We inspected Bruce Lodge on 21 and 23 March 2018. The inspection was unannounced, so this meant they did not know we were coming.

At the last inspection on 22 September 2016, the service was rated as requires improvement. We found two breaches of the regulations, as improvements were needed in the management of medicines, fire safety and the registered provider had not ensured good governance in the home.

Bruce Lodge is a purpose built care home situated in Stockport. The service provides care and accommodation for up to 47 older people, some of whom were living with dementia. At the time of our inspection 39 people were living at the home, with two people were receiving a day care service.

The home has four units, called Bluebell, Rose, Sunflower and Fern, which people can move freely between. The service has communal lounges, dining rooms and bathing facilities available. Accommodation is provided over two floors which can be accessed by a passenger lift. To the front of the building is a large secure landscaped garden and car parking is available. People in care homes receive accommodation and nursing and/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.

A registered manager was in place 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. We explained to the current registered manager that the previous registered manager of the home was still registered for Bruce Lodge. We were provided assurances that the provider would ensure an application to de-register the previous manager would take place.

The provider had not taken reasonable actions to ensure the safety of the premises. During our tour of the home we noted several potential safety hazards. For example, we found the sluice room on the ground floor was unlocked which stored hazardous substances, such as cleaning products. The premises had not been made secure to minimise the risk of people unintentionally touching or drinking the hazardous substances with the potential of causing themselves harm.

The management of medicines had improved which meant people would get the medicines that they required. Records in regards to medicines were accurate and there were care plans which provided staff with information to ensure that the right medication was given to the right person at the right time. However, we found the room temperature in the ground floor clinic was exceeding 25 degrees centigrade. Manufacturers advise that medicines are stored at a temperature below 25 degrees centigrade. If the temperature is above this medicines can lose their efficacy. The registered manager told us they were considering installing an extractor fan to circulate the air more and reduce the temperature in the room. We found there were no plans, or 'when required' (PRN) protocols in place to inform staff when and how they should administer people medicines that were not required routinely. We signposted the registered manager to review the NICE guidance on 'Managing Medicines in Care Homes' as this provides recommendations for good practice on the systems and processes for managing medicines in care homes.

We examined staff training records which demonstrated that training relevant to their job roles was provided. The provider recognised they needed to adapt the training programme delivered to staff with the introduction of classroom dementia awareness training, which was due to be provided to the staff team to help staff gain a better understanding of supporting people living with dementia.

People told us that they were well cared for and in a kind manner. Staff k

The inspection took place on 22 September 2016 and was unannounced. This meant the registered provider and staff did not know we would be visiting.

Bruce Lodge is a purpose build care home situated in Stockport. The service can provider care and accommodation for up to 47 older people. At the time of our inspection 46 people were living at the service. The service has communal lounges, dining rooms and bathing facilities available. Accommodation is provided over two floors which can be accessed by a lift. To the front of the building is a large secure landscaped garden and car parking is available.

The service had a registered manager in place. 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.

Emergency procedures were in place for staff to follow and personal emergency plans were in place for everyone, however these lacked details. Fire drills had not taken place; discussion on what to do in the event of a fire had taken place but these were not practical fire drills.

Medicines were not always managed appropriately. The registered provider had policies and procedures in place to ensure that medicines were handled safely. Medication administration records were completed fully to show when oral medicines had been administered and disposed of. People we spoke with confirmed they received their oral medicines when they needed them. However, topical medication, such as creams, was not always recorded when it had been administered and we saw gaps in these records.

People and their relatives told us they felt safe. Risk assessments were in place for people who needed these. Risk assessments had been regularly reviewed and updated when required.

Accidents and incidents were monitored to identify any patterns and appropriate actions were taken to reduce the risks.

Staff we spoke with understood the procedure they needed to follow if they suspected abuse might be taking place and the registered provider had a policy in place to minimise the risk of abuse occurring.

Certificates were in place to ensure the safety of the service and the equipment. Maintenance and fire checks had been carried out regularly.

A recruitment process was followed to reduce the risk of unsuitable staff being employed. All new staff completed a thorough induction process with the registered provider.

Staff performance was monitored and recorded through a regular system of supervisions and appraisal. Staff had received training to support them to carry out their roles safely.

People were supported to maintain their health. People spoke positively about the food and drink provided at the service. Staff understood the procedures they needed to follow if people became at risk of malnutrition or dehydration.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and knew what action they would take if they suspected a person lacked capacity. We saw that documentation was in place to show best interest decisions being made appropriately.

Each person was involved with a range of health professionals and this had been documented within each person's care records. From speaking with staff we could see that they had a good relationship with health professionals involved in people’s care. People’s care records contained evidence of appropriate referrals to professionals such as falls team, SALT and tissue viability nurses.

The service was clean and neutrally decorated throughout but was adapted to support people living with a dementia. People were able to bring their own furniture and personalise their bedrooms.

People spoke highly of the service and the staff. People said they

When we arrived at Bruce Lodge we found people were up and about in the reception area, dining rooms and lounges. The atmosphere was relaxed, calm and friendly.

We looked at the care files of eight people living at Bruce Lodge. We found examples of people being involved in the planning of their care. We saw information was written in a style which encouraged them to be involved in decision making about their own care and support.

We saw safety checks were in place to protect people from the risks associated with the storage, preparation and cooking of food. These checks included ensuring food had been stored within the recommended temperature ranges.

Families told us they felt confident their relatives were safe. They said "we come most days and would know if something was not right, we are able to visit anytime, it is very open here, people are well looked after".

People told us they were happy with the way they were supported. We observed staff and people's interactions throughout the inspection. Relationships were positive and respectful.

We saw regular supervisions were taking place and staff said they felt supported.

During the visit we spoke with the relatives of two people who use the service. They told us they were very happy with the staff and the care received. They told us they were regularly involved in the review of their relatives’ care plans. They also told us they had no concerns around medication processes.

The people we spoke with told us the staff were very kind, patient and carried out a very good job in caring for their relatives. They told us they felt there were enough staff around.

They also told us they had no concerns about the care they received and would speak to the Registered Manager if they had any concerns.

"we are really, really pleased with the home, we went to see others but this was by far the best", "it is wonderful here the girls are really caring", "we looked at other homes but the staff here are fabulous", "they keep us informed about what is going on", "we can read the care plan and see what has been happening", "we have no concerns about 'x's safety", "staff are welcoming and friendly and will answer any questions we have", "staff seem wonderful there are no problems at all", "we were involved with the care plan and asked for information", "the care is superb", "we are immediately made aware of any changes", "I have no qualms about the home", "the manager regularly asks for feedback", "there is always something going on lots of activities arranged", "people are very well cared for", "the level of care and facilities is wonderful", "'x' looks and feels better", "I really like it here I could not live in any other home", "staff are very good, always around when you need them", "they are very good they have a lot to put up with", "there is plenty to do", "staff never loose their temper, I would say the staff give 150%", "they regularly bring me tea and biscuits", “I can please myself really I can sit in any of the lounges or in my room”.