This inspection took place on 5 July 2018 and was unannounced

We carried out an unannounced comprehensive inspection of this service on 3 October 2017. After that inspection we received concerns in relation to how people were supported to manage their finances and that there was a controlling culture at the service. As a result, we undertook an unannounced focused inspection of Welcome House – Ruby Lodge. We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe. At this inspection the service was rated as it requires improvement in safe and well-led, therefore the overall rating for the service is now requires improvement. This report only covers our findings in relation to these two domains. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Welcome House -Ruby Lodge on our website at www.cqc.org.uk.

Welcome House – Ruby Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ruby Lodge is registered to provide accommodation and personal care for up to 17 people with mental health needs who do not require nursing care. People who lived at the service needed support with managing their mental health needs. They needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, 13 people lived in the service. On the whole people could make their own decisions about how they lived their lives.

There was a registered manager working at the service. 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.

The registered manager had oversight about what was happening at the service on a day to day basis, however in certain areas they lacked knowledge and awareness. People were not fully protected from harm and abuse. The registered manager had not followed safeguarding protocols. Incidents had occurred when people had been abusive towards each other. The registered manager had not reported or discussed potential safeguarding incidences with the local safeguarding authority. Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like police or safeguarding incidences. The registered manager had not informed CQC of important events that occurred at the service, in line with current legislation. Clear staff disciplinary procedures had been adhered to when they identified unsafe practice.

The staff culture at the service did not fully take into account the rights of the people. People reported some staff being not being respectful.

Some potential risks to people were identified like eating safely and when people had behaviours that could be challenging. Full guidance on how to safely manage risks was not always available. Some people smoked, there was a generic risk assessment which outlined how to prevent the risk of fires related to smoking but there were no individual, personalised risk assessments in place. Some people presented an increased risk of harming themselves or others due the fact they carried lighters on their person. There had been incidences when staff and people had been placed at risk because of this. Action had not been taken to reduce the risk. Some environmental risks had not been identified there was a risk of people being scalded as the hot water was over the recommended safety temperature. Some windows were not restricted to prevent people opening them widely.

The inspection was carried out on 03 October 2017, and was an unannounced inspection.

Ruby Lodge is registered to provide accommodation and personal care for up to 17 people with mental health needs who do not require nursing care. The people who lived at the service lived with mental health disorders and needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, 15 people lived in the service. They were fairly independent and required minimal support.

At the last Care Quality Commission (CQC) inspection on 05 October 2015, the service was rated Good in all domains and overall.

At this inspection we found the service remained Good.

People continued to be safe at Welcome House - Ruby Lodge. People continued to be protected against the risk of abuse. People felt safe in the service. Staff recognised the signs of abuse or neglect and what to look out for.

Medicines were managed safely and people received them as prescribed.

There were enough staff to keep people safe. The provider had appropriate arrangements in place to check the suitability and fitness of new staff.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received regular training and supervision to help them to meet people's needs effectively.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff were caring and treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff encouraged people to actively participate in activities, pursue their interests and to maintain relationships with people that mattered to them.

The registered manager ensured the complaints procedure was made available to people to enable them to make a complaint if they needed to.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

Further information is in the detailed findings below.

We inspected this home on 6 October 2015. This was an unannounced inspection.

Ruby Lodge is registered to provide accommodation and personal care for up to 17 people with mental health needs who do not require nursing care. The people who used the service lived with mental health disorders and needed support to understand their particular conditions; identify triggers for relapse; and learn coping strategies. At the time of our inspection, 13 people who lived in the home were fairly independent, hence requiring minimal support.

There was a registered manager at the home. 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 against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The home had risk assessments in place to identify and reduce risks that may be involved when meeting people’s needs such as mental health, and details of how the risks could be reduced. This enabled the staff to take immediate action to minimise or prevent harm to people.

There were sufficient numbers of staff to meet people’s needs. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

Staff were recruited using procedures designed to protect people from unsuitable staff. Staff were trained to meet people’s needs and they discussed their performance during one to one meetings and annual appraisal so they were supported to carry out their roles.

Safe medicines management processes were in place and people received their medicines as prescribed.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

People’s care plans contained information about their personal preferences and focussed on individual needs. People and those closest to them were involved in regular reviews to ensure the support provided continued to meet their needs.

Staff were aware of signs and symptoms that a person’s mental health may be deteriorating and how this impacted on the risks associated with the person’s behaviour. People were supported as appropriate to maintain their physical and mental health.

Staff meetings took place on a regular basis. Minutes were taken and any actions required were recorded and acted on. People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained. The registered manager understood the requirements of their registration with the Commission.

There were assessments undertaken on admission and care plans had been developed and drawn up with the individual; these were focused on promoting independence with the person who used the service.

We spoke with three people who used the service, one said “staff treat me with respect”, another said “staff treat me well, I get lots of choices and I know about my care plan”.

We looked at care plan files for people who used the service and saw that individual risk assessments were in place. We saw that mental health assessments were up to date and that Community Psychiatric Nurses (CPN’s) were involved in peoples care.

People who lived at Ruby Lodge were encouraged to be as independent as possible through their care plans and support; they did their own cleaning and helped to maintain the overall cleanliness of the communal areas of Ruby Lodge. We saw that the areas of the home we viewed were clean and tidy.

We found that the registered manager had a range of risk assessments in place including but not limited to, slips, trips and falls, an up to date fire risk assessment, environmental risk assessments and assessments covering the control of substances hazardous to health. (COSHH).

We found that the registered manager used a range of methods to collect feedback from people who used the service, their representative or relatives and that these had been responded to.

There were effective recruitment and selection processes in place.

At the time of our inspection there were nine people living at Ruby Lodge. People were able to lead semi-independent lives and received care and support from staff at a level which was appropriate to each person.

People told us that they "enjoyed living at the home" and that staff were "very friendly and approachable". One person told us that the food was "lovely" and there was always "plenty of it".

The manager and staff at Ruby Lodge understood the needs of each service user and were very well informed about each of the service users.

There was a robust complaints procedure in place and people felt able to raise concerns with the manager and staff members. There was a copy of the complaints procedure available to the service users and this was in an easy-to-read format.

Overall, the home was clean and tidy but the home did not have a system in place to prevent, detect and control the contamination of the homes water supply system with legionella bacteria. This posed a risk to the people using the service and also to those working at Ruby Lodge and we have asked the Provider to address this in a timely manner.

People told us that they liked the home, the staff members were very nice, they went out where and when they wanted to, the food was good and they felt looked after.