We carried out this unannounced inspection on 11 April 2017. Finn Farm Lodge is a Prader Willi Service (Prader Willi is a genetic disorder characterized by a number of health conditions that includes uncontrolled appetite). It provides accommodation for up to six people. At the time of inspection there were five people living at the service. People had their own bedrooms. Some bedrooms were located downstairs but the service was not accessible for people who needed to use a wheelchair. This service was last inspected on 1 & 4 April 2016 when we found the provider was not meeting all the requirements of the legislation in regard to the safe care and treatment of people, management of medicines and complaints, effective quality monitoring, adequate checks on staff recruitment, and ensuring new staff received an appropriate induction. We asked the provider to send us action plans of how they intended to address these shortfalls which they did.

At this inspection there was a new 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.

Although some people we spoke with wanted to move on from the home now they spoke positively about the support they gained form the registered manager and staff and felt there had been improvements since the last inspection. Professionals and relatives said the new registered manager was doing a good job; they had confidence in her knowledge and ability.

People were provided with a clean comfortable environment to live in and could personalise their own space to their requirements. All servicing and checks including the fire alarm and emergency lighting had been updated to help make the environment safe for people. Improvements had been made to fire drill frequencies to ensure all staff attended at least two annually and knew the action to take in a fire.

There were enough staff. There had been continued unsettled staffing since the previous inspection; this looked to be reducing and those staff present showed that they were knowledgeable about people’s individual needs. Appropriate checks were made of new staff who were given induction and training to provide them with the basic knowledge and skills they required for their role. Specialised training was also available in regard to Prader Willi and positive behaviour support of people for when they became anxious and their behaviour could be affected.

Staff said they felt better supported and listened to. They said overall communication had improved within the team and they felt better informed. There were increased opportunities for them to meet together as a team and also to have one to one time with their supervisor to discuss training and development needs.

Staff knew how to keep people safe from harm. Individual and environmental risks that impacted on people were assessed; measures were implemented to reduce risk of harm. Staff understood their reporting responsibilities in regard to accidents and incidents and took appropriate action when these occurred to ensure people were safe, and people’s support needs were reviewed if necessary.

People were very relaxed and involved in the routines of the house and enjoyed the freedoms these gave them within clearly defined boundaries. Staff understood people’s needs and preferences and provided them with individualised support. People were supported to follow a calorie controlled diet designed specifically in relation to their condition. Their health and wellbeing was monitored by staff and they were supported to attend health appointments when needed. Interactions between staff and people were respectful, kind and patient.

Improvements had been made to the robustness of the quality checks

We carried out this unannounced inspection on 1 & 4 April 2016. Finn Farm lodge is a Prader Willi Service. It provides accommodation for up to six people. At the time of inspection there were three people living at the service. People had their own bedrooms. Some bedrooms were located downstairs but the service was not accessible for people who needed to use a wheelchair. This service was last inspected on 2 September 2014 when we found the provider was meeting all the requirements of the legislation.

At this inspection there was a new manager in post who was not yet registered with The Care Quality Commission. 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.

For a period of time leading up to this inspection the service had had an extended period of unsettled management and this had led to shortfalls in the quality of service people received through an absence of consistent management support. A new experienced manager had been appointed. The inspection found there were strengths within the service and that staff now felt better supported, the manager and senior managers in the organisation understood and had identified many of the shortfalls present within the service and were taking action to address these. The atmosphere of the service was relaxed, people told us they felt safe now that changes had been made to who lived in the house with them. People were comfortable in the presence of staff and actively sought their attention if they wanted something. People received individual support from staff that interacted well with them and showed that they understood their individual needs.

This inspection however, found that people were not always safe because the checks made on new staff were not robust in order to meet the requirements of the legislation. The induction of new staff was poor. Some important details about how people’s health needs or behaviour should be supported were not in place to inform staff. Improvements were needed in the management of medicines to ensure boxed and bottles medicines were dated upon opening and staff competency to administer medicines was updated in accordance with the expectations of the organisation. Informal concerns raised by people in the service although listened to were not routinely recorded to ensure that action was taken to address them.

Fire drills were held but improvements were needed to how these were scheduled to ensure all staff participated in fire drills each year, Improvements were needed to the way in which people were provided with activity and stimulation to meet their needs.

The new manager had taken steps to improve communication between staff and with relatives and other stakeholders. Assessments of risk people might be subject to from their environment, or from activities or risks associated with their assessed support needs had been developed and measures implemented to reduce the likelihood of harm occurring; these were kept updated.

Appropriate systems were in place to ensure staff received training to support the needs of people in the service such as Prader Willi Syndrome, and diabetes. Staffing levels were appropriate to ensure there was enough flexibility to meet people’s demands and needs.

Staff felt supported and listened to and opportunities for more frequent one to one meetings with the manager, and more regular staff meetings was an area both the manager and provider representatives had identified for improvement, and plans were in hand for this. Annual staff appraisals were scheduled.

A range of quality audits were in place to help the manager and provider monitor the service, and these were mostly effective in identifying many but not all shortfalls highl

We carried out this inspection over six hours. During this time, we met all the people living in the home, looked at three people’s support plans and other records about how the service was managed, we also spoke with three care staff. There was a registered manager for the service but they were away on the day of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law as does the provider. In the absence of the manager an area manager was available for part of the inspection and was able to answer any queries we had.

