This inspection took place on 18 July 2017 and was unannounced. May Lodge is a care home which provides care and support for up to 6 people with learning disabilities or autistic spectrum disorder with additional physical disability needs. The service is a bungalow and is fully accessible for people in wheelchairs. The service is set within residential housing and is set back from a busy road and off street parking is available. At the time of our inspection there were three people living at the service.

Our last inspection in August 2016 found five breaches of our regulations and an overall rating of requires improvement was given. This was because there were concerns in respect of risk assessment and effective quality assurance. We also highlighted that improvements were needed in respect of medicines management, restrictions to a person’s liberty and staff training. The provider sent us an action plan which told us how they would improve and when this work would be completed. At this inspection we found that all these issues had been addressed.

There was a new registered manager in post. A registered manager is a person who is 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. The registered manager was present throughout the inspection.

The environment was well maintained although some improvements were needed to improve safety in the garden. Fire prevention and other equipment and installations were routinely serviced, checked and tested. Staff received fire training and plans were in place to ensure all staff participated in fire drills.

Staff had received training to recognise and act upon suspected abuse. Incidents and accidents were appropriately managed and analysed for trends. There was a robust staff recruitment process in place. New staff were inducted into their role and all staff received appropriate training. Staff felt supported and listened to, and received regular opportunities to express their views and discuss their training and development needs with their line manager. There were sufficient staff on duty at all times to meet people’s needs.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards and what this meant for the people they supported.

Staff understood people’s food likes and dislikes and developed menus that took account of individual preferences and special dietary needs. Alternatives to the menu were available for people and snacks and drinks were provided in between meals. Any nutrition and hydration risks were addressed with health professionals. People had individualised plans of care and support about which they and their relatives were consulted. People‘s health needs were met.

Staff demonstrated they knew people well. Staff were respectful to people and treated them with dignity and kindness. Staff showed they had a good understanding of people’s individual characters and provided support in a person centred way. People’s social needs were met. Staff communicated effectively with people and understood when they were unhappy about aspects of the service they received.

The provider had a quality monitoring system in place. A range of audits were in place to provide assurance that all aspects of service quality were being monitored and shortfalls acted upon to ensure people’s safety.

The inspection was unannounced and took place on 15 August 2016. May Lodge is a care home which provides care and support for up to 6 people with learning disabilities or autistic spectrum disorder with additional physical disability needs. The service is located in bungalow accommodation and fully accessible for people in wheelchairs. The service is set within residential housing but is set back from a busy road and off street parking is available.

At our previous inspection of this service in February 2016 we found the service was not meeting the required standards of quality, safety and personalisation of care and support to the person living there at that time and there were significant shortfalls, the service was placed into special measures. We took enforcement action against the provider and asked them to tell us what they were going to do to put the shortfalls right. Since that time the provider has kept us informed regularly of progress they have made towards meeting the required standards. This inspection was to assess whether the improvements they had told us about had been embedded and were now everyday practice.

At the time of our inspection a second person had been admitted within the past week and a third had been assessed and was commencing transition to move to the service. People were unable to tell us about their experience of care but when we met them they were relaxed in the company of staff and in good moods. A relative spoke positively about the quality and delivery of care provided by staff to their family member.

A registered manager had not been in post since December 2015, although there was an on-going recruitment for this. A registered manager is a person who is 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.

Our inspection highlighted that whilst there had been significant progress made there were still shortfalls that needed further work to evidence they fully met the requirements of some regulations. The use of medicines in the service had been minimal with an occasional ‘as required’ medicine used, however with the admission of more people there was now a need for staff to administer prescribed medicines and we noted some shortfalls within the current system that needed to be attended to. A framework was in place for the assessment of both individual and environmental risks to ensure people were kept safe but there were some risks that had still to be assessed and this could place people at risk of harm.

People referred to the service were assessed prior to admission and a programme of transition implemented to enable them to familiarise themselves with the new service; some key information however, had still not been sufficiently detailed about people’s needs and this left staff still asking questions in relation to needs and support around this. Staff said access to training had improved but some important relevant courses were still outstanding for some staff.

Quality audits were in place but not always carried out robustly or evidenced clearly that actions had been taken to provide assurance that the service was meeting standards.

