This inspection took place on 6 September 2018. The inspection was unannounced. At our last inspection in May 2016 we rated the service as good. During this inspection we found breaches of regulations 9,12,15, 17 and 18. These related to the lack of person centred records, unsafe care and treatment, lack of effective systems to monitor the service, out of date records, and lack of appropriate support to staff.

Chase Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care service accommodates up to 21 people. At the time of our inspection 21 people were living at Chase Lodge Care Home, however two people were currently in hospital. The service specialises in providing care to people living with complex mental health needs.

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.

Appropriate governance arrangements were not in in place to monitor and improve the service. Errors we found during our inspection had not been identified when the limited audits in use had been applied to the service. There was no evidence of the provider or registered manager regularly auditing the service.

We found there were unsafe practices in managing the administration, storage and disposal of people's medicines.

People were sometimes put a risk of unsafe care as records were out of date or inaccurate. We found the involvement of people in the service was limited. Whilst there had been ‘Residents’ meetings, there had been no surveys for people or staff to complete about how the service was run.

The provider did not have an effective system to review incident and accident records and therefore could not always identify actions to reduce potential risks to people using the service.

Risk assessments were not updated when there was a change in the person's support needs. The provider had a range of audits in place but some of these were not effective and did not provide appropriate information to enable them to identify any issues with the service and act to make improvements.

Staff had not been supported with regular supervision and appraisals. There had been no regular meetings for staff.

During our inspection, we found that the service needed tidying, decorating and some repairs were required especially in the bathrooms. Some infection control practices around laundry procedures needed to be addressed.

We found there were few up to date mental capacity assessments in people’s files. This meant the provider did not always meet the requirements of the Mental Capacity Act.

Most of the people we observed spent long periods of time watching the tv, either in their rooms or in one of the lounges. We did not observe people engaged with meaningful activities

Staff employed in the making of meals knew what food people liked to eat. The kitchen was clean with daily, weekly and deep clean practices in place.

People positive comments to us about the caring nature of the staff. Staff protected people's privacy .

People confirmed there were sufficient staff to meet their needs. There were systems in place to safeguard people from abuse and the recruitment of staff was safely completed to make sure that they were suitable to work in the service. Staff were aware of their responsibilities and knew how to report any concerns.

The registered manager was experienced and was supported in their role by the provider. People who used the service and staff described the registered manager as

This inspection took place on 19 and 20 May 2016 and was unannounced.

The inspection was carried out by one inspector, and one expert by experience. Chase Lodge Care Home provides care and support for up to 21 adults with mental health needs. Accommodation is provided in a large house and a four bedded annexe. They also provide support to one person who lives independently in their own flat.

On the day of our inspection 21 people were using the service. There was a registered manger 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.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them.

People had risk assessments in place to enable them to be as independent as they could be.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs.

Effective recruitment processes were in place and followed by the service.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Staff received a comprehensive induction process and ongoing training. They were well supported by the registered manager and senior carers and had regular one to one time for supervisions.

Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff gained consent before supporting people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

People were able to make choices about the food and drink they had, and staff gave support when required.

People were supported to access a variety of health professional when required, including dentist, opticians and doctors.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well.

People and relatives where appropriate, were involved in the planning of their care and support.

People's privacy and dignity was maintained at all times.

People were supported to follow their interests.

A complaints procedure was in place and accessible to all. People knew how to complain.

There were some quality audits in place to ensure that people were kept safe and received a quality service. However not all audits were used effectively to make changes in a timely way.

This short inspection was carried out to follow up on the concerns raised at the last inspection about the recording of medication.

We met with the manager and looked at medication records to gauge what improvements had been made. We did not speak with people who lived at the home on this occasion.

At this inspection we looked at the medication administration records for everyone who lived at the home. These gave evidence that improvements had been made in the recording of medication which ensured that potential risks to people were minimised.

All medication was administered by staff who had received specific training and been assessed as competent. The manager informed us that six members of staff had completed additional training in the administration of medication in October last year. We saw certificates of attendance to confirm this. Further training in the safe administration of medicines was booked for all staff before the home changed its pharmacy supplier next month.

We spoke with a number of people living at Chase Lodge and observed staffs understanding of the care and support needed. The people who use the service we spoke with said that staff "were nice and look after me." People told us they liked their bedroom which were decorated with their personal belongings for example "family photographs."

We looked at people's individual files which incorporated their personal and social profile, care plans and risk assessments and found that they encompassed the safety and well-being of people who use the service.

Training records showed that staff had received all relevant training. We noted that staff supervision had not been conducted for 2013 and although annual appraisals were in place they were irregular and not reflected on the records that we looked at.

