This inspection took place on 4 April 2017 and was unannounced. At our last inspection in March 2015 the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

Sidney Avenue Lodge is a care home for adults with learning disabilities, including those with a dual diagnosis of a mental health condition. The maximum number of people the home can accommodate is eight. On the day of the inspection there were six people residing at the home.

There was a registered manager in post but they were not available on the day of our inspection. The deputy manager, who is planning to become the new registered manager, supported us with the 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.

People told us they liked the staff and they felt safe at the home. They were aware of the risks they faced as part of their care and these risks were recorded and known to staff. Risks had been recorded in people’s care plans and ways to reduce these risks had been explored and were being followed.

Relatives were positive about this family run home and the domestic nature of the accommodation. Everyone we spoke with told us the service was very homely and relaxed and everyone knew each other very well.

Staff understood their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff turnover was low and staff were positive about working at the home and told us they appreciated the support and encouragement they received from the deputy manager.

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 the food cooked by staff. People were offered choices of what they wanted to eat and any special diets they had were catered for.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences.

People told us that the management and staff listened to them and acted on their suggestions and wishes.

Both people using the service and their relatives told us they were happy to raise any concerns they had with any of the staff and management of the home.

People were included in monitoring the quality of the service. People's suggestions for improvements and preferences about how they wanted to live their lives were respected and acted on.

As the Care Quality Commission was not always receiving statutory notifications about certain changes, events and incidents affecting their service or the people who use it, the judgment for well-led has been rated as 'requires improvement'.

After our inspection of 8 July 2014 the provider wrote to us to say what they would do to meet legal requirements for the breaches we found. We undertook this unannounced focused inspection to check that the breaches of legal requirements had been addressed.

These breaches related to staff recruitment procedures, safeguarding people from abuse, consent to care and treatment, staff training, planning care and responding to health care needs, respecting peoples’ privacy and assessing the quality of service provision.

We undertook this inspection on 10 March 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Sidney Avenue Lodge Residential Care Home on our website at www.cqc.org.uk.

Sidney Avenue Lodge Residential Care Home provides care and support for eight men who have learning disabilities and also have a mental health diagnosis. There were eight people living at the service at the time of our inspection. It is a family run business and four family members were working at the home, one of whom was the 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.

Following the comprehensive inspection in July 2014 we were informed that the deputy manager would be applying to become the registered manager of the home and the existing registered manager would be stepping down from this role. At this inspection we met both the deputy manager and the registered manager.

At this inspection we found that the provider had addressed these breaches of legal requirements.

People we spoke with told us they felt safe and had no concerns about how they were being supported at the home. The management and staff had undertaken safeguarding adults training and could clearly explain how they would recognise and report abuse.

The deputy manager made sure that people were being protected from unsuitable staff being employed at the home.

Care plans showed that decision specific capacity assessments were being undertaken for each person who used the service to make sure their decisions and choices about their care were recorded, respected and acted on.

Staff training and supervision had improved since the last inspection and staff told us they were more confident when supporting people because of this.

We saw that people’s weight was being monitored and discussed both in management and staff meetings and action taken if any concerns were identified.

Staff gave us examples of how they maintained and respected people’s privacy. These examples included keeping people’s personal information secure as well as ensuring people’s personal space was respected.

At this inspection we found that the kitchen remained open and food was available to people without them having to ask staff and undermine their independence.

The deputy manager had made sure that regular house meetings took place with people who used the service and we saw from minutes of these meetings that people’s views about the quality of the service were sought as well as any suggestions they had for improvements.

Staff told us that their opinions about the home and how it was run were sort and respected by the management.

We carried out an unannounced comprehensive inspection of this service on 8 July 2014. Several breaches of legal requirements were found. As a result we undertook a focused inspection on 4 November 2014 to follow up on whether action had been taken to deal with the most significant breaches.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 8 July 2014

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

This was an unannounced inspection. At the last inspection carried out on 4 March 2014 we found that the provider was not meeting the regulation in relation to medicines as there were not appropriate arrangements in place for the safe storage, administration and disposal of medicines. Following the inspection the provider sent us an action plan telling us about the improvements they were going to make. During this inspection we found that the provider had not taken action to address these issues. We have taken action against the provider and issued a warning notice about the unsafe management of medicines.

