We carried out the inspection on 21 June 2017.

The Hall provides accommodation, nursing and personal care for up to 19 people who have a mental illness. There were 9 people receiving support at the time of our inspection.

The service had a registered manager. A registered manager is a person who has 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.

People told us that they felt safe. Staff understood how to keep people safe and report concerns if needed. The registered manager had ensured that all staff had undergone relevant employment checks.

Risks had been assessed and measures put in place to support people to remain safe. The environment had been considered and where people displayed behaviours which may harm themselves or others staff supported them to manage their anxieties.

People received their medicines as and when they needed them and medicines were managed safely.

People made decisions about their care and the support they received. People were involved and their opinions sought and respected. The registered manager understood their responsibility to ensure people were supported in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff felt supported by the registered manager. There received training and guidance to carry out their role. Staff had a clear understanding of their role and how to support people who used the service as individuals.

People’s health needs were met and when necessary, outside health professionals were contacted for support. Staff understood how to support people to maintain their health. People were supported to have sufficient to eat and drink.

People were treated with kindness and respect. Their independence was promoted and their opinions asked. People were clear on what support they could expect to receive and had access to independent professionals who could help them ensure they received the care they wanted.

People received care and support that was tailored to their individual needs. Professionals with expertise in their conditions were involved in planning people’s care with them. People’s needs were kept under review and plans were changed to reflect changing needs.

The registered manager and staff team were working to support people to engage in activities that were meaningful to them.

People who used the service felt they could talk to the registered manager and had confidence concerns would be acted upon. Staff were clear of their role.

There were effective systems for gathering information about the service, identifying areas of concern and to drive improvement. The provider demonstrated a drive for improvement through lessons learnt and best practice.

The registered manager was aware of their responsibility to report events that occurred within the service to CQC and external agencies.

We inspected the service on 27 and 29 January 2016. The inspection was unannounced.

At our last inspection carried out on 27 August 2014 the provider was not meeting the requirements of the law in relation to the care and welfare of people who use services and staffing. Following that inspection the provider sent us an action plan to tell us about the improvements they were going to make.

During this inspection we looked to see if these improvements had been made. We found that whilst some improvements had been made, some issues of concern remained.

Bhajan Kaur Rai Hall provides accommodation for up to 20 older people. There were 20 people using the service on the day of our inspection including people living with dementia.

The person managing the service was an acting manager. They were in the process of applying to be 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 and associated Regulations about how the service is run.

Some of the people using the service and their relatives felt there were not enough members of staff to support them properly. We observed occasions when people were required to wait to have their needs met as there were not always staff available to support them.

We saw that there was a policy in place that provided staff, visitors and people using the service with details of how to report safeguarding concerns. Staff were aware of this policy and how to report and escalate concerns if required. The provider followed safe recruitment practices.

People could not be fully assured that they would receive their medicines as prescribed by their doctor. Clear guidance about how staff should administer ‘as required’ medicines and creams was not available to staff.

We saw that staff received appropriate training to enable them to meet the requirements of their role and they felt supported by the acting manager.

Systems were in place to monitor the health and wellbeing of people who used the service. People’s health needs were met and when necessary, outside health professionals were contacted for support.

The service catered for individual dietary needs and staff were aware of how to provide these. People told us that they enjoyed the food provided. We saw that when people required support to eat their meals this was not always provided in a dignified manner and one person was required to wait for over an hour in the dining room before they were assisted with their meal.

The provider could not be sure that staff had given people the correct amount of fluids they needed to keep them well because recommended fluid intake was not clear and the total amount people drank was not tallied.

Where people lacked capacity to make decisions, records did not to show that decisions had been made for them in their best interest or in consultation with others.

Consideration had been given to the responsibility of the service to meet the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staff treated people with kindness and respect but there were times when staff were rushed and task orientated. People told us that they felt listened to and their opinions sought.

People were not always supported to follow their interests and limited activity or stimulation was provided.

We saw that people’s needs had been assessed and care plans had been put in place for staff to follow to ensure people’s needs were met. People had been referred for specialist input and advice received had been followed. Staff were made aware of people’s changing needs so that they were able to meet them.