People who use the service told us that they knew how to raise a concern or complaints and felt confident in doing. They said if they had any issues or concerns they could "tell staff" or speak to their key-worker.

We reviewed the medication records and found shortfalls in the way daily recordings were completed which may have an impact on the people who use the service.

We observed people being supported in ways that respected dignity and privacy and was consistent with care plans. We were told by a family member that "there's a homely feel." We found that people were supported to promote their independence and community involvement.

People's needs were assessed with care plans written to meet those needs. We found that people's care plans were implemented and reviewed. The provider had in place a system for risk assessment and management to deal with foreseeable emergencies.

The provider had policies and procedures for safeguarding and staff were trained and knowledgeable regarding these. We found the provider had raised safeguarding alerts appropriately. We asked a family member if the felt they would be able to raise any concerns with staff regarding safeguarding, they told us “yes, I could talk to staff if necessary".

We found the provider had sufficient staffing in place to meet people's needs with staff receiving training, professional development and access to relevant qualifications. We were told by one person that "they know me well and are very nice".

The provider had systems in place to seek people's views on the quality of service provided. We found these systems were used and changes were made as a result. We also found the provider learnt from any incidents and investigations and from comments and complaints. One person told us "they do everything they can to make it better".

People that spoke to us expressed their views about how they are supported by the staff and the overall service they received. Examples of comments people made included, “the manager is very good but the home has gone downhill”, “I feel safe here”, “it’s alright here I’ve got no complaints”.

People told us they can approach staff and discuss matters about the day to day running of the service if they wanted to.

We saw people being supported by staff with their care . We saw people have their needs met by staff. We saw staff listening to people and talking to them with a warm and respectful approach. We also saw a member of staff using a person’s bedroom for their coffee break. This showed a lack of respect for the environment of people who use the service.

We saw that there were certain care plans that properly supported and guided staff, to give people the care they needed. We also saw care plans that were not sufficiently detailed or informative, because they failed to guide the staff to give people the care and support they needed.

We found that people were being cared for by staff who have undertaken training and who have an understanding about the subject of safeguarding vulnerable adults.

Staff were being supported to undertake training and do care qualifications. This helped to make them competent to care for people who use the service.

Staff were not being effectively supervised in their work. This impacted on people who use the service as it meant they were cared for by staff whose quality of work, overall strengths and abilities were not being formally monitored.

We found that the quality of the service people receive was not being monitored in a formal and systematic way. This puts people at risk if the overall quality of the service is not being monitored and reviewed. It also impacted on the rights of people who use the service as they were not being consulted as part of quality monitoring about the care and overall service they receive.

We carried out the inspection to monitor how Chase Lodge had responded to the compliance action actions we made, when we visited in September 2011. At our last inspection we had found that care plans were not sufficiently detailed or informative, because they failed to guide the staff to give people the care and support they needed. Staff were not being effectively supervised in their work. We had concerns that the quality of the service people received was not monitored in a formal and systematic way.

On this inspection we found that care plans properly supported and guided staff to give people the care they needed. People told us about how they are supported by the staff and the overall service they received. Examples of comments people made included, “The manager does her best”. “I love my key worker to bits”. “I would like to go out more”.

We saw a system of staff supervision had been put in place to monitor and support the staff. We found that systems had been improved to monitor the quality of the service people receive. People were being involved in the quality monitoring of the care and overall service they received.

People that spoke to us expressed their views about how they are supported by the staff and the overall service they received. Examples of comments people made included, “the manager is very good”, “I feel safe here”, “it’s alright here I’ve got no complaints”.

People told us they could approach staff and discuss matters about the day to day running of the service if they wanted to.

We saw people being supported by staff with their care. We saw people have their needs met by staff. We saw staff listening to people and talking to them with a warm and respectful approach. We also saw a member of staff using a person’s bedroom for their coffee break. This showed a lack of respect for the environment of people who use the service.

We saw that there were certain care plans that properly supported and guided staff to give people the care they needed. We also saw care plans that were not sufficiently detailed or informative, because they failed to guide the staff to give people the care and support they needed.

We found that people were being cared for by staff who have undertaken training and who have an understanding about the subject of safeguarding vulnerable adults.

Staff were being supported to undertake training and do care qualifications, to support them in their work.

Staff were not being effectively supervised in their work. This may impact on people who use the service, as it means the overall quality of each staff members work is not being formally monitored and reviewed.

We found that the quality of the service people receive was not being monitored in a formal and systematic way. This puts people at risk if the overall quality of the service is not being monitored and reviewed. It also impacted on the rights of people who use the service, as they were not being consulted as part of quality monitoring about the care and overall service they receive.