We inspected this service on 31 October 2017. The inspection was unannounced. Baytree Lodge is a care home registered for a maximum of twelve adults who have mental health needs. At the time of our inspection there were eleven people living at the service. The residential care service is located in two large adjoining houses, on two floors with access to a back garden. The provider is also registered to provide personal care at a supported living unit for two people in a house next door. This inspection covered both services.

We previously carried out an unannounced comprehensive inspection on 27 September 2016 and found there were two breaches of regulations, one in relation to staffing and the other for the safe administration of medicines. We took action against the provider and issued a Warning Notice for the breach relating to medicines. We told the provider they must meet the requirements of this regulation by 28 November 2016. A focused inspection in January 2017 found the provider had met the requirements of the Warning Notice.

At the time of the inspection there was 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.

At this inspection we found the provider had ensured staff were provided with training in key areas and an up to date log of training was in place so the registered manager could ensure staff undertook refresher training as required. Supervision took place on a regular basis for staff.

The service assessed and managed risks relating to care delivery. Risk assessments were up to date and covered a broad range of risks. Care plans were person centred and contained detailed information on people’s preferences and routines.

People told us they were happy living at the service, and that staff were kind and caring. People received care and support from staff who responded to their individual needs and preferences, and who had the knowledge and skills needed for their care roles.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible. The policies and systems in the service support this practice.

People living at the service, relatives and other health and social care professionals spoke highly of the registered manager and told us they were approachable and responsive to any issues raised. We could see the registered manager worked in partnership with health professionals to meet the needs of the people living at the service. Records showed that preparation and multidisciplinary working that had taken place to facilitate the smooth transition of a new person to the service.

Staff told us they felt supported in their role, and we could see from meeting records that the registered manager involved both staff and people living at the service in how the service was run.

Medicines were safely managed. People's finances were managed in an organised and effective way.

Staff understood the importance of safeguarding and the service had systems to help protect people from abuse and ensure safe staff recruitment practices occurred.

The service was clean throughout and there were hygiene controls in place to ensure that the kitchens were kept clean and food was safely stored. The provider was working through a plan of improvements to the service.

The registered manager undertook quality assurance audits in medicines and hygiene. The provider’s Quality and Systems Director undertook six monthly audits across a broad range of areas including finance, care planning and training. We could see when tasks highlighted from these actions plans were completed. In this way the service was seeking to continually improve the serv

We carried out an unannounced comprehensive inspection on 27 September 2016 and found there were two breaches of regulations, one in relation to staffing, the other for the safe administration of medicines. We took action against the provider and issued a Warning Notice in relation to the breach relating to medicines. We told the provider they must meet the requirements of this regulation by 28 November 2016.

At the inspection on 27 September 2016 we found that medicines were not all stored safely. There were discrepancies when we checked stocks against records. This was of concern as the provider could not satisfy themselves that all medicines were safely accounted for. Also the medicine system was not easy for staff to use for two of the people living at the service. These concerns were a breach of the regulations.

Baytree Lodge is a care home registered for a maximum of twelve adults who have mental health needs. At the time of our inspection there were twelve people living at the service. The provider is also registered to provide personal care at a supported living unit next door. This inspection relates to the care home service only. The service is located in two large adjoining houses, on two floors with access to a back garden.

At the time of the inspection there was no registered manager in place. Baytree Lodge have not had a registered manager actively managing the service since September 2015. However the manager recruited to run the service in September 2016 had put in their application to the Care Quality Commission to become the registered manager at the time of writing this report. 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 undertook an unannounced focused inspection on 17 January 2017 to check that the service was now meeting legal requirements in relation to the Warning Notice served in October 2016. This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Baytree Lodge on our website at www.cqc.org.uk . We did not inspect the other breach of regulations at this inspection but will do so when we return to carry out our next comprehensive inspection.

At the inspection on 17 January 2017 appropriate arrangements were in place for recording the administration of medicines. Stocks tallied with records and medicines were stored securely. People received their medicines when they needed them and there were no gaps in recording on medicine administration records (MAR). The provider had updated their procedures following the inspection in September and staff were now working to these new arrangements.