Sidney Avenue Lodge Residential Care Home provides care and support for eight men who have learning disabilities and also have a mental health diagnosis. There were eight people living at the service at the time of our inspection. It is a family run business and four family members were working at the home, one of whom was the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were not kept safe at the home. There were poor arrangements for the management of medicines that put people at risk of harm, staff were unable to demonstrate they knew how to identify or respond to abuse and the recruitment checks for new staff were not complete.

We found that there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves as required under the Mental Capacity Act (2005) Code of Practice.

Although people’s needs had been assessed and care plans developed these did not always adequately guide staff so that they could meet people’s needs effectively. Also, potential health concerns such as significant weight loss were not always identified which could result in people’s healthcare needs not being met.

Staff were not provided with sufficient supervision and training to ensure they were able to meet people’s needs effectively but they were given an induction to the service so that they knew what people’s needs were.

Staff did not always respect people’s privacy and standard restrictions were unnecessarily applied to everyone using the service. For example, people were at times restricted from making themselves snacks and drinks which meant their independence was not always promoted.

The provider was not adequately monitoring the quality of the service and therefore not effectively checking the care and welfare of people using the service. In addition to this the provider had failed to provide information requested by the Care Quality Commission about the service.

People told us they were cared for by staff and we saw that people were involved in the recruitment of new staff and planning social events at the home. They told us they enjoyed the food and were supported to maintain relationships with family and friends. We observed caring interactions between staff and people using the service and saw that people were encouraged to access local amenities and take part in leisure activities.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Focused inspection of 4 November 2014

After our inspection of 8 July 2014 the provider wrote to us to say what they would do to meet legal requirements for the breaches we found. We undertook this unannounced focused inspection to check that the most significant breaches of legal requirements, concerning the management of medicines, which had resulted in enforcement action, had been addressed. We checked to see that the provider had followed their plan and to confirm that they now met legal requirements. We found that the provider had followed their plan in relation to this regulation. This means legal requirements for the management of medicines had been met.

A system for auditing the management of medicines had been implemented to check whether medicines were being administered safely and as prescribed. Medicines were stored safely. Medicines policies had been updated. A risk assessment was now in place for a person who wanted to self-administer their medicines. Care plans were in place for people prescribed medicines for challenging behaviour. Staff managing medicines for people had received medicines training, and staff without recent medicines training did not administer medicines unsupervised.

We found that there were some issues with the recording of medicines. We were provided with evidence following the visit that medicines records were now completed fully and that systems were now in place to manage medicines safely, to protect people using the service against the risks associated with the unsafe use and management of medicines.

We will undertake another unannounced inspection to check on all other outstanding legal breaches identified for this service.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

This was an unannounced inspection. At the last inspection carried out on 4 March 2014 we found that the provider was not meeting the regulation in relation to medicines as there were not appropriate arrangements in place for the safe storage, administration and disposal of medicines. Following the inspection the provider sent us an action plan telling us about the improvements they were going to make. During this inspection we found that the provider had not taken action to address these issues. We have taken action against the provider and issued a warning notice about the unsafe management of medicines.

Sidney Avenue Lodge Residential Care Home provides care and support for eight men who have learning disabilities and also have a mental health diagnosis. There were eight people living at the service at the time of our inspection. It is a family run business and four family members were working at the home, one of whom was the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were not kept safe at the home. There were poor arrangements for the management of medicines that put people at risk of harm, staff were unable to demonstrate they knew how to identify or respond to abuse and the recruitment checks for new staff were not complete.

We found that there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves as required under the Mental Capacity Act (2005) Code of Practice.

Although people’s needs had been assessed and care plans developed these did not always adequately guide staff so that they could meet people’s needs effectively. Also, potential health concerns such as significant weight loss were not always identified which could result in people’s healthcare needs not being met.

