This inspection took place on 21, 23 and 27 March 2018 and was unannounced on the first day. We last inspected the service in July 2016 when we rated the service as good. This inspection was prompted by information we received from the service regarding a serious incident; we are making further enquiries in relation to this incident.

At this inspection we found the provider was in breach of four regulations of the Health and Social Care Act 2014. You can see the action we have told the provider to take at the end of this report.

Cheddle Lodge is a ‘care home’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Cheddle Lodge is registered with CQC to provide accommodation for 13 people who require support and care with their daily living. The home is a single storey building situated in Cheadle, Cheshire.

The service 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.

On our inspection we found some shortcomings in the safety within the home. Some hot surfaces posed a scalding risk to people, the electrical Portable Appliance Testing (PAT) had expired and we observed a fire door in the home being propped open which could have allowed unauthorised people into the home. When these were raised with the registered manager they were immediately addressed and measures put in place.

We also found some support workers had not received update training meaning their practices may not be in line with current best practice.

People’s consent was sought before any care or support was given. The authorisation for some people’s Depravation of Liberty Safeguarding (DoLS) had expired and new applications were submitted when this was raised with the registered manager.

People told us they felt safe. Support staff were able to explain the process for reporting any suspected abuse. Support staff told us they felt happy to raise any concerns they had.

We found staffing levels to be appropriate and staff had time to spend with people and the care given was unhurried. Appropriate checks were made on applicants before they started work.

People’s medicines were managed safely and in line with national guidelines. The home worked well with the local pharmacy and had procedures in place to prevent the over-ordering of medicines that the home had sufficient stocks of.

During the inspection we saw people being offered choices in all aspects of their daily living and their choices were respected.

Meals were freshly prepared in the home. At weekends the chef baked cakes and decorated them as the people living in the home requested. We saw people being supported patiently to ensure they ate and drank enough.

Bedrooms in the home were individually decorated according to the person’s choices. A senior support worker explained the rooms were decorated before people moved in but the person moving in, their family and their key worker were encouraged to make it look and feel as homely as possible.

We saw people being treated with care and compassion throughout our inspection. It was evident that the staff in the home knew the people living there very well. Staff were able to understand people’s non-verbal communication to ensure their needs were being met. People were encouraged to be as independent as possible.

People’s care records were detailed and contained a lot of information about the person’s background and preferences. Staff told us these were very useful either when new staff started or new people moved in for people to get to

This was an unannounced inspection of Cheddle Lodge on 29 April 2016. We last inspected the home in November 2013. At that inspection, we found the service was meeting all the regulations that we reviewed.

Cheddle Lodge is registered to provide accommodation for thirteen residents who require support and care with their daily living. At the time of our inspection the home was fully occupied. The home is a single story building situated in a residential area of Cheadle in Stockport. Care staff are available twenty-four hours a day to provide support and ensure the safety and well-being of the residents. All the residents have physical needs and some have learning disabilities. Cheddle Lodge is situated in its own grounds with a garden and small car park to the rear of the building.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the inspection. A registered manager is a person who has registered with CQC 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.

We found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014, and we have made two additional recommendations.

The home had a supervision policy which recommended staff receive a formal supervision every two months, but we found that this policy had not been adhered to, and some staff had not had a formal supervision from their line manager for over three years. This meant that staff were not receiving the appropriate support to enable them to carry out their duties effectively.

The home did not formally seek feedback from residents or their relatives about the quality of service provision.

When we looked at the complaints procedure we saw that this was written in a format which many of the residents may not be able to understand. We made a recommendation that this is reviewed and a separate complaints leaflet be produced so residents would be able to better understand how to make a complaint.

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

We saw that Cheddle Lodge was clean and well maintained, and all rooms were fitted with tracking rails to assist with safe transfers into and out of beds and seats. Access to the building was secure and staff understood how to protect the residents from different forms of abuse. The service had whistleblowing and safeguarding policies and staff was aware of their responsibilities to report any untoward behaviour they might witness.

Residents were supported by a stable staff team who had worked together for a number of years and knew the residents well. We saw that there were enough staff and people told us that the staffing ratio reflected the needs of the residents.

Care records gave a good indication of resident’s abilities and provided a good description of their likes and dislikes. Where risk had been identified, risk plans were in place to minimise the risk of harm occurring. The staff were trained to administer medicines and we saw residents were assisted to take their prescribed medicines in a way they were comfortable with by staff who understood their needs.

The visitors we spoke to told us they believed the staff were competent and knowledgeable. We saw from training records that all new starters received a thorough induction and ongoing refresher training to maintain their competence. The service also provided bespoke training to assist staff to meet the identified needs of residents who lived at Cheddle Lodge, such as epilepsy training or training in supporting residents with swallowing difficulties.

Staff communicated well with each other and we saw that information was exchanged between staff informally throughout the working day, and a detailed handover meeting to

During this inspection we were unable to speak with people who lived in the home, because of their care needs they were unable to comment on the care and treatment they received.

We did however, speak to family members visiting the home or via the telephone. They provided wholly positive comments about the home, care and staff.

These comments included: “I think it’s marvellous”; “My relative has really come on since they have been there” and “The staff are A1, they are so kind.”

During this inspection we spoke to two people who live in the home, however because of their care needs they were unable to comment on the care and treatment they received. During our inspection we spoke to three family members. One person told us they were always informed of changes to their relatives care and treatment and the staff had a very good relationship with their relative and said “staff are very good” and they were “very happy with the care”.

Another person visiting the home said if they had any problems they felt they could always talk to staff and the staff were “marvellous”.

One family member told us they knew their relative was very happy and could “see the changes” and could see how happy they were.

One person told us they rang the home every night and it was never too much trouble for staff. Another person said “I am always involved in the care”.

All the family members we spoke to told us they were happy with the care and treatment provided by the home.