We judged that the provider had made improvements and had met the requirements of the Warning Notice. As improvement have been made we are able to change the rating for the Safe domain to good.

We will review the overall ratings for the service at our next comprehensive inspection.

We inspected this service on 27 September 2016. The inspection was unannounced. Baytree Lodge is a care home registered for a maximum of twelve adults who have mental health needs. At the time of our inspection there were twelve people living at the service. The provider is also registered to provide personal care at a supported living unit next door. This inspection relates to the care home service only.

The service is located in two large adjoining houses, on two floors with access to a back garden.

We previously inspected the service on 25 November 2015, where a breach of the legal requirements was found. This was because we found that staff had not received sufficient training to support them in their role.

At the time of the inspection there was no 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.

Since the last inspection there had been an acting manager in place at the service who was responsible for the day to day running of the service for the majority of the time. A new manager had been recruited since the last inspection but had not remained at the service, and had not applied to be the registered manager. As of September 2016 a new manager had been recruited to the service and had started work the day before the inspection visit. The new manager planned to apply to be the registered manager.

At the last inspection on 25 November 2015, we asked the provider to take action to make improvements in relation to staff training. We found this action had been partially completed. At this inspection we found whilst most staff had received training in the required topics, the acting manager had not undertaken required training. This was of concern as he was supervising and guiding staff in relation to safeguarding adults and working with people with mental health needs without the necessary skills or knowledge. This meant there was a further breach of the regulations in relation to training.

We found that medicines were not all stored safely. There were discrepancies when we checked stocks against records, and the medicine system was not easy for staff to use for two of the people living at the service. This was of concern as the provider could not satisfy themselves that all medicines were safely accounted for. Also the system did not support staff to easily administer medicines safely and so was a breach of the regulations.

Staff had been carefully recruited and we could see that regular supervision took place with the majority of staff. Staff told us they felt supported and there was always management support available.

The service was clean throughout and we noted that food was stored and labelled safely in fridges in both the main kitchen and the kitchen used by people who lived at the service.

On the day of the inspection there was no hot water in one of the bathrooms. The provider reported to us that this has since been resolved. The provider had drawn up a maintenance action plan to make improvements to the scheme over the coming three years which they were working through.

During this inspection we observed good interactions between staff and people using the service. People using the service informed us they were mostly satisfied with the care and services provided.

We reviewed risk assessments and care plans for people using the service. The quality of these varied. Elements of these provided good detailed information on the needs of people, but identified goals were always followed through with people living at the service.

The systems for managing people’s money were safely managed.

Many people living at the service went out to social activities and hobbies independently. A small n

We inspected this service on 7 September 2015. The inspection was unannounced. Baytree Lodge is a care home registered for a maximum of twelve adults who have mental health needs. At the time of our inspection there were eleven people living at the service. The provider is also registered to provide personal care at a supported living unit next door.

The service is located in two large adjoining houses, on two floors with access to a back garden and spaces for parking in the area to the front of the houses.

We previously inspected the service on 29 May 2013 and found that the regulation about safe management of medicines was not being met. We carried out a follow up inspection in October 2013 to look at medicines management and found the provider had made the improvements required and was meeting the regulation.

At the time of our inspection the registered manager was on leave and an acting manager covering in his absence. 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.

Since the inspection on 7 September 2015 there have been some changes in the management of the service.

Referrals to the service are made by local authorities. At the time of our inspection there were residents from Barnet and Enfield living at the service.

People using the service informed us they were mostly satisfied with the care and services provided, however some people said they did not always get the type of food they preferred. In particular, Halal food was not routinely provided for a Muslim person who used the service.

At this inspection we saw that the building was in need of redecoration and some repairs were required. We found that people were not protected from the risks of infection, as there were ineffective cleaning and food hygiene processes in place. The residents’ fridge was not clean. In the fridge in the main kitchen there were two open cartons of food with no date of opening on them so people were at risk of eating food that was no longer fresh.

Some of the equipment for cleaning the home was not in good condition and there was evidence of poor cleanliness in some communal areas. There were mouse droppings in an airing cupboard on the first floor.