At a previous inspection in December 2013 it had been found that the home was not meeting the expected standards in two areas. This was in relation to keeping people’s care and health records up to date to ensure these areas were appropriately monitored and action was taken where necessary. We also found that systems in place to monitor individual and environmental risks for people were not always used effectively or regularly to ensure risks were managed and people were kept safe. We asked the provider to tell us what action they were taking to ensure improvements were made in these areas, and they had done this. We checked these areas again as part of our inspection.

The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

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

Is the service safe?

People were supported in an environment that was safe, clean and hygienic. There were safe procedures in place for the ordering, receipt, storage, administration, recording and disposal of medicines. There were enough staff on duty to meet the needs of the people living at the home. A member of the management team was available for any evening and weekend emergency support.

Is the service effective?

People were involved in their assessment and care planning. All care and support was planned with their consent. Where people lacked capacity, mental capacity assessments had taken place; and where any restrictions were in place these had been referred appropriately to the Deprivation of Liberty Safeguards team. People’s relatives or representatives were consulted about people’s care when important decisions needed to be made. People were asked about day to day choices, such as the things they liked to eat. They were enabled to develop their cooking skills, and were encouraged to eat healthily.

Is the service caring?

People’s care was reviewed regularly, and adjustments were made to make sure they remained comfortable, safe and as independent as possible. Everyone we spoke with said they liked living at the home and used words such as ‘good’, ‘friendly’, ‘nice’ when talking about them. People were supported to maintain contacts with their family and friends, some people went home to their relatives to stay on a regular basis.

Is the service responsive?

People’s day to day support was kept under close review, and any changes needed were communicated to the team. People told us the manager and team were easy to speak with and were quick to sort out problems. We saw that the team sought help from other health and social care professionals or services without delay, meaning people remained well supported.

Is the service well led?

Records showed us that the management team were up to date on safety matters. There was an effective action plan in case of emergencies. An accessible complaints procedure was available to people and they were supported when making complaints to other agencies or bodies. Comments were responded to quickly and used to improve service provision. People told us that they found the manager and staff approachable and felt able to tell them about things that worried them. They had opportunities to express their views directly to staff through one to one sessions and meetings with other people in the home. A programme of quality audits was in place to ensure service quality was kept under review and that people experienced a safe and improving service.

One person living at the service told us that they were happy with the recent redecoration of their bedroom and another person told us that they had enjoyed their last holiday, that it had been “a real cracker".

At our inspection on 29 July 2013 we found that one person’s risk assessment did not provide clear information to staff about the risk that was being managed. We found that matters related to two people's diet and weight were not always followed up or monitored effectively. One of these people was unable to access all areas of the service without staff support and had not been given the opportunity to attend regular meetings with a staff member to discuss matters related to their care. The provider wrote to us and told us that they would take action to address these matters by the 30 November 2013. At this inspection we saw that the person’s risk assessment had been reviewed and updated. People were provided with the opportunity to provide feedback about the service on a regular basis. However, one person’s support plans and risk assessments had not been reviewed, people’s weight had not always been monitored regularly and dietary matters had not always been followed up. Following the inspection we were provided with information to show that these matters were being addressed.

At our inspection on 29 July 2013 we found that there were locks fitted to a shared bathroom that could not be overridden in the event of an emergency. We saw that the systems in place to regularly assess and monitor the quality of the service were not always effective because they were not always used regularly. The provider wrote to us and told us that they would take action to address these matters by the 30 November 2013. At this inspection we saw that a new lock had been fitted to the bathroom that could be overridden in an emergency from outside and a window restrictor in a vacant bedroom had been repaired. However, fire safety checks were not always undertaken regularly to ensure people’s safety.

People we spoke with were positive about the service. People told us that the staff were nice. One person told us that the service was “really good”, and another person told us “This room is a real cracker”. Another person told us that the staff were “really good fun”.

We saw that the provider had systems in place to obtain consent from people in relation to people’s care and support.

There were four people living at the service at the time of inspection and we looked in detail at the care records of two people. We found that one person had their needs planned for and they were supported by staff to have their needs met. However, a risk assessment for this person did not provide clear information to staff about the risk that was being managed. We found that matters related to both people’s diet and weight were not always followed up or monitored effectively. The other person was unable to access all areas of the service without staff support and had not been given the opportunity to attend regular meetings with a staff member to discuss matters related to their care.

Staff were offered appropriate support for their roles and staff knew where to find further information at the service about matters related to their role. We saw there were systems in place to monitor staff training and development.

We saw that one person's bedroom had been redecorated following a recent fire. However, we found that there were locks fitted to a shared bathroom that could not be overridden in the event of an emergency.

We saw that the systems in place to regularly assess and monitor the quality of the service were not always effective because they were not always used regularly.

Although most of the people who lived at Finn Farm Lodge spoke with us, to help us more fully understand the experiences of the people who used the service, we also looked around the service and observed how staff interacted with people.

The people we spoke with who used the service said they liked living at Finn Farm Lodge and spoke positively about the staff and the environment, one person commented “I am happy living here”.

People said they chose what to do during the day and were encouraged to increase their independence and development of life skills. We found that people had the opportunity to be involved in a wide variety of activities both within the service and in the community, together with direct involvement in making decisions about the service and their care.

People told us that they liked the house, they said their bedrooms were comfortable and they could have their room decorated as they wanted. We saw that one person had drawn a mural on their wall, other people had achievement certificates in their rooms from work placement and training events that they had attended.

We saw positive interactions between staff and the people who lived at the service, they were offered choices and we saw that their dignity and independence was respected. Staff spoke with people in a professional, yet warm manner and explained what they were doing when they supported them.