This inspection took place on 11 October 2018 and was unannounced.

Ebor Lodge 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.

Ebor Lodge is located in the west of Hull. The home has three floors which are accessed via stairs. Additionally, there is a stair lift to reach the first floor. There are two communal lounge areas and a dining room, two bathrooms and a kitchen. Some bedrooms are shared and others are for single occupancy.

The home is registered to provide care and accommodation for up to 13 people who have mental health needs. At the time of our inspection, there were 12 people using the service.

The service was managed by the provider, 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. There was no requirement for this service to have a registered manager as part of their registration.

At the last inspection on 22 August 2017, we asked the provider to take action to make improvements to their governance systems, staff recruitment and ensure staff received annual appraisals. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well-led to at least good.

During this inspection, we found the provider had made improvements to staff recruitment and staff had now received an annual appraisal. They were now complaint in these areas.

We found the provider had made some improvements to their governance systems. However, there continued to be concerns in this area. The provider had implemented some systems to assess the quality and safety of the service in order to drive improvement, although they had failed to implement systems in other areas including care records, medicines and staff recruitment, support and training. This had led to some shortfalls not being identified and addressed and therefore any opportunity for improvement had been lost. Furthermore, record keeping for staff recruitment and support was disorganised and there continued to be some gaps in these.

We found a new area of concern because there was a risk some people were receiving care they had not consented to. The provider had failed to consider when applications for Deprivation of Liberty Safeguards (DoLS) were required. Through discussions with them it was identified there may be three people living at the service who could have potentially been deprived of their liberty. Following the inspection, the provider confirmed they had made the relevant applications.

Staff had awareness of the Mental Capacity Act 2005 (MCA). They could tell us how they would follow the principles of the MCA when making decisions for people in their best interest, but this was not always documented in people’s care records. Furthermore, peoples consent to their care records had not been reviewed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service had not always supported this practice due to the above shortfalls.

This is the second consecutive time the service has been rated requires improvement.

You can see what action we told the provider to take regarding the above areas at the end of the full version of the report.

Staff protected people from avoidable harm, were knowledgeable about safeguarding and able to raise concerns.

Staff were equipped with the necessary skills to provide effective support. They supported people to manage their medicines safely, as well as supporting them to meet their nutritional needs and healthcare needs. Staff knew people well and how best to communicate with them.

There was a home

This inspection took place on 22 August 2017 and was unannounced. The inspection team consisted of two adult social care inspectors.

At the last comprehensive inspection on 9 September 2015, we rated the service as Good overall.

Ebor Lodge is located in the west of Hull and is close to local amenities. The home has three floors which are accessed via stairs. Additionally, there is a stair lift to reach the first floor. There are two communal lounge areas and a dining room, two bathrooms and a kitchen. There are seven single bedrooms and three shared bedrooms.

The home is registered to provide care and accommodation for up to 13 people who have mental health needs. At the time of our inspection, there were 13 people using the service.

When we inspected, 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.

During the inspection, we found shortfalls in the provider’s recruitment process. References had not been received for all members of staff and the provider had not followed their own guidelines for disclosure and barring service renewals. This meant that the provider was not fully aware of the employment history of staff and therefore could not be assured that staff were of good character.

The provider had no recorded evidence that members of staff were competent in their roles. Provider documentation had not been completed for checking competency. The provider had no documentary evidence of completed appraisals with staff. This meant that the provider could not be assured that staff were proficient in caring for the needs of individuals.

We found the provider’s governance systems were not effective in identifying shortfalls. Audits had not been maintained and some records were not being kept. Staff had failed to record when medicines were opened.

Analysis of survey and audit results was not always completed, and subsequently not used to drive improvements. This meant that the people who used the service and their relatives were not notified of the outcomes of their contributions to surveys and meetings.

You can see what action we told the provider to take regarding the above areas at the end of the full version of the report.

People who used the service told us that they felt safe. Risk assessments were in place and the provider also had policies to keep people safe in cases of emergency.

Certificates relating to the safety of the premises were all in date. These included certificates assuring the safety of fire equipment, water (for legionella), gas and electrical appliances.

Staff were aware of how to protect people from the risk of harm and abuse and knew what to do if they had any concerns.

The provider had Deprivation of Liberty Safeguards (DoLS) for the people who used the service who required these. The provider was aware of their responsibilities under the Mental Capacity Act legislation. Best interest meetings had taken place as required. This meant that people’s best interests and least restrictive interventions had been considered.

We observed staff showing kindness and patience when caring for people who used the service. Staff were able to say how they respected the privacy and dignity of people and staff had a good understanding of the individual needs of the people who they were caring for.

Staff supported people to be as independent as possible according to their individual needs. Rooms were personalised and reflected individual needs and preferences.

Care records were person centred and paperwork had been adapted to fit people’s individual needs. This meant that people received a personalised service.

People who used the service were supported to engage in activitie

The inspection was carried out by an adult social care inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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. The summary is based on our observations during the inspection, speaking with people who used the service and the staff supporting them, and from looking at records.

