Our last inspection of the service was on 4 April 2017. The overall rating at that time was requires improvement with three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.We served a warning notice to the provider as they were in continued breach of regulation 12 in relation to managing medicines. Following the previous inspection we found care plans did not relate to care provided, people’s nutritional and hydration needs were not met, a designated member of staff was not available to manage the service and audits were not fully completed to show shortfalls.

We asked the provider to complete an action plan to show what they would do to improve the key questions in safe, effective, caring, responsive and well led.

The previous registered manager had implemented actions from the action plan which had shown improvements in all areas had been made and the provider was no longer in breach of the regulations. The inspection took place on 12 and 15 December 2017 and was unannounced. At the time of the inspection the previous registered manager had left the service. There was a person managing the service who had submitted an application to become the new 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 person managing the service had been in post since November 2017.

Buckingham 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. The service is registered to accommodate 64 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of our inspection there were 37 people using the service.

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Medicines were managed safely; we examined the handling of people’s medicines during our inspection. Medication Administration Records (MAR) charts were correctly completed and people received their medicines as prescribed by the GP.

People were safeguarded from abuse. There were systems in place to ensure people were safe. Staff were knowledgeable about abuse and what to do if they had any concerns. People told us they felt safe living at Buckingham Lodge.

Staff were available to support people. Our observations showed that staff were able to spend quality time with people and care was not rushed. People told us staff were kind and caring.

Risk assessments were in place and were regularly reviewed. People with a specific risk such as malnutrition had a care plan in place to support this.

Staff were knowledgeable and received effective training and support to enable them to carry out their role.

The service complied with the Mental Capacity Act 2005 (MCA). Staff understood the mental capacity, best interest decision making and deprivation of liberty. We saw evidence of best interest meetings and decisions made. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had a choice of menu and could have additional snacks throughout the day. We saw people were offered fluids throughout the day to ensure they did not become dehydrated.

The service provided responsive care, people’s wishes, preferences and dislikes were taken into consideration. Complaints were responded to and used as a way of improving the service.

Staff told us the culture of the service had improved and they felt supported by the management. One member of staff tol

Buckingham Lodge is a care home that provides accommodation for up to 64 older people. There were 41 people using the service at the time of our inspection. The last inspection took place in March 2016 where the overall rating was requires improvement. The provider had not met the regulations and there was a breach of regulation 12.

At the time of our inspection, there was 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.

On the first day of our inspection, the registered manager and the deputy manager were not at the service. Staff told us they did not know of their whereabouts or why they were not available. There was not a designated member of staff in charge of the home. This left the building unsafe in the event of an incident. The regional manager was contacted and arrived at the service later that day.

Medicines were not always ordered administered or recorded appropriately. This meant that people were at risk of not receiving their medicines safely. We advised the provider to seek guidance to ensure medicines were managed safely. For example, following the National Institute for Health and Care Excellence (NICE) guidelines on managing medicines in care homes.

People told us staff were caring; although, we did not always observe this during our inspection. We observed that some staff were focused on tasks and did not engage with the people they were caring for. People’s privacy was protected, but their dignity was not always supported. However, some staff demonstrated kindness and compassion when assisting people. There were enough staff to meet people’s needs at the time of our visit.

People were protected against abuse and neglect. Staff we spoke with were knowledgeable of the process to follow if they suspected abuse had occurred. People told us they felt safe living at Buckingham Lodge.

Staff received training support and appraisal. However, staff supervisions were not always carried out on a regular basis. The service complied with the Mental Capacity Act 2005. Staff understood mental capacity, best interest decision making and deprivation of liberty. People had the ability to voice their concerns and had regular ‘residents and relatives’ meetings where they could discuss any concerns they had. However, we saw some complaints had not been responded to with outcomes. We did not always see evidence that complainants were kept informed of the status of their complaint.

Risk assessments were in place for most people’s needs. However, some people who had been identified at risk of weight loss did not have a plan of care to address this. There was a risk that people were not always provided with adequate nutrition and hydration. We discussed this with the regional manager who immediately put food and fluid charts in place for people who were assessed as being at risk of malnutrition.

Staff told us the workplace culture could improve and they said if they voiced an opinion or idea, they were not always listened to.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service was registered on 5 April 2015 and provides accommodation and personal care for up to 64 people who require residential and dementia care. At the time of our inspection there were 21 people using the service. The service had a registered manager supported by a deputy 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.

We saw people were well cared for and comfortable in the home. Everyone we spoke with complimented the staff who supported them. People’s comments included. “They are very patient and treat me well”.

People were cared for by motivated and well-trained staff that had completed a programme of essential training to enable them to carry out their roles and responsibilities. New staff had completed an induction training programme and there was a programme of refresher training for the rest of the staff.

People were supported to make their own choices and decisions where possible. Staff understood the principles of the Mental Capacity Act (2005). Where identified as a care need, people were provided with the assistance they needed to eat and drink. Staff liaised with the district nurses and the person’s GP when needed.

Managers and senior staff provided effective leadership to the service and regular residents’ meetings ensured people were involved in the running or the home. The atmosphere of the home was warm, friendly and supportive.

People were supported to engage with a variety of activities and entertainments available within the home.

The home employed two activity coordinators; activities were available to all people living in the home. The home is a member of the National Activity Providers Association (NAPA) and had participated in the Dignity in Care campaign and received recognition for this. People were actively involved in activities and entertainments within the home, one person told us they enjoyed different people visiting the home and the opportunity to go out.

Care plans were not always personalised and did not always make reference to people’s emotional, psychological and spiritual needs. However, new documentation in relation to this was in progress at the time of our inspection.

We have made recommendations in relation to pre admission information and ensuring internal audits are more robust and effective.

We identified concerns in relation to medicine practices. This constituted to a breach of the regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.