This inspection took place on 22 March 2017 and was unannounced. At the previous inspection on 7 April 2016 the service was rated ‘requires improvement’ in the key questions we asked of providers, ‘Is the service safe? and ‘Is the service effective?. As a result the service was overall rated ‘requires improvement although there were no breaches of regulations. This was because the provider did not always carry out suitable checks of criminal records prior to staff starting work. In addition, mental capacity assessments were not always carried out in relation to specific decisions people needed to make. This meant the provider may have incorrectly assessed that some people lacked capacity to make some decisions and made decisions for them inappropriately.

Barons Lodge Sutton provides personal care and support for up to 17 people with mental health needs within a care home setting. There were 15 people using the service at the time of our inspection.

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.

At this inspection we found the provider had improved their recruitment processes and checked staff suitability, including criminal records, more thoroughly. In addition, the provider had reviewed their procedures for supporting people in line with the Mental Capacity Act 2005 (MCA).

The registered manager made applications to the local authority for authorisations to deprive people of their liberty appropriately and staff were aware of the conditions attached to the authorisations which they followed as part of caring for them in line with the MCA. legislation.

There were enough staff on shifts to support people. Staff managed people’s medicines safely, storing, administering and recording medicines in line with best practice. Staff understood how to respond if they suspected people were being abused to keep them safe and had received training in safeguarding adults at risk. The registered manager managed risks to people and the premises well, ensuring people had accurate risk assessments in place with risk management plans to guide staff in caring for people safely.

The registered manager supported staff well through an effective programme of training, supervision and appraisal. People had access to the healthcare services they required to maintain their health. People enjoyed the food and drink they received and were provided food and drink of their preference. However, staff did not always follow professional guidance in preparing a person’s food to be mashed with a fork, ‘fork-mashable’. Instead they sometimes mixed their food altogether as a liquid in a blender which meant the person missed out on the textures and different flavours of the components of their meal. The registered manager told us they would ensure staff followed the professional guidance at all times when we reported our findings to them.

Staff knew the people they were supporting including how to respond when they became anxious or presented behaviours which challenged the service. Staff treated people with dignity and respect and encouraged and catered for people's ethnic and cultural needs and preferences. People were supported to be as independent as they wanted to be. The registered manager received regular support from a specialist provider in relation to helping people plan how they would like to receive their end of life care.

A complaints procedure was in place and people knew how to complain. People received appropriate care because the provider planned people's care in response to their needs and this was reflected in their care plans. People were involved in planning their own care and people were supported to do activiti

This inspection took place on 7 April 2016 and was unannounced. At the previous inspection on 23 January 2015 we found the service to be meeting all the regulations we inspected.

Barons Lodge Sutton provides personal care and support for up to 17 people with mental health needs within a care home setting. There were 16 people using the service at the time of our inspection.

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.

The provider carried out a range of checks that staff were suitable to work at the service. These checks included identification, right to work in UK and previous work history. However they did not always carry out suitable checks of criminal records prior to staff starting work. There were enough staff deployed at the service to meet people's needs. Staff felt well supported by the registered manager who had put in place a programme of induction, training, support, supervision and appraisal.

Mental capacity assessments were not always carried out in relation to specific decisions people needed to make. This meant the provider may have incorrectly assessed that some people lacked capacity to make some decisions and made decisions for them inappropriately. After the inspection the provider confirmed they had improved processes to demonstrate they were meeting their responsibilities under the MCA. Staff had received training on these topics and the registered manager made applications for authorisations to deprive people of their liberty appropriately. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The provider managed risks to people using the service and those relating to the premises well. They assessed the risks and where necessary, put in place suitable management plans for staff to follow. Records were regularly reviewed so they remained current and reliable in guiding staff. The premises were well maintained with a team in place to make repairs when these arose. A programme of renovations to improve the home was in progress. Staff offices and a new laundry area had been built in the grounds of the home and renovations to the interior were also being made.

