We inspected Outlook Care Waterside Lodge on 11 May 2017. This was an unannounced inspection. At the last inspection in April 2015 the service was rated as Good.

Outlook Care Waterside Lodge provides accommodation and 24 hour support with personal care for up to 16 adults with mental health needs. At the time of our inspection there were 14 people using the service.

There was a registered manager at the service at the time of our inspection. 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.

The service was safe and had practices in place to protect people from harm. Staff were knowledgeable about safeguarding and what to do if they had any concerns and how to report them. People who used the service told us they felt safe and protected from harm and bullying.

Risk assessments were robust and personalised and staff knew what to do in an emergency situation. People had risk assessments in place for their mental health and instructions for staff if a person displayed signs of relapse.

Staffing levels were meeting the needs of the people who used the service and staff demonstrated that they had the relevant knowledge to support people with their care. Arrangements for staff cover were in place if there were any unexpected absences.

Recruitment practices were safe and records confirmed this.

Medicines were managed, stored and administered safely and audited on a weekly basis. People who used the service had risk assessments in place for their medicines. There was a member of staff on each shift who was the ‘medicines lead’ to ensure robust medicines management at the service.

Newly recruited care staff received an induction and shadowed senior members of staff. Training for care staff was provided on a regular basis and updated regularly. Staff spoke positively about the training they were provided and told us they were informed of any training that they needed to complete.

Care staff demonstrated an understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was recorded in people’s care plans.

People were supported with maintaining a balanced diet and the people who used the service were involved in menu planning and told us that there were always options on the menu. People with dietary needs were supported to manage those needs and the cook demonstrated good knowledge of people’s individual requirements.

People were supported to have access to healthcare services and receive on-going support. The service made referrals to healthcare professionals when necessary.

Positive relationships were formed between staff and the people who used the service and staff demonstrated how well they knew the people they cared for.

The service supported people to express their views and be actively involved in making decisions about their care. People who used the service told us they felt in control of their care and involved with their care plans.

The service promoted the independence of the people who used the service and people felt respected and treated with dignity.

Care plans were detailed and contained relevant information about people who used the service and their needs. Care plans were reviewed regularly and any changes were documented accordingly.

Concerns and complaints were encouraged and listened to and records confirmed this. People who used the service told us they knew how to make a complaint.

The registered manager and deputy manager for the service had good relationships with staff and the people who used the service. Staff spoke highly of the management style and the support they received from their peers.

The service had quality assurance methods in place and carried o

People told us they were treated with respect and dignity. We found people who used the service understood the care and treatment choices available to them. People we spoke with told us they received good care. We found people’s needs were initially assessed when they began using the service.

People we spoke with told us they felt safe. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

At this inspection we found the provider had made improvements to the areas of concern we raised in our last report. We found adequate maintenance procedures were in place for the proper operation of the premises. The toilet on the ground floor had been repaired and was in working order.

There were effective recruitment and selection processes in place. Staff told us they had to complete an application form as part of the recruitment process before they started work. We confirmed this when we viewed staff files.

People’s personal records including medical records were accurate and fit for purpose. Staff told us they updated people's records regularly and kept accurate records about them. People's records we viewed verified this.

People we spoke with told us they felt staff respected them and maintained their dignity and privacy. People were cared for by staff who were well trained and supported to fulfil their roles and responsibilities. One person told us one staff member "sings songs to me and talks to me about life."

We found people were cared for in a supportive environment which met their personal needs. However we found more activities were needed to keep people engaged and occupied.

People told us they felt safe in Waterside Lodge. We found staff had the appropriate safeguarding adult's training and were knowledgeable about the different types of abuse and how to recognise the signs of abuse.

We found the premises were in a good condition however there were faults which the provider needed to be addressed in the toilets and bathrooms.

We found the provider kept people's records securely and followed the appropriate guidance for the safe management of people's records and information. The provider was able to locate records promptly when we requested them.

This review was based on evidence sent to us by the organisation in relation to outstanding improvement and compliance actions. As a visit did not take place we did not talk to people about the service on this occasion. Based on the evidence submitted to us we did find the service compliant on this occassion.

The inspection took place on 24 and  25 February and was unannounced. The last inspection was on 19 June 2013 and was found to be meeting all of the regulations we looked at.

Waterside Lodge is a residential home for up to 16 adults with mental health problems. On the day of our visit there were 12 people using the service.

The service had a registered manager. 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 were protected from harm and abuse. The service had a clear safeguarding procedure and staff all knew how to recognise and report any suspected abuse and keep people safe. All incidents had been investigated and reported to the local authority and CQC.

There were sufficient staff to meet people's needs and to provide personalised care. We saw that staffing levels had recently increased at night in response to changes in needs of people using the service.

People's medicines were managed safely. The service had a good system for recording and monitoring people's medicines, with regular audits taking place to make sure the processes were being followed correctly by all staff.

Staff had been fully trained and had the skills and knowledge they needed to care for people. The staff had been recruiting following safe recruitment processes and they received regular supervision and annual appraisals to make sure they had the support they required for their work.

Staff and managers all had a clear understanding of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People's consent was always sought for care and nobody was restricted in their freedom or deprived of their liberty.

People were supported to eat a healthy and balanced diet and were given choices about what they had to eat and drink, and when they had their meals.

Staff had good, caring relationships with people using the service and treated them with kindness and compassion.

People were involved in making decisions about their care and support. People had allocated keyworkers who they met with to discuss their care and make changes to their care plans and support programmes.

People had comprehensive, person-centred care plans based on their assessed needs, personal preferences and discussions with people and their families.

The provider had a clear complaints procedure and encouraged people to give their feedback about the service. Complaints were acted upon and action plans developed to respond to complaints.

The service had an open culture that was supportive and encouraged people using the service and staff to develop ideas and participate in the development of the service.