of people who used the service.

During this inspection we found improvements had been made. We looked at three care files and found two files contained up to date and accurate information regarding people’s needs. A third care file required further information to ensure staff were able to access written information regarding a person’s needs. The manager assured us they would address this.

We saw a medication audit had been introduced and individual daily care notes were checked to ensure entries contained an accurate reflection of people’s day to day activities and the care and support they received.

An inspector visited this service on 11 June to carry out an inspection. Prior to our visit we looked at all the information we hold on this service to help us to plan and focus on our five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During the inspection we spoke with four people who used the service, three relatives, three care staff, the registered manager and the deputy manager of the home. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

Is the service caring?

We spoke with four people who used the service who all told us they liked living at the home and they were treated well and supported to do the things they liked to do. We also spoke with three relatives who told us they were happy with the care and support the staff provided to their family. Some comments included; "It’s good care here. (My family member) is really well now", "I’m being really honest, it’s a lovely home." and "I'm absolutely delighted with the care." We saw staff were patient and kind. Our observations and the comments from people we spoke with showed us people were treated with empathy and dignity by the staff.

Is the service safe?

The people we spoke with us told us they felt safe.

On the day of our inspection we found staff were knowledgeable of the procedures to take if there was an emergency such as a fire or health emergency. However we noted there was no documentary evidence to show us when staff had last received fire training, and some information was sometimes difficult, or not present in care records. We discussed this with the manager who acknowledged this was the case and informed us this would be amended. We considered improvements were required in this area.

We also checked whether improvements which were required from our last inspection had been carried made. On the day of our inspection we saw there were sufficient staff on duty to support people in the way they had agreed and the staff we spoke with were knowledgeable of the action to take if they were concerned a person was at risk of harm and abuse. People told us they felt safe and there needs were met in a timely manner. Comments we received included; “I sleep well here because I am safe” and “If I need any help, they are there straight away.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. At the time of our inspection there were no applications in place as these were not required.

Is the service effective?

We saw people who lived at Alness Lodge had received support from other health professionals as required and this was recorded within the care records. The people we spoke with were positive about their experiences at Alness Lodge. Comments we received included; “When I came here I was really ill, but they’ve made me better.” and “I’ve improved no end since I came here.” We spoke with three staff members who were knowledgeable of the care and support each person needed and could also describe people’s individual likes and dislikes. Our observations and the comments from people we spoke with showed us the service was effective when meeting people’s needs.

Is the service responsive?

The service had systems in place to ensure people were regularly consulted about their views and ideas on how the service should be run. This was done by means of regular discussions with people, meetings and satisfaction surveys. The people we spoke with told us they were consulted and the management of the home listened to their views.

We saw records that showed us regular environmental audits were carried out and we saw refurbishment had taken place in some areas of the home to ensure people had facilities that met their needs.

Is the service well led?

We discussed other audits with the manager. The manager told us audits such as records, medication and incidents and accidents were carried out but these were not recorded. We considered the audit systems in place required improvement to enable the manager to review the information the audit contained and identify and respond to any shortfalls noted.

This was a scheduled inspection during which we spoke with most of the 10 people who lived in the home although not everyone could respond verbally. People looked comfortable and clean.

People told us that “Things are good here, I like living here because the staff listen to me”, “Staff speak nicely to me” and the staff were “very good”.

Staff spoken with were aware of people’s individual needs and provided care according to their care plans. We saw involvement of other professionals, such as doctors, district nurses or a chiropodist.

Although people told us they enjoyed their meals they sometimes experienced lack of support during meal times.

We found that improvements are needed to the way in which incidents and safeguarding matters are managed.

We found that improvements are needed to the way staffing levels are planned and implemented for the service.

People living in Alness Lodge were provided with information about how to raise a concern or complaint. Details of how to contact the local authority were also made available.

We spoke with five people who received support from the service. They were all happy with the care they received. All the people we spoke with told us that they liked the staff and felt they were listened to. Comments included, “The staff are very good with me”, “I like the home, it’s very nice living here”, “I like going out. I usually go to the day centre and sometimes I go shopping” and “They (staff) are all very nice, I don’t want to move anywhere else.”