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

• Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service, their relatives, friends and other professionals involved with the service, completed an annual satisfaction survey. Where suggestions or concerns had been raised the provider had listened and made changes to the service.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

• Is the service responsive?

Staff knew the people they cared for and understood their preferences and personal histories.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated when required.

• Is the service safe?

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

The people who used the service told us they were happy and that they felt safe. We saw that people were treated with respect and dignity by staff.

The home had policies and procedures in relation to ‘preventing abuse’, ‘signs of abuse’ and ‘suspicion of abuse’. Staff had completed training in how to safeguard vulnerable adults. This meant that people were safeguarded as required.

The home was safe, clean and hygienic. Equipment was well maintained and serviced regularly so people who used the service were not put at unnecessary risk.

• Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

The premises had specialised equipment to meet the needs of people with physical impairments.

• Is the service well led?

The service had quality assurance systems in place and records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

What people who used the service and those that matter to them said about the care and support they received.

A person who used the service told us, “It was my birthday yesterday, I went to see my daughter; I can go where ever I want.”

Another person said, “All the staff are nice to me and all the people here are nice.”

People we spoke with told us, “I like it here”, “They look after me well, it’s nice”, “Sometimes we go to the amusements or the park and sometimes we go to the seaside” and “I’m happy thanks.”

A person who used the service told us, “I feel safe.” Another person said, “This is my home, they (the staff) look after me.”

A person who used the service said, “The staff listen to me and if I want anything they help me.”

People who used the service told us they were supported in promoting their independence. People said they were able to make choices about their everyday lives and this included when they went out or got up in the morning. Comments included, "I like to get up early, around 6am" and "I get up and go out when I want to, but the staff do come with me if I need them to."

People who used the service told us they were happy with the level of care and support they received. They also told us they were involved with developing their care plans and other decision making within the home. Comments included, "I love it here", "It's my home" and "We all get on."

People told us the food was good and choice was offered.

We saw that people's views were sought in a variety of ways and consultation took place on a regular basis.

People were supported in promoting their independence and commented, “I decide when I go to out and the staff support me if I need them to”, “The staff are supportive and I couldn’t ask for anything better.”

People also told us that choice was offered and they had agreed to restrictions in relation to smoking. They told us that choice was offered and consultation took place particularly regarding the menu, “The food is very nice and there is always a good choice” and “The food is great.”

People who used the service told us they were happy with the level of care and support they received. They also told us that they were involved and consulted about the support and care they needed.

People who used the service told us, “I feel safe here” and “The staff listen to any concerns.”

People who used the service told us staff were approachable, helpful and supportive.

People told us their views and concerns were listened to and commented, “I have no complaints” and “It’s my dream come true, it is my ideal place.”

This unannounced inspection took place on 9 September 2015. At the last inspection on 24 April 2014, the registered provider was compliant with all the regulations we assessed.

Ebor Lodge is a three storey home for up to thirteen people who have mental health needs. It is situated to the west of Hull close to local amenities. The home has four double bedrooms and five single bedrooms. One bedroom is situated on the ground floor while the others are accessed by stairs on the first and second floor of the building. There are also two lounges, a dining room, office, kitchen, utility room, downstairs toilet and two bathrooms. A garden and parking area are situated to the rear of the building. At the time of our inspection there were twelve people living in the home.

The service had a registered manager in post who is also the registered provider. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 staff were recruited in a safe way; all checks were in place before they started work and they received an induction. Staff received training and support to equip them with the skills and knowledge they required to support the people who used the service. Training was updated on a regular basis and staff were encouraged to undertake further training and qualifications in care. There were sufficient staff on duty to meet people’s health and welfare needs.

Systems were in place to protect people from the risk of harm and abuse. Staff had received training and knew how to report any concerns. They had policies and procedures to guide them.

People’s health and nutritional needs were met and they had access to a range of professionals in the community for advice, treatment and support. We saw staff monitored people’s health and responded quickly to any concerns.

People’s medicines were handled safely. Training records showed staff who were involved in the administration of medicines, had received training in the safe handling and administration of medicines.

Equipment used in the home was serviced regularly. We found the environment was clean and tidy and odour free.

We saw people had assessments of their needs and care was planned and delivered in a person centred way. Risk assessments had been completed to provide staff with guidance in how to minimise risk, whilst promoting their independence. People had access to activities within the local community and within the service.

We observed staff treated people with dignity and respect and they knew people’s needs well. Staff supported people to make their own choices and decisions. When people were assessed as lacking capacity, staff followed the principles of the Mental Capacity Act 2005 and held best interests meetings, with relevant people present, to make decisions on their behalf.

The registered provider/manager undertook audits which ensured people lived in safe environment and their health and welfare was monitored and upheld. We saw that when information was received; action was taken to improve the service as required. Relatives, people who used the service and staff told us they were encouraged to express their views about the service.