This inspection took place on 11 June 2018 and was unannounced. At our previous inspection on 13 November 2017 we identified six breaches of the regulations in relation to safe care and treatment of people, recruitment of staff, safeguarding people from abuse, person centred care, notifying CQC of important events and the governance of the service. We issued a Warning Notice in relation to the breach of Regulation 17, the governance of the service.

This comprehensive inspection was to follow up on the actions taken following the last inspection and to check the requirements of the Warning Notice had been met.

Elm Park Lodge is a ‘care home’. 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.

Elm Park Lodge accommodates up to 27 people with mental health needs in two buildings next door to each other. At the time of our inspection there were 22 people living in the main building with four people living in two flats next door.

At this inspection there was a registered manager at the service but they were on extended leave. The deputy manager was acting up into the role of manager, and providing day to day management 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 the requirements set out in the Warning Notice had been met as the service had made improvements in key areas such as safeguarding, recruitment, person centred care and risk assessments. Recruitment was safe, people were safeguarded from abuse and the service could show us they were offering person centred care.

There were also improvements in areas such as hygiene, complaints and reviewing of accident and incident logs, with minor concerns remaining. The service had been notifying the Care Quality Commission of important incidents since the last inspection.

At this inspection we found that medicine stocks did not tally with medicine administration records which meant the service could not prove medicines were being safely managed.

Systems and processes were in place to check quality at the service and quality audits showed us the acting manager had an oversight of the majority of key areas including care plans, risk assessments, training and recruitment.

The service had appropriate documentation in place in relation to consent and compliance with the Mental Capacity Act 2005. 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 supported this practice.

People told us they enjoyed living at the service and staff were kind and caring.

Staff told us they were supported in their role through supervision, training and team meetings. People were positive about the skills and knowledge of staff. Health and social care professionals highlighted that some staff had limited experience of mental health conditions.

People and their relatives told us the acting manager was approachable and responsive to issues raised.

We found a breach of the regulation relating to safe care and treatment due to mismanagement of medicines.

We have made recommendations in relation to supporting people to move onto independent living and regarding staffing levels.

This inspection took place on 13 November 2017 and was unannounced. At our previous inspection on 7 December 2015 we identified a breach of the regulations in relation to safe care and treatment of people living at the service and governance.

Elm Park Lodge is a ‘care home’. 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.

Elm Park Lodge accommodates up to 27 people with mental health needs in two buildings next door to each other. At the time of our inspection there were 20 people living in the main building with four people living in two flats next door.

There was a registered manager in post at 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.

We found at this inspection that some areas which had been subject to a breach of regulation had improved, whilst other areas had not. We also found new areas of concern at this inspection.

At this inspection we found that recruitment of staff was not always safe as some staff had been employed before references had been received.

Whilst there were risk assessments in place for a number of risks identified, staff were not always provided with guidance on how to safely manage people’s needs.

Whilst people told us they felt safe living at the service and staff had been trained on safeguarding issues, the process to be followed by the provider to alert the local authority when safeguarding issues arose had not always been followed. CQC was not always notified of significant events as required by law.

There were issues of cleanliness at the service, and in particular, in the flats attached to the main building.

People and their relatives told us the registered manager was approachable and responsive to issues raised. However, there were concerns regarding the management of the service and the oversight of the provider in ensuring quality checking systems were in place and that they resulted in improvements and learning for the service.

People told us they enjoyed living at the service and staff were caring but we found a blanket ban on coffee provided at the service which indicated the service did not always provide person centred care. Although people told us they enjoyed the food, apart from breakfast items, food was stored in a locked basement and brought up as required by staff. People did not tell us this was a concern to them.

Staff understood the importance of consent and people were supported to have choice and control of their lives and staff supported them in this, although the ban on coffee was unquestioned by staff. The service operated within the requirements of the law in restricting one person’s liberty and the policies and systems in the service supported this practice.

Staff told us they felt supported in their role and they received regular supervision. People were positive about staff skills and knowledge and their ability to care for them. This was confirmed by relatives.

We found breaches of the regulations relating to safe care and treatment, safeguarding, person centred care, recruitment and notifying CQC of significant events.

We took enforcement action against the provider by serving an enforcement warning notice in relation to governance of the service.

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

This inspection took place on 7 December 2015 and was unannounced. At our previous inspection of 25 February 2015 we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because the registered provider did not have an effective system in place to assess the risk and prevent the spread infections. For example, there were gaps in cleaning schedules, there were no paper towels in communal bathrooms, the kitchen had not been properly cleaned and the food in the fridges was out of date. At this inspection we found that these areas had been addressed in the main part of the home but other areas were found to be unclean and unkempt in the adjoining flats which also formed part of the home.

Elm Park Lodge care home is registered to provide accommodation and personal care for up to 27 persons with mental health needs. At the time of our inspection there were 25 people using the service, including one person on respite.

The registered manager had previously been in post as the deputy manager but had become the registered manager in October 2015. 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 told us they felt safe with the support they received from staff. There were arrangements in place to help safeguard people from the risk of abuse. Staff understood what constituted abuse and were aware of the steps to take to protect people.

People had risk assessments in place, however these did not always provide guidance to staff on how risk should be managed. The service was not following their recruitment policy. We found references were not verified and interview process could not be evidenced. Therefore this may have put people at risk of being cared for by staff who were not fully verified as safe to work with vulnerable people. The service was not following their recruitment policy in .