People who used the service felt they could talk to the acting manager and had faith that they would address any issues if required. Relatives found the staff and the ac

Prior to our inspection we reviewed all the information we had received from the provider. On the day of our visit we spoke with nine people that used the service, and three visiting relatives for their views and experiences. Some people who used the service were not able to tell us their experience of the care they received due to illness or disability. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We also spoke with the registered manager, senior manager and eight staff this included a variety of both care staff and non care staff such as domestic and maintenance staff. We looked at some of the records held in the service, including the care files for three people who used the service.

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. This is a summary of what we found.

Is the service safe?

The provider assessed and reviewed people's needs to ensure plans of care, and associated risk assessments were up to date and reflected people's needs.

People were supported in an environment that was maintained to a safe, clean and hygienic standard. We also found equipment at the home had been maintained and serviced on a regular basis.

People’s dependency needs had been assessed. However, we had concerns that there were not sufficient staff available at all times to meet people’s assessed needs and keep people safe.

Is the service effective?

We saw the provider completed a pre-assessment of people’s need prior to moving to the service. Care staff had information available to them that instructed them of how to meet people’s needs.

People’s care and welfare needs were monitored and we saw appropriate action had been taken when changes to people’s health had occurred.

The provider had a detailed and structured induction programme for new staff. Staff received formal opportunities to discuss their training and development needs.

Is the service responsive?

People we spoke with told us they felt they had their needs met and that they were confident the provider acted appropriately to any changes in need.

People received support to practice their faith where they had requested it. Whilst we were told that an activity coordinator was employed at the service, people raised concerns about the lack of activities and stimulation. The lack of meaningful activities and stimulation impacted on people’s welfare needs.

Is the service caring?

We found the service to have a warm, welcoming and relaxed atmosphere. Staff were observed to interact with people in a caring manner, showing dignity and respect at all times.

People using the service and relatives spoken with, talked positively about the staff. Comments included, “Staff are very good, helpful and friendly.”

Is the service well-led?

We found the provider had systems in place that enabled them to monitor the quality and safety of the service.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

The provider had a complaints policy that promoted people's rights and choices. This was easily accessible to people who used the service.

People using the service told us they were involved in decisions made about their care and support. People spoke highly of the quality of care and support they received. One person said: “You get what you pay for and that’s why we are here. As you can see I’m very satisfied.”

People had a range of assessments and care plans in place to inform staff about how to support people and meet their daily needs. People were supported to take their medicines. Arrangements were in place to ensure people’s care and health needs were met safely and risks were managed.

People were supported by staff that underwent a robust recruitment process to ensure they were suitable and qualified to work with vulnerable people. People were comfortable with the staff that supported them. One person said: “Staff seem to be very nice here.”

People were aware of how to make a complaint and provided with a copy of the complaint procedure. One person said: “I haven’t got any complaints. I would complain if I had a problem.”

Information about the people who used the service was kept in their individual care files and stored securely. Staff were aware of their responsibilities to maintain accurate records. Other records relating to the staff and the management of the service were accurate, kept secure and could be easily accessed when required.

People had a range of assessments and care plans which detailed the care and support they needed. People were supported with their choice of lifestyle and interests. One person said “They helped me recover when I was poorly and now I pretty much look after myself”. Another person said “The staff help people that need the help, you see staff sit and help some people with meals or spend time doing their nails.”

People’s health and care needs were monitored and reviewed regularly by staff. People had access to a range of health and social care professionals that ensured their health needs were met.

People told us they always had a choice of meals and were satisfied with the quality and choices available. One person said “The meals are lovely, especially the hot dinners for tea.”

People told us they had opportunities to make comment about the service. People were aware of how to express concerns or make a complaint about the service and were confident that the concerns would be addressed quickly.

People were supported by enough qualified, skilled and experienced staff to meet their needs. One person said “I’ve found the staff to be kind and very caring.”

The provider had an effective quality assurance system, which monitored the day to day running of the service. These included audits and checks on the environment, and the management and delivery of care, staff and health and safety. People using the service and their relatives had opportunities to comments and give their views about the quality of services experienced.

People praised the staff employed at Bhajan Kaur Rai Hall (BKR) one person said they were bored as they didn’t have enough to do.