Staff had an understanding and awareness of the Mental Capacity Act, capacity assessments were being undertaken but staff did not recognise that some of their practice could be considered as restrictive and should be discussed within a best interest discussion. Staff respected people’s choices but there was a risk their privacy could be compromised without appropriate equipment to alert them to the presence of others. A lack of skilled communication by staff could lead to isolation for some people. People were consulted about their menu choices but there was some repetition in the meals provided to them on

We carried out this unannounced inspection on 10 February 2016. May Lodge was an existing service that closed for refurbishment and people living there moved on. There was a period of dormancy whilst refurbishment works were carried out to provide up to six people with ensuite bedrooms. The service reopened 11 December 2015 on admission of the only and current service user. The new service was set up for people with learning disabilities or autistic spectrum disorder with additional physical disability needs. The service is fully accessible for people in wheelchairs and off street parking is available. At the time of our inspection one person was living at the service and there were five vacancies.

This service was last inspected in September 2013 when we found the provider was meeting all the requirements of the legislation.

At this inspection there was not a registered manager in post: the previous manager ceased to be the registered manager for the service from 11 December 2015. Interim management cover arrangements from within the organisation had lacked continuity and been ineffective. 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.

There had been a lack of preparation for the opening of the service and the support of the only person currently admitted. The person accommodated could be placed at risk because although staff had received their basic essential training to undertake their role, they had not received additional specialist training in regard to the person’s method of communication, their moving and handling needs. Staff had been provided with training to support people whose behaviour could be challenging, but, an individual behaviour management strategy had not been developed and implemented for the service user to ensure support around behaviour was consistent.

Risks were not appropriately assessed or measures implemented to protect the health and safety of the person or staff. Some checks and tests of the fire alarm and equipment were not undertaken and new staff had not participated in a fire drill in the new premises. Accidents and incidents were recorded by staff but not analysed by senior staff or managers to assess whether measures implemented were effective or needed amending. The persons health care needs were not appropriately assessed with detailed support plans around this in place.

Staff showed that they understood the principles of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS), but the provider and senior staff had not ensured that capacity assessments had been completed or a DoLS authorisation reviewed and updated.

A detailed care plan to provide staff with a step by step guide to the support the person required to meet their needs had not been developed, and staff were not recording changes that they became aware of to inform the plan of care.

A complaints procedure was not displayed and information including the complaints procedure was not in suitable formats for the person supported to understand and make use of. Staff were working to out of date policies and procedures. In the absence of formal staff meetings and management support staff were holding their own informal meetings to seek support for each other around the operation of the service and the delivery of care to the person. A system had not been established yet for the assessment and monitoring of service quality through a series of audits.

There were enough staff to support the person but they lacked all the competencies they needed to support the person safely. Seventy five percent of staff support was provided by agency staff block booking by the provider assured that a continuity of staff support was

People told us they were happy living at May Lodge and told us about the activities they were supported to do. People had care plans that provided staff with information about the things they could do for themselves and the things they needed support with. Staff knew people well and records showed that they provided the care that people’s care plans said they needed. The service had ensured that the risks related to people’s anxiety and challenging behaviours had been assessed and that staff knew how to avoid the triggers for such behaviours.

Staff had received the training and support they needed to care for people safely and effectively.

People that used the service had been provided with information about how to make a complaint. There were a range of opportunities each week to talk about their care and any concerns they had with staff. Staff and the manager knew what they needed to do to keep people safe from abuse and how to report any concerns appropriately.

Six people were living at the home at the time of the inspection. Some people were unable to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff on duty, read records and observed some of the support that people were given.

People were treated with respect and dignity. They were supported to make decisions about their daily lives and things that were important to them. People chose when to get up and go to bed, what to do and what to eat and staff respected their choices. People chose how to spend their time and were provided with activities at home and in the community. We saw that staff had a good understanding of people's needs and their individual methods of communication and that people were relaxed with staff. There were enough staff on duty to support people safely.

People were encouraged to be as independent as they could by helping with tasks such as cleaning their rooms and preparing meals in line with their individual skills and abilities.

People’s rooms were personalised and they told us or indicated by thier preferred methods of communication that they liked the rooms and had chosen the colour schemes.

The provider made regular checks of the service to make sure that people were getting the support they needed and the service was safe. These included asking the people who lived there for their views.

During our visit we saw that staff treated people that use the service with respect. We saw that staff listened to people and took their views seriously and always answered their questions in a way that they could understand. We observed that the people were happy and relaxed. They were involved in planning their own care and how they preferred to be supported.

People told us and indicated that they received the care and support that they needed at May Lodge.

Staff told us that care plans had enough information about how to look after people in the best way. They said that they thought the training they received was adequate to meet the needs of the people living in the home.

Staff also told us that they felt that the organisation did not listen to them when they raised concerns especially with regards the maintenance and up keep of the home.