We completed an unannounced inspection at Blacklake Lodge on 10 October 2018. When we completed our previous inspection on 29 June 2017, we found breaches in Regulations 12, 13, 17 and 18. The provider did not have safe medicine management systems in place, staff did not always recognise how to protect people from abuse, staff were not deployed effectively and the systems to monitor the service were not effective. This is the second consecutive time the service has been rated Requires Improvement.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective and well led to at least good. At this inspection we found that improvements had been made to meet the regulations. However, some further improvements were needed.

Blacklake 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.

Blacklake Lodge accommodates up to 37 people in one adapted building. There were 34 people using the service at the time of the inspection.

There was a newly appointed registered manager 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 2008 and associated Regulations about how the service is run.

Improvements were needed to ensure medicines were consistently managed safely to protect people from potential harm.

Records were not always accurate and up to date. Improvements were needed to ensure the systems in place to monitor the service people received were imbedded and sustained.

We have made a recommendation about the environment for people living with dementia.

People were protected from the risk of abuse because staff how to recognise and report suspected abuse.

Risks to people’s health and wellbeing were managed and followed by staff who knew people well, which ensured people were supported safely.

There was enough suitability recruited and skilled staff to provide support to people. Staff had received training to ensure they had sufficient knowledge to carry out their role effectively.

People were protected from the risk of infection because the provider had policies and systems in place to control infection risks at the service.

The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005, which ensured people were supported in their best interests and in the least restrictive way possible.

People enjoyed the food provided and were supported with their nutritional needs. Action was taken to ensure people at high risk of malnutrition were supported effectively.

Advice was sought from health and social care professionals when people were unwell, which was followed by staff.

There were systems in place to ensure people received consistent care from staff within the service and external agencies.

People received support from staff that were kind and compassionate. People’s dignity was respected and their right to privacy upheld.

People were supported with their communication needs and information was provided in a format people understood which meant that people were supported to make informed choices.

People received care that met their preferences. People’s past lives, cultural and diverse needs were assessed and considered to enable individualised care that met all aspects of people’s needs. People had opportunities to participate in social activities, interests and hobbies.

The provider had a complaints policy which was available to people and their relatives.

People, relatives and staff felt able to approach the registered manager and feedback had b

This inspection visit was unannounced and took place on 29 June 2017. At our last comprehensive inspection on 25 February 2017 the provider was rated as inadequate and this provider was placed into special measures by CQC.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We saw some improvements had been made, however the provider had not taken sufficient action to comply with the regulations recognising the importance of staffing, people’s consent and capacity, person centred care, safe care and treatment, and good governance. The provider sent us an action plan on 3 March 2017 explaining the improvements they planned to make. At this inspection, we found improvements had been made in some areas, however in other areas there was insufficient improvements where compliance actions had been identified.

The service was registered to provide accommodation for up to 37 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 31 people were using the service.

The service did not have a 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. The provider had recruited a manager and we saw that they had commenced the process for registration with us. People and relatives told us that since the new manager had been employed they had seen some improvements.

The provider did not always notify us of events. Audits to monitor and evaluate the service were not completed to reflect on quality and drive improvements. The fire procedures and maintenance had not been completed; the provider has been advised by the fire service to make some improvements to meet the regulations.

Medicines were not always available when required to meet people’s needs and , the stock had not been checked and maintained access to as and when required medicine had not always been available to support people’s pain relief.

There was not always enough staff to support people’s needs and respond when they required support. Not all the staff were able to provide us with the assurance they understood how to protect people from harm and the reporting process. Staff had not all received training to enable them to support people and initial inductions had not been completed to cover the required levels of support for their role.

People’s capacity assessments had been completed to consider how the person can contribute to their decision making, however it was not clear how this assessment had been obtained. Best interest decisions had not been made with the relevant people to ensure the decision was the least restrictive. Some people were deprived of their liberty and the authorisations had been sought from the local authority.

People were able to make their preferences known, which had been documented in the care records. People were encouraged to be independent and make choices about how they spent their day. There was a complaints procedure and people felt able to raise any concerns.

People had established relationships with staff and felt cared for. People told us staff treated them with dignity and respect. Relationships and friendship that were important to people were maintained. Staff felt supported by the new manager and that things had started to improve.