There were ineffective quality monitoring systems and records. Management of medicines was not safe. People using the service felt safe most of the time, but one person using the service said they were affected by the behaviour of other people using the service, as they were loud and didn’t behave in a ‘nice’ way. Management of people’s money was not robust enough to prevent abuse.

We reviewed risk assessments and care plans for people using the service. We found all risk assessments and care plans had been updated, however there was not enough detail in some of the documents to ensure the needs of people using the service were met.

Staff recruitment procedures were not always thorough and some of the required information was not obtained in line with the provider’s recruitment policy to make sure staff employed were suitable to work in a care home.

We observed some good interactions between staff and people using the service.

Staff had been provided with training but lacked training in the Mental Capacity Act 2005 and not all staff had received training to work with people who have behaviours that can be challenging. Staff need a broad range of training to enable them to care effectively for people.

The home had an activities programme but people did not have enough social and leisure opportunities and their spiritual needs were not always met.

We found the provider was in breach of standards relating to the safe care and treatment of people using the service, safeguarding people from abuse, nutrition, staff recruitment, premises and equipment and monitoring the quality and safety of the service.

We are taking enforcement action against the provider for one of the breaches.  Details of these breaches are at the back of the full version of the report.

We carried out this inspection to check whether the registered manager had made improvements in the service since we last inspected 29 May 2013. At that inspection we found the provider was not following its own medication policy, by not returning out of date medication. We found out of date medication in a box on the floor which had been there for some time. The home had not been returning out of date "dosette boxes" (used to store and dispense medication). Two of which had medication in them.

At an inspection on 10 October 2013, we saw that the manager had, refurbished the room where the medication was kept. The medication cupboard and fridge only contained medication which people needed and was all in date. We looked at the providers records and saw that medication was returned to the chemist promptly when no longer needed and return records signed by the staff and the pharmacy.

People’s needs were assessed and care and treatment was planned and delivered in line with individual care plans. We looked at three care plans. We saw that each person had an individual care plan which gave some guidance to staff about the care and treatment of the people they supported. The five staff we spoke with understood people’s support needs. Care plans were being reviewed on a regular basis. One person told us “I know my key worker and we have lots of chats about how I’m doing."

People living at the home told us that staff explained what medication they were taking before administering these. However the homes current medicine storage was not allowing the correct guidance to be followed and may have put people at risk due to poor storage of medication and cleaning of equipment. The provider was not handling medicines safely or securely nor following its own medication policy related to disposal of medication.

Staff received regular supervision and felt supported by the manager. We spoke with five members of staff; all confirmed they had or were having a comprehensive induction to the home and the organisation. This included the aims and objectives of the service, policies and procedures, information about the people they care for and actions to be taken in an emergency.

There were systems in place to monitor the quality of care and treatment; however, we were concerned that the appropriate arrangements were not in place to manage medicines safely.

People who use the service indicated that they were satisfied with the services provided and they were well cared for. They spoke highly of staff and informed us that staff had treated them with respect and dignity. Their views can be summarised by the following comments, “staff do what they should be doing. They are always available for us.” And “I can express my views, staff listen to me”.

The home had consulted with people who use the service regarding the running of the service and activities arranged. Assessments, including risk assessments had been carried out and care plans had been prepared for people who use the service and signed by them. We observed that people who use the service appeared comfortable and were able to go out freely.

Arrangements were in place to ensure that people who use the service were protected from abuse. People who use the service stated that they were well treated by staff. We noted that staff were vigilant in ensuring that the home was secure and visitors were met at the door and requested to sign the visitors’ book.

People who use the service informed us that the premises had been kept clean and they were pleased with their accommodation. All areas visited by us were clean and tidy. The home had a record of essential maintenance and safety inspections carried out. Fire safety measures were in place.

People who use the service were satisfied with the accommodation provided and they indicated that their care needs had been attended to. They spoke highly of staff and said they were involved in the running of the home.

Comments made by them included the following :

“Happy with the care here.”

“They treat us well.”

“Nice staff.”

