We undertook this unannounced inspection on 7 February 2018. The service provides residential and care for 90 people who are living with Dementia. On the day of our inspection 62 people were using the service. Clipstone Hall and Lodge is a ‘care home’. People in care homes receive accommodation and 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.

The service is provided over five units. Three units, over three floors in the Lodge and two units in the Hall.

The service had a registered manager in place at the time 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 and associated Regulations about how the service is run.

Medicines were not managed safely, and as a result a person had received out of date medicines that may not have been effective. Some people who required medicines at particular times for a health condition had not received their medicines in a timely way. This had not been picked up through the provider’s governance processes. We have made a recommendation about this.

People were not always protected from risk as there was a lack of essential information in some people’s risk assessments, and staff could not always tell us how risks to people’s safety were managed.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening. The registered manager shared information with the local authority when needed and acted on concerns when they were raised to them. The service reviewed safeguarding issues to learn from incidents and prevent reoccurrence.

Staffing levels in the service were sufficient and the registered manager regularly reviewed staff levels to ensure that they remained safe. However, deployment of staff in one area of the service had an negative impact on some people.

The cleanliness of the service was maintained and monitored and staff were knowledgeable on how to protect people from the risks of infection. Staff had a full understanding of people’s care needs and received regular training and support to give them the skills and knowledge to meet these needs.

People were protected from the risks of inadequate nutrition and dehydration. Specialist diets were provided if required. Referrals were made to health care professionals when needed. People lived in a service which met their needs in relation to the premises and adaptions were made where required.

Staff understood the importance of obtaining consent when providing care and there were mental capacity assessments in place for people who lacked the capacity to make a decision. However prior to our inspection the registered manager had identified that the service had not always followed the principles of the Mental Capacity Act (2005) when undertaking these assessments. The registered manager had already started to address this issue by reviewing the assessments to ensure the principles of the MCA would be followed in the future

People who used the service, or their representatives, were encouraged to contribute to the planning of their care. They were treated in a caring and respectful manner by staff who delivered support in a relaxed and considerate manner.

People, who used the service, or their representatives, were encouraged to be involved in decisions about their environment, and systems were in place to monitor the quality of service provision. People also felt they could report any concerns to the management team and felt they would be taken seriously.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can