The inspection took place on 15 March 2018 and was unannounced. At our last inspection on 2 August 2017 we rated the service ‘Requires Improvement’ and identified two breaches of regulation in relation to staffing and governance.

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 of Safe, Effective and Well-led to at least good. At this inspection, we found that despite some improvements having been made the provider had not met the legal requirements. We found further breaches of regulation in relation to risk management, medicines and consent.

Corrina 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. Corrina Lodge accommodates up to 58 people in one adapted building. At the time of our inspection there were 57 people living at the service. People were living with a range of complex health care needs. This

included people who have had a stroke, diabetes and Parkinson's disease. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required a variety of help and support from staff in relation to their health, mobility and personal care needs. Accommodation was provided over two floors with a passenger lift that provided level access to all parts of the home.

There was a registered manager in post who was present during the 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 2008 and associated Regulations about how the service is run.

Staff were not always effectively deployed to ensure people’s needs were met in a timely manner. We observed people waiting for care and some people told us they felt isolated and lonely. There was a lack of leadership and direction on individual shifts and nurses and care staff worked in isolation.

Risks to people’s health and well-being were not always effectively monitored. Records did not always contain clear and consistent information to evidence the action taken to keep people safe. Where accidents and incidents occurred, robust action was not always taken to ensure that lessons had been learned and reduce the risk of them happening again. Some areas of medicines management were not safe. Protocols for PRN (as and when required) medicines lacked detail and topical creams were not labelled when opened and were not appropriately stored. Other areas of medicines storage and administration were managed well.

The principles of the Mental Capacity Act 2005 were not always followed which meant there was a risk that people’s legal rights were not being upheld. There was a lack of management oversight of the service. The registered manager was unable to provide information in a timely way and did not demonstrate a clear understanding of the provider’s systems. Quality assurance process were not always effective in identifying and addressing areas of the service which required improvement. There was a lack of guidance for staff which had led to the service not moving forward in their development.

Although improvements had been noted to the training and supervision of staff, this was not always appropriately monitored. The registered manager was not able to demonstrate how clinical staff developed their professional skills. We have made a recommendation regarding this. Safe recruitment processes were in place to ensure staff safe to work at the service were employed. Staff told us they felt supported by the management team and regular staff meetings took place.

Staff were aware of their responsibilities to safeg

This unannounced inspection took place on 2 August 2017.

Corrina Lodge provides nursing and personal care for up to 58 people. There were 57 people living at the service at the time of the inspection. People were living with a range of complex health care needs. This included people who have had a stroke, diabetes and Parkinson’s disease. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required a variety of help and support from staff in relation to their health, mobility and personal care needs. Accommodation was provided over two floors with a passenger lift that provided level access to all parts of the home.

There was a registered manager in post who was present during the 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.

During the inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Sufficient staff were not deployed to meet people’s needs in a timely manner. People routinely needed to wait for their personal care needs to be met in the morning and we observed people spent considerable time without staff interaction. Staff did not consistently receive training updates and supervision records did not reflect that concerns regarding staff performance were followed up on.

Quality assurance processes were not always effective in ensuring continuous improvements. Where auditing processes identified shortfalls in the service, these were not always addressed in a timely manner. Records regarding the care people received were repetitive and task focussed. Although staff knew people’s needs well, care plans did not always reflect people’s current needs and preferences.

Care records contained up to date risk management plans which contained guidance for staff regarding how to support people in managing risks to their safety. Accidents and incidents were reported and action taken to update risk management strategies where required. Staff were aware of their responsibilities in safeguarding people from abuse and concerns were appropriately reported. Robust recruitment processes were in place to ensure staff employed were suitable to work at the service. The provider had developed a contingency plan which detailed the arrangements in place should an emergency occur.

People received their medicines in line with their prescriptions. Medicine administration records were accurate and consistently completed. People received support to access healthcare professionals and where advice was provided this was followed. People had a choice of foods and their nutritional and hydration needs were monitored. People told us they enjoyed the food provided and were able to request alternatives.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People were provided with choices and their wishes were respected. People were supported by staff who knew them well and understood their needs and preferences. Staff encouraged people to develop and maintain their independence. People told us that staff treated them with kindness and people’s dignity and privacy were respected.

People received support in line with their needs and staff responded to people’s changing in needs in a timely manner. People had access to a range of activities both within the service and in the community.

People, relatives and staff told us that the registered manager was approachable and responded well to suggestions and any concerns raised. There was a complaints policy in place and any concerns raised were responded to and monitored. The registered manager was committed to creating an open culture with t

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We further gathered information from people and their relatives who used the service and from staff who worked at the service.

Below is a summary of what we found. The summary is based on our review of records, speaking with people who used the service, their relatives and staff who supported them.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People who used the service told us they were treated with respect and dignity. For example, one person said, “The carers informed me of what they were going to do before undertaking the task”.

We observed the service had a system in place to ensure that people’s risk assessments were kept under regular review. Any trends identified were dealt with to minimise the risks relating to people’s health, welfare and safety.