Staff received training in how to keep people safe and our discussions showed they understood the signs people may be being abused and how to respond to this appropriately.

Staff managed people's medicines by following robust medicines management processes. Medicines were received, stored, administered, disposed of and recorded appropriately by the nursing staff.

People enjoyed the food they received and staff provided choice. Staff monitored people's nutritional status and referred them to specialists where they were concerned, such as if people were losing weight rapidly. Staff supported people to see a range of healthcare professionals relevant to their needs such as psychiatrists, GP, dentist, optician, challenging behaviour team, epilepsy and diabetes professionals.

Staff were caring and treated people with dignity and respect as well as providing privacy. Staff knew the people they were supporting including their preferences and backgrounds. People were encouraged to be involved in making decisions about, and reviewing, their care. The registered manager had systems in place for reviewing care plans each month so they contained accurate and reliable information to guide staff.

People were supported to be as independent as they wanted to be and they were sufficiently occupied in various activities they were interested in. People and staff were involved in the running o

When we last inspected in September 2014 we found the management of medicines was not always safe. One person was not protected against the risks associated with a medicine which required close monitoring. This was because staff had not followed instructions to administer the medicine correctly. We asked the provider to improve and they submitted an action plan stating when they would become compliant.

This inspection was carried out by a single inspector who helped answer one

of our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service had improved and was managing medicines safely.

We visited this service to check whether the provider had made the necessary improvements in relation to medicines management after we had served a warning notice on them in July 2014. The warning notice was served because the provider was not meeting the requirements of the law in respect of the management of medicines and required that the provider made the necessary improvements by 15th August 2014.

Below is a summary of what we found. The summary is based on our observations during the inspection, the staff supporting people and from looking at records. If you want to see the evidence supporting our summary please read our full report.

We found that the provider had addressed most of the concerns identified in the warning notice. We however also found that more improvements were required to ensure people were fully protected against the risks associated with the management of medicines.

At our previous inspection in April 2014, we found that the provider did not have an effective system for the management of medicines. We asked them to make improvements and they wrote to us and told they would make the necessary improvements by. This inspection was carried out by an inspector who helped answer one of our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the management of medicines was not carried out safely. Procedures were not always appropriate for the obtaining, disposal and administration of medicines with audits not picking up issues.

This inspection was carried out by an inspector who helped answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents. This reduces the risks to people and helps the service to continually improve. There were no Deprivation of Liberty Safeguards in place for any people using the service at the time of the inspection. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This means that systems are in place to safeguard people as required.

The service was clean and hygienic. Equipment was well maintained and serviced regularly to avoid putting people at unnecessary risk. However, window restrictors were inappropriate and there was no evidence of any electrical installation check.

We found that the management of medicines was not carried out safely. We found that staff felt well supported by management and received training to support them in their role. This enabled staff to deliver care to people safely and to an appropriate standard.

Is the service effective?

People’s health and care needs were assessed, and information in care plans and risk assessments was accurate and regularly reviewed. Care plans were therefore able to support staff consistently to meet people’s needs.

Is the service caring?

Staff knew the needs of people using the service well. People using the service made positive comments about the staff, as did family members we spoke with. One relative told us, “They care, and it really makes such a difference.” People using the service told us that they liked living here. People told us that they liked the food provided and we saw that people were getting adequate nutrition and hydration. One social worker told us that the person they work with seemed, “incredibly happy there”.

Is the service responsive?

Peoples care needs are reviewed regularly, as are care plans and risk assessments, so people are getting the care that they need. The provider had invested in the home since acquiring it in November, making improvements such as renovating toilets, installing a shower room, a wet room and a new boiler. The manager had responded well to a recent external consultant’s audit of the care home, to make improvements where weaknesses had been highlighted.

Is the service well-led?

People felt well supported by management, and were offered a range of training courses. The service worked well with other agencies, such as local mental health teams, to make sure people received their care in a joined up way.

The manager monitored and assessed quality within the home in various ways, including seeking the views of people using the service, staff and family members.