The inspection took place on 22 and 24 August 2017 and the first day was unannounced.

Swanage Lodge provides support and accommodation for up to six people who have a mental health diagnosis. There were six people using the service at the time of this inspection.

There was a registered manager in post who was also the provider and had a second registered location near to Swanage Lodge. 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 last inspection took place on 26 and 27 April 2016 when we rated the overall service and Safe and Effective domains as Requires Improvement. We had previously found there needed to be improvements in relation to obtaining consent for decisions made about people’s lives and ensuring there were systems and processes in place to prevent abuse of people using the service. At this inspection we found improvements had been made in these areas.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. Those staff we asked knew what to do if they thought a person using the service was at risk of being abused.

There was an ongoing safeguarding investigation taking place at the time of this inspection. This had not been concluded at the time of writing our report.

Feedback from people using the service, staff we spoke with was positive about the service.

The atmosphere in the service was relaxed and we saw that staff chatted with people to make sure they were happy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

People’s care records included people's needs and preferences. Potential risks had been identified and assessed to guide staff on how to support people appropriately. We saw information had been reviewed on a regular basis.

People were involved where possible with agreeing to the support they received. House meetings were held regularly to encourage people to voice their opinions of the service.

People were supported to be as independent as they could safely be. Some people went out without staff and accessed various places in the community. Staff went with people on holidays and assisted them to see their family and friends.

There were checks on a range of areas in the service, including health and safety and medicines to ensure people received safe good care and that improvements were made where needed.

Staff continued to receive support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged in various ways that were relevant to staff member's roles and responsibilities.

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People received the medicines they needed safely.

People had access to the health care services they required and their nutritional needs were being met.

There was a complaints procedure available and people knew to talk with staff if they had a complaint.

This inspection took place on 26 and 27 April 2016 and the first day was unannounced. We last inspected the service in July 2014 when it met all of the regulations.

The service is a care home without nursing and provides accommodation and personal care to up to six people with mental health needs. When we inspected, six men and women with mental health needs were using the service.

There was a 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.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. However, there were no clear systems and processes in place to demonstrate how all allegations would be effectively investigated.

Staff had undertaken training in the Mental Capacity Act (MCA) 2005 and the registered manager was aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). We were told and saw that people were given choices and the opportunities to make decisions. However, people’s ability to make decisions was not clear on their care records. Also there was a restriction for people in that they could not access the kitchen without a member of staff and this had not been risk assessed or identified by staff as a restriction.

People had various levels of independence and required different levels of support and encouragement. Staff understood people's individual needs and knew how to motivate them.

People’s nutritional needs were being met. Staff supported people to cook meals where they were able to.

Staff received the training they needed to provide them with the skills and knowledge to care for and support people effectively.

There were enough staff on duty day and night to make sure people’s needs were met in a safe and timely way.

The provider carried out checks to make sure staff were suitable to work with people using the service.

Care plans were in place and people had their needs assessed. Care records reflected the needs and wishes of the individual and included information about these needs so the staff could support them.

People had a range of risk assessments in place to help them maintain their independence and to guide staff in how to support them.

The health needs of people were being met. Staff had received support from healthcare professionals and worked with them to ensure people's individual needs were being monitored and met.

A range of activities were offered to people and they had the chance to engage in these both in house and in the community with each other. People also had the opportunity to go on holiday.

The provider had a complaints procedure and people told us they knew how to make a complaint or what to do if they were unhappy about something.

People received their medicines as prescribed and in a safe way and there were records to show these had been administered.

There were systems in place to monitor the quality of the care being provided.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to systems and processes had not been established or operated effectively to protect people from abuse. The provider had not also not acted in accordance with the Mental Capacity Act.

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

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

Below is a summary of what we found. The summary is based on discussions with management during the inspection, speaking with relatives of people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

Staff were familiar with people’s risk assessments and how to manage and mitigate those risks.

There were suitable systems and procedures for managing medicines and evidence of these procedures being followed carefully and correctly to ensure medication was stored, administered and disposed of safely.

Systems were in place to make sure accidents and incidents were reported along with complaints and other concerns and action taken when required. This reduced risks to people and helped the service to continually improve its performance.

There were procedures for managing emergencies. Staff had received appropriate training and were aware of relevant procedures and contacts to access help and support.

Is the service effective?

People using the service experienced care that was planned and delivered to meet their needs and reduce any risks. Assessments were undertaken prior to using the service using input from people and their relatives, and other health professional involved in their care. Care plans were personalised and took account of preferences, cultural and religious requirements.

Care needs were reviewed on a regular basis and care plans could be modified if needs changed. Records showed the care delivered reflected the current care plan and reviews were all fully documented or up to date. Regular reports were prepared by care staff to make sure the care and support provided matched current needs. People were encouraged to engage in activities and life inside and outside the home and to be involved in managing their care as far as possible.