Staff were not provided with sufficient supervision and training to ensure they were able to meet people’s needs effectively but they were given an induction to the service so that they knew what people’s needs were.

Staff did not always respect people’s privacy and standard restrictions were unnecessarily applied to everyone using the service. For example, people were at times restricted from making themselves snacks and drinks which meant their independence was not always promoted.

The provider was not adequately monitoring the quality of the service and therefore not effectively checking the care and welfare of people using the service. In addition to this the provider had failed to provide information requested by the Care Quality Commission about the service. 

People told us they were cared for by staff and we saw that people were involved in the recruitment of new staff and planning social events at the home. They told us they enjoyed the food and were supported to maintain relationships with family and friends. We observed caring interactions between staff and people using the service and saw that people were encouraged to access local amenities and take part in leisure activities.                                                                                                    

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

At our inspection on 4 October 2013, we found that there were insufficient numbers of staff employed for the needs of people who use the service. The provider gave us an action plan to address the staffing levels. Concerns were raised with us about medicines in the home after this inspection.

During this visit we visited the home to identify whether the provider had implemented their own action, and to review the how medicines were managed. We found four new care workers were recruited in February 2014, and rotas showed that two members of staff, rather than one, were on duty most nights. This meant that there were enough staff employed to meet people's needs.

However, we found that medicines were not always managed safely. We identified some concerns with the recording, ordering, administration and storage of medications.

At our inspection on 11 April 2013 we found the service had not ensured that people and management records were up to date and consistent. The assistant manager gave us an action plan to address these concerns. We returned on 4 October 2013 and as their action plan had not been implemented, we served a warning notice on the registered manager.

At this inspection we visited the service to whether the service had made changes to ensure that records were consistently maintained. We found that although the service had changed the dates on people’s care plans and risk assessments, the contents referred to outdated information. Some people’s daily records had not been updated for one or two days and others were not available to us. A number of policies and procedures requested at the last inspection were not available and others had not been updated. We also saw that staff training records for members of staff that no longer worked at the service were displayed in the hallway. The registered manager was not present during the inspection and we raised our concerns with the assistant manager, who is also the nominated individual for Sidney Avenue Lodge. They told us they had primarily focussed on improving staffing levels since the last inspection, and that they felt sufficient changes had been made to records used in the service.

Since the inspection, the Enfield safeguarding team gave the provider a limited timeframe to address their record keeping and staffing issues. We met formally with the provider to review the progress they had made shortly after this. We also undertook a follow up visit on 4 March 2014, and found a number of care plans had been reviewed and updated. As a result of these interventions, the provider had made improvements to their records so that they were used to protect people's safety and welfare.

We talked to four people who used the service and one person's relatives. One view was representative when we were told "you've got nothing to worry about inspector, this place is our home and it's great." The service had recently implemented new systems to routinely gather people's views.

We found that there were insufficient numbers of staff employed for the needs of people who use the service. We also found that the accuracy of people's records and the homes' policies were not always maintained.

The registered manager had completed a night shift on the day of the inspection and we spoke with the deputy manager. We talked to four people who used the service. One person's views were representative when they said "the place is good." People were asked to give their consent for all aspects of the care provided. Arrangements were in place to ensure people had appropriate care and treatment. In relation to their care one person told us they "feel much healthier here." We found that staffing levels were sufficient for the needs of people who use the service.

We identified concerns with the monitoring of the quality of service provision. The home was not routinely gathering people's views. We also found that the accuracy of people's records and the homes' policies were not always maintained.

We observed that people were involved and consulted about decisions affecting their care. A pictorial format has been used so that people could be involved and their choices were reflected in their care plans. The three people we spoke with said that they received the care and support they needed. A person said, “Staff have time for you.” Care plans gave clear guidance for staff about how they should meet people's learning disability needs.

People spoken with confirmed that they trusted staff and felt safe. A person told us, “I feel safe here.” The three staff spoken with knew how to respond to safeguarding concerns to keep people safe and promote their rights. People felt that staff knew how to meet their needs. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.