Bishopsmead Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bishopsmead Lodge provides accommodation with nursing and personal care for up to 51 people. At the time of our inspection 43 people were living in the home.

At the last inspection on 15 March 2017 the service was rated Requires Improvement. We found a breach in the regulation relating to personalised care. Following this inspection, the provider sent us an action plan telling us how they would make the required improvements.

We carried out a comprehensive inspection on 17 and 18 April 2018. At this inspection, we found improvements had been made in the recording of personalised care and the legal requirement was met. However we found three breaches in the regulations relating to the management of medicines, meeting nutritional and hydration needs and quality assurance systems.

The service remains Requires Improvement.

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.

Medicines were not always safely managed. The provider’s monitoring and checking systems had not picked up when medicines had not been given as prescribed. This meant people were at risk of not receiving the care and treatment they needed.

There were on-going organisational safeguarding investigations at the time of our inspection, due to a number of care concerns raised. The provider had been required by the local authority safeguarding team to complete a protection plan to demonstrate that people were safe in the home.

Risk assessments and risk management plans were completed. Incidents and accidents were recorded and the records showed that required actions were taken to minimise future occurrences.

Sufficient numbers of staff were deployed at the time of our visit. There were significant registered nurse vacancies and the home was reliant on agency registered nurses on a regular basis each week to provide clinical expertise and leadership. Staff performance was not effectively monitored. Improvements were needed to make sure staff received supervision in line with the provider’s policy, and to make sure they could meet people’s needs.

Appropriate health and safety checks were undertaken to reduce risks to people. The home was clean and on most occasions staff followed the homes infection control policy and procedures.

People were not always provided with the support they needed with food and fluids and records were not accurately maintained. People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

People’s legal rights were respected. People were supported to exercise control, consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

Staff were kind and caring. We found people were being treated with dignity and respect and people’s privacy was maintained.

People who used the service felt able to make requests and express their opinions and views. People were helped to exercise choice and control.

The service that was not consistently well-led. Systems were in place for monitoring quality and safety. However, shortfalls in care were not always identified.

This inspection took place on 15 March 2017 and was unannounced. Since the previous inspection conducted in July 2016 the registration status of the service has changed to a new legal entity, but has remained with the same provider organisation.

Bishopsmead Lodge is registered to provide accommodation for persons who require personal or nursing care for up to 51 people. The service cares for older people, some of whom are living with dementia. At the time of our inspection there were 42 people living in the service.

There was a registered manager in place on the day 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.

In the main care plans contained risk assessments for areas such as falls, moving and handling and skin integrity and where risks had been identified the plans guided staff on how to reduce the risks. For example, plans contained hoist and sling details when required. Care plans did not reflect people’s individualised needs. The quality and content of care plans were variable.

We found that arrangements in place for managing medicines were in the main managed safely. Some medicines were not stored correctly, in line with legal requirements. This was identified in a previous pharmacy check. Staff told us they were in the process of obtaining a new store cupboard for these medicines.

People's rights were in the main being upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. In people's support plans we saw information about their mental capacity and Deprivation of Liberty Safeguards (DoLS) being applied for. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

Records showed that a range of checks had been carried out on staff to determine their suitability for work. Staff were supported through an adequate training programme but further work was required regarding holding regular supervision. Supervision is where staff meet one to one with their line manager.

The staff we spoke with had a good awareness and understood their responsibilities with regard to safeguarding people from abuse. Staffing rotas viewed demonstrated that staffing levels were maintained in accordance with the assessed dependency needs of the people who used the service.

We observed some positive interactions between people and staff throughout the inspection. There was plenty of laughter and the atmosphere was calm and friendly. Staff were knowledgeable about people's needs and were aware of their life histories and background. Staff told us how people preferred to be cared for and demonstrated they understood the people they cared for.

People spoke positively about the activities offered and told us the programme was varied and enjoyable. Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

People had access to on-going healthcare services. Records showed that people were reviewed by their GP, the physiotherapist, the tissue viability nurse, the chiropodist and the dementia well-being team.

Although regular staff meetings were not held staff felt well supported by the registered manager.

People advised that they would be either extremely likely or likely to recommend the service to friends and family if they needed similar care or treatment. They felt listen