Staff told us and we saw from their records that they had received training in relevant areas of their work. This training enabled staff to support people effectively. Staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA). Although staff administering medicines to people had received medicines training, the provider had not carried out any medicines competency assessments. Therefore people were put at risk because medicine protocols were not followed.

People told us and we saw from their records they were involved in making decisions about their care and support and their consent was sought and documented.

People received nutritional balanced meals and were given choice. People told us they chose what they ate and staff supported them with meals.

People told us they were treated with dignity and respect. Staff understood the need to protect people’s privacy and dignity. We saw that staff spoke to people in a respectful manner and people responded positively.

The service encouraged people to raise any concerns and people were involved in the running of the service. Staff gave positive feedback about the management of the service. Managers had an open door policy whereby people were able to enter the office to talk with staff. Staff described managers as supportive and helpful. Although some systems were in place to continually monitor the quality of the service and people were asked for their opinions, we found records of audits were not in place for key aspects of the service.

We found a breach relating to risk assessments, staff recruitment and medicine management.

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

People were protected from the risks of inadequate nutrition and dehydration. We saw that meals were served in a timely manner and appeared hot. We observed a group of 10 people eating in the dining room; we asked whether they were enjoying their lunch, one person said, “yes, I do like my food.” Another person said, “meal is hot, but could be hotter.” We spoke with a mental health professional on the day of our visit who told us, “the food is of good standard.”

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We reviewed care files for three people. We saw that each person had a life map which included areas such as, hobbies, likes and dislikes, important relationships and previous employment.

We found the provider worked closely with the primary care mental health team. This was confirmed by a mental health professional visiting on the day of our inspection who told us that he was generally happy with the service, but would like to see the provider do more to encourage people to develop life skills.

The provider had taken steps to provide care in an environment that is suitably designed and adequately maintained. We saw that service contracts were in place to help maintain the building.

There were systems in place to monitor the quality of the service, however we were concerned that there were no systems in place to assess the risk of and to prevent, detect and control the spread of a health care associated infection.

We previously inspected Elm Park Lodge on 4 December 2012 and found non-compliance in areas of staff support and records. We carried out a compliance review to check compliance against the action plan produced by the manager had been implemented. During this visit we found that the service had made some improvements. We noted that most staff had received regular supervision since our last visit in December 2012. This was confirmed by staff who told us they felt supported by the manager. Records relating to people who use the service were up to date as were most staff records.

We spoke to a healthcare professional who told us that the person they were supporting had, “settled in nicely.” However, they felt they would benefit from more intervention in terms of activities. We spoke with a group of three people sitting in the lounge. Feedback on staff included comments such as, “fairly polite,” and “quite nice.”

People told us that they were treated with dignity and respect and that their privacy was respected. Staff interacted positively with people and we observed that people appeared comfortable in the presence of staff. Comments about staff from people using the service ranged from “very considerate and supportive,” to “generally good.”

Care plans were not regularly reviewed and up to date, which meant that people were not always protected from the risk of unsafe or inappropriate care and treatment. The deputy manager was aware of this and told us that they will be addressing this issue with staff.

There were systems in place to ensure that people were protected from abuse and that they received the care they needed. We saw that people walked around the home freely, they told us that they felt safe. People were given a choice of activities which included the art project located at the back of the house. One person told us “I enjoy art therapy and reading the newspaper.”

Systems were in place to monitor and to make improvements to the quality of care and support provided to people by the home. However, we were concerned that staff supervision was inconsistent and staff were not always supported to carryout their role in providing care and support to people.

Most people expressed overall satisfaction with the service and told us that they were satisfied with the accommodation, the meals served and overall levels of cleanliness. One person told us that “it’s not bad, living here” and another person told us that they were “quite happy”. However, one person said that they wanted to leave the service.

They told us that staff listened to what they had to say and acted on this. Most people said that consent was sought before providing care although one person said “not all the time”. They told us about the opportunities to make choices and confirmed that they were treated with respect and that their privacy and dignity was respected. When asked about how they spent their time they told us about art work and using a computer. They also told us about playing monopoly, playing games, a guitarist coming to play in the home and taking part in outings.

Although people did not appear to be familiar with their care plan they told us that they attended their Care Plan Approach (CPA) meetings and confirmed that they received the support that they needed. Not all people using the service spoke English as their first language and Mandarin, Cantonese and Gujarati are spoken by some members of staff. We asked people whether they felt safe and comfortable with the staff supporting them and with the other people using the service. While some people said that they “couldn’t feel any safer” and “I feel very safe” another person said that some people using the service could be violent and fight on occasions although “most people are OK”. When we asked people if there was someone they could talk to if they were worried or concerned about anything they told us that they “would tell the staff”. Another person named their key worker as someone they could talk and also said that the managers “are approachable”. People were satisfied with the home being responsible for the storage and administration of medication. One person was pleased that when staff noticed that the person had forgotten to come for their medication “they come and find me”.

We asked people for their views on the manner and conduct of the staff supporting them and of the sufficiency of overall staffing levels. They said that people were very helpful, courteous and polite. One person said that staff were “very nice but sometimes a bit too strict. They tell you off”. When asked when this might happen they related it to refusing to take medication. Another person said that staff “tried their best”. They told us that there were enough staff although one person said that staff spend a lot of time in the office. When we discussed with people using the service whether they were asked if they were satisfied with the service provided they were not sure although they told us that they attended residents’ meetings and that “you can speak up”.