We saw people had a choice of food and were

This inspection visit was unannounced and took place on 28 February 2017. At our last inspection visit on 20 January 2015 we asked the provider to make improvements to the deployment of staffing, supporting people with their decision making and their stimulation. The provider sent us an action plan in April 2015 explaining the actions they would take to make improvements. At this inspection, we found improvements had not been made and we observed additional areas of concern. The service was registered to provide accommodation for up to 37 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 32 people were using the service. The overall rating for this service is Inadequate which means it will be placed into special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service had did not have a 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. The provider had employed a new manager; however they had left the service after less than a month. Another manager had been recruited; however they had not commenced their employment with the home until the end of March 2017.

We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found that staff had not received recent training in safeguarding adults and showed limited understanding. The provider had not recorded accidents and incidents and documented the support people were getting after they experienced a fall. Risk assessment that had been undertaken were not in date or relevant to the current risk levels people had and we could not be sure the support reduced the risks for the people.

We found people's medicines had not been managed safety. Some people had not received their medicine and other people had not been supported when they refused their medicine over a period of time. The stock of medicines was

This inspection took place on the 20 January 2015 and was unannounced.

Blacklake Lodge Residential Home provides accommodation and personal care for up to 37 people. Some people may be living with dementia or a physical disability. At the time of this inspection 36 people lived at the home.

The home had 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.

Some people who lived at the home were unable to make certain decisions about their care. The legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were not being followed. The MCA and the DoLS set out the requirements that ensure where applicable, decisions are made in people’s best interests when they are unable to do this for themselves. People could not be assured that decisions were being made in their best interests when they were unable to make their own decisions.

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

We found there were insufficient numbers of suitably skilled staff to meet people’s care needs and preferences. People were not provided with meaningful recreational or leisure activities and were left unsupervised for periods of time in the communal areas.

People who lived at the home told us they felt safe and secure. Equipment and aids were provided to support people with their safety. Staff had a good knowledge of people’s individual care needs and we saw they supported people were care and compassion. Records did not always reflect the care being provided.

People’s medicines were managed safely; staff were knowledgeable and supported people with their medication as required.

People told us they enjoyed the food, had plenty to eat and drink and lots of choice. Where people needed help with eating, we saw staff provided the level of support that each individual required.

People’s health care needs were met. They were supported to see a health care professional when they became unwell or their needs changed. People told us the staff were kind and caring. We saw staff were patient and understanding when interacting with people.

‘Resident’, relatives and staff meetings took place on a regular basis. We saw examples of where action had been taken when suggestions had been made. Staff told us they felt well supported by the management and worked well as a team. The safety and quality of the home was regularly checked and improvements made when necessary.

This inspection of Blacklake Lodge was to follow up on concerns which we identified during our previous inspection on 6 September 2013.

We had identified that people did not always receive the care and support they needed in a timely manner. Staff were caring and attentive but during busy periods some people had needed to wait until staff became free in order to have their own needs met.

As a result of our findings the service provided us with an action plan advising us how they intended to improve. The provider told us that they had implemented the action with immediate effect. We allowed time to see if the action plan improved experiences for people who used the service.

During this inspection we took the opportunity to see how the provider cooperated with the wider health community and with other services.

We spoke with four people who used the service and with the family of one person who used the service. We spoke with two members of staff and the registered manager.

We saw that there were sufficient suitably skilled and experienced staff available to meet people’s needs. One person who used the service said, “I’m not kept waiting at all”. A member of staff said, “There has definitely been an improvement”.

We saw evidence of how the provider had cooperated with other services in assessing and transferring people between Blacklake Lodge and other services including hospitals and other care homes.

When we inspected Blacklake Lodge the providers were in the process of registering a new manager. Because the process had not been completed the registered manager details do not appear on this report.

People who used the service were treated with respect and dignity, they told us they were happy living at Blacklake Lodge. One person said, “I don’t know how you could better this”.

People received care appropriate to their needs. Care plans and risk assessments were completed and these were reviewed regularly.

Systems were in place which ensured people who used the service were protected from abuse. Staff were aware of their responsibilities and people told us they felt safe.

People who used the service could not always be confident that their needs would be met in a timely manner, as there were not always sufficient suitably qualified staff available.

There were systems in place to enable the provider to assess and monitor the care provided to people who used the service.