We inspected this service on 3 and 25 November 2015. The inspection was unannounced. Baytree Lodge is a care home registered for a maximum of twelve adults who have mental health needs. At the time of our inspection there were eleven people living at the service. The provider is also registered to provide personal care at a supported living unit next door.

The service is located in two large adjoining houses, on two floors with access to a back garden.

We previously inspected the service on 7 September 2015. Breaches of legal requirements were found. This was because we found that medicines were not being managed safely. There were ineffective procedures in place that could place people at risk of infection and there were some repairs required to the premises to make the building safe for the people living at the service. In relation to these breaches we served an enforcement warning notice against the provider.

There were other breaches of legal requirements relating to employment of staff, managing people’s money, meeting people’s nutritional needs and the overall management of the service.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Baytree Lodge on our website at www.cqc.org.uk

We carried out a full comprehensive inspection on 3 and 25 November to check the progress the provider had made in relation to the enforcement warning notice and the other breaches of legal requirements.

At the time of the inspection there was no registered manager in place due to changes in personnel within the organisation. An acting manager was responsible for the day to day running of the 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 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 that all medicines were now stored safely, and there was no backlog of medicines awaiting disposal. When we checked supplies of medicines against people’s medicines records, there were no discrepancies, providing assurance that people were now receiving their medicines as prescribed. This meant the provider was no longer in breach of the regulations in relation to the issues previously identified.

At the inspection on 7 September 2015 we found that people were not protected from the risks of infection, as there were ineffective cleaning and food hygiene processes in place. The residents’ fridge was not clean. In the fridge in the main kitchen there were two open cartons of food with no date of opening on them so people were at risk of eating food that was no longer fresh.

Also, some of the equipment for cleaning the home was not in good condition and there was evidence of poor cleanliness in some communal areas.

At this inspection on 3 and 25 November we found there were significant improvements and people were no longer at risk of infection. The residents’ fridge was clean, and we saw packets of food that were opened, dated and sealed. Sinks in the communal bathrooms were clean and there were facilities for people to dry their hands. The cupboards in the main kitchen and the residents’ kitchen were clean. There had been evidence of pests in the main kitchen but the provider had ensured a pest control organisation were managing the problem.

The mops for cleaning the home which were identified as a hygiene risk at the last inspection due to their condition, were now replaced and there were suitable buckets to implement effective hygiene control. We noted the floor in the residents’ kitchen whilst not yet repaired was clean. The provider has since confirmed the flooring has been replaced.

The mice droppings we identified in the airing cupboard on the first floor at the previous inspection were no longer in evidence. The pest control agency had identified them as pellets of poison not mice droppings.

At the inspection on 7 September 2015 we saw parts of the building were in a poor state of repair. In one of the laundry rooms there was a cupboard door hanging off its hinges and the shelf was sufficiently damaged to be unsafe to hold anything of weight. At this inspection we saw this was now replaced by a new cupboard.

The provider had identified additional maintenance issues that required repair in the bedrooms of people who lived at the service. With the exception of one shower these had been completed.

During this inspection we observed good interactions between staff and people using the service. People using the service informed us they were mostly satisfied with the care and services provided.

At the inspection on 7 September we found Halal food was not routinely provided for a Muslim person who used the service. At this inspection we found evidence of Halal meat being bought on a regular basis and people living at the service told us the range and amount of food had improved in the last few months.

We reviewed risk assessments and care plans for people using the service. We found most risk assessments and care plans had been updated, however there was not enough detail in some of the documents to support staff to provide the best care to the people using the service.

Staff recruitment procedures had improved since our inspection on 7 September, and there was evidence of supervision taking place on a regular basis.

The home had an activities programme but people still did not have enough social and leisure opportunities.

The quality monitoring systems and records had improved since our inspection on 7 September. The acting manager was now monitoring hygiene and infection control processes and carrying out audits in relation to medicines management and financial management of people’s money. Management of people’s money was well managed to prevent abuse.

Staff had been provided with some training but there was no systematic process to check all staff had received mandatory training in areas such as safeguarding adults or the Mental Capacity Act 2005. This meant that staff did not have sufficient training to enable them to care effectively for people.

We identified a new breach in relation to staff training that placed people at risk of not receiving care from suitably skilled staff.

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