Staff had regular training and supervision to ensure their skills were up to date and appropriate. This helped to ensure people received a good quality service

Is the service caring?

We observed that people were cared for by empathetic staff who demonstrated a good understanding of people’s individual needs, behaviour and preferences. Staff we observed communicated well with people and were patient and friendly.

People we spoke with told us they were happy with the care and support provided and that staff were kind and supportive in meeting their needs. One person said, “The staff are very good. They’re always helpful and willing to help out.”

Is the service responsive?

People using the service had regular opportunities to express their views and opinions. Weekly meetings were very well documented and detailed issues raised and any resulting action points.

Monthly staff meetings were held so any concerns could be raised and addressed promptly and changes made to the care and support provided if required.

There was a written complaints procedure which was readily available for people using the service. No written complaints had been recorded but there was evidence of informal complaints having been dealt with at house meetings in a timely and appropriate manner.

Is the service well-led?

The provider had a variety of systems to monitor the quality of service provided and audit their performance.

People using the service and their relatives were provided with information about the service and were contacted regularly to obtain their feedback and views.

There were appropriate procedures for dealing with complaints and reporting accidents and incidents.

At the last inspection which took place on 5th June 2013 we found that the service was not meeting essential standards of quality and safety as not all of the fire doors closed properly. Following the inspection the manager submitted an action plan informing us that the service would address this issue and be compliant by 7th June 2013. He also confirmed that weekly checks on the fire doors would be carried out and recorded.

At this inspection we found that the provider had taken steps to provide care in an environment that was adequately maintained. We met with the manager and saw records that confirmed that staff had been checking the fire doors on a weekly basis to ensure that they were closing. We carried out a tour of the home with the manager. We checked the fire doors and those that had not closed at the previous visit were closing properly. However, three bedroom doors did not fully close when we checked them.

We informed the London Fire and Emergency Planning Authority (LFEPA) of this as they carry out checks in services to ensure that appropriate steps are taken in relation to fire safety.

The manager confirmed that there had been issues with the equipment the home was using to ensure doors closed safely and not too quickly which might place some people using the service at risk of harm. On the same day of the visit the manager confirmed to us in writing that the fire doors had all been fixed and were closed properly which protected people in the event of a fire occurring in the home. He also told us that these doors would be checked daily to ensure they always closed appropriately. This will be checked during our next inspection visit.

We met with four people who use the service, the manager, three other members of staff and a volunteer.

Before people received any care or support they were asked for their consent and the provider acted in accordance with their wishes. Staff told us they supported people to make daily decisions about their lives. One person said “I can choose where I go and I like to visit the shops and my family.”

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Overall care records provided staff with a good picture of each person, their needs and how these were to be met. Appointments were recorded if people saw a healthcare professional. This included input from the GP and dentist. This ensured that staff could monitor people's health needs and respond accordingly if they changed.

The provider had not taken steps to provide care in an environment that was adequately maintained. We found two fire doors that did not close properly and therefore would not protect people if a fire occurred.

There were enough qualified, skilled and experienced staff to meet people's needs. We viewed the rota and saw that the majority of time there were two care staff on during a shift. One person said there was always a member of staff to talk to if they wanted to have a chat with them. The manager was based in the home and was available to assist people and staff if they needed support.

Various audits took place in order to monitor the running of the home and any issues identified were recorded so they could be addressed. The staff team obtained the views of people in different ways. We saw that house meetings took place on a regular basis where people could hear news about the home and share their views. The manager confirmed that satisfaction surveys would be given to people living in the home, their relatives and professionals.

We spoke with four people who live in the home, the manager and one member of staff during the visit. In addition we telephoned two relatives and saw comments from healthcare professionals in the 2012 satisfaction surveys. We also received direct feedback from one healthcare professional. We found no concerns during this visit and saw a report showing that the monitoring team from Hillingdon Local Authority had last visited the home on 6 October 2011. They had no issues with the care and support people received in the home.

One person said staff “were easy to talk with” and they would talk with them if they had a complaint. Another person said “the other people in the home are fine and I can spend time with them or in my bedroom”. People told us they did not feel pressured to always be with everyone and enjoyed having their own space.

Relatives confirmed they were happy with the home and how staff supported people. Both relatives commented positively about the staff team with one saying the staff team were “consistent” and they kept them informed if there were any changes to the person’s needs.

The results from the March 2012 satisfaction survey that healthcare professionals completed contained favourable comments about the home. One survey noted the home was an “individualised service” and another said there was a “high standard of care” provided in the home.

People who use the service told us they were happy with the support they receive and felt that the staff were "friendly". They said there was always a member of staff in the service that they could talk to.

People told us they were involved in the care planning process and information that staff write about them.

People said they would talk with staff or family if they had a complaint and they felt safe living at the service.

Other comments about the service included:

"I can cook when I want to and make myself a drink" and "I am happy that staff look after my medicines".