We found that the service had systems in place to ensure that the staff they employed to support people had the required knowledge and skills. The service had processes in place to ensure that there were enough staff employed to keep the service clean and hygienic.

We saw documented evidence that the service used a range of quality monitoring tools such as yearly clients, relatives and staff satisfaction surveys to measure the quality of care and support people received from the service. People told us they felt safe with the staff.

Is the service effective?

We found that people’s care plans provided detailed information on how they wished to be supported with their care needs. For example,individual care needs had been clearly stated. We observed that records of people’s daily care were documented. Care staff spoken with told us they used the communication sheet to highlight any changes to the person’s care to ensure continuity of care. These were appropriately maintained to ensure if necessary a new member of staff would be able to deliver care safely and effectively.

We found that people’s health care needs were kept under regular review and they had been involved in the reviews. People had access to health care professionals such as the GP, dentist, optician and district nurse. This meant that people were supported to keep healthy and well.

Is the service caring?

People told us that care staff spoke to them in a kind and respectful manner. One person said, “The staff all of them demonstrate a genuine affection, care and concern to me”. All members of staff spoken with were knowledgeable about people’s care needs including their preferences and personal histories. It was evident that people were listened to and care staff responded to them in a positive and caring way. One person said, “I feel I receive excellent care”.

Is the service responsive?

People told us they were supported to express their views and be actively involved in making decisions about their care, treatment and support. In the care plans we looked at, we saw evidence which reflected that people and their relatives were involved in making their views known about how they wished to be cared for and supported. If people were not able to sign their care plans these were signed by family members. We saw evidence that regular care plan reviews took place. This meant that people’s care needs were regularly reviewed.

We found the service had received two complaints which had been dealt with to the satisfaction of the complainants. People we spoke with said they knew how to make a complaint, but had never done so. Relatives of people who used the service told us they discussed their relative’s care needs with the manager or deputy manager and they worked well together so there was never any need to complain.

Is the service well led?

Staff told us they felt supported by the new manager and that since their arrival staff meetings had been re-instated. At these meetings they were able to raise questions relating to the delivery and implementation of best practice. This meant that staff felt supported and well-led.

Staff spoken with said that they were provided with adequate training. This enabled them to perform their roles and to be accountable for their actions.

People told us the manager or the deputy manager was always available in the home. They said, “Either the manager or the deputy spoke daily with the residents to check if they were happy with the care and if the care workers were performing satisfactorily”. This ensured people received agreed and effective care as documented on their care plans.

The service had arrangements in place to monitor complaints, accidents and incidents. This meant that lessons were learnt from incidents and complaints investigations to ensure improvements to the service delivery.

People confirmed to us that they were treated respectfully and had been provided with regular opportunities to speak directly to heads of department including the head chef about all aspects of their care.

People that we spoke with were very positive about the activities that had been organised. One told us “The activities are good fun and I always enjoy them”. Others told us that they enjoyed the opportunity to be taken shopping locally in the service mini bus.

People that we spoke with confirmed that the food in the service was good and that there was always plenty for them to drink. One person said “It is much better now”. Another person told us, “I have not been here long but the chef took the time to come and sit with me and plan what I could eat and discuss what meals he could make for me. It has made me feel so welcome and has helped me settle in”.

Care staffing levels had been increased resulting in one additional nurse and two additional care assistants being scheduled to work during each day shift. A care assistant told us, “I have learnt a massive amount from matron. There are enough of us now and we know what we’re doing”.

We found that an effective complaints procedure was in place. Every person we spoke with confirmed that they would be confident to make a complaint about the service. One person said “I am able to complain if I need to”.

The service was run by a manager who is registered with the Care Quality Commission. (CQC)

We found the service to be clean and well maintained. It is equipped with comfortable lounges, a cinema room and other facilities for people to enjoy.

The views of people using the service were varied. Some told us that they felt safe and happy in the service. Others told us that the delays in receiving meals and care was a source of frustration.

The general manager told us that she had been reminded by the service provider of the requirement to register with the CQC as the registered manager following her appointment before our inspection in November 2011. They had not applied as this had not been viewed as a priority.

People told us that they had not been involved in developing their care plans and we saw that this was the case.

We found that, the provision of care and welfare was not person centred. Where preferences had been expressed by people, they were not always acted upon. Particular examples were meal choices and personal care preferences.

This service has a large number of high dependency residents which we considered was not reflected in the numbers of staff available to provide care. We found the staff to be enthusiastic and caring.

To help us to understand the experiences people have we used an expert by experience and also

used our SOFI (Short Observational Framework for Inspection) tool.

The expert by experience observed and spoke with people using the service to help us to get a clearer picture of what it is like to use the service.

The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

Some people using the service were able to tell us about their experiences and their comments have been included within the report.

Most people thought the food served at the service was satisfactory but a relative commented that although the menu looks fancy the food is not as good as the menu would suggest.

A compliment was made about the Sunday chef saying the brunch was good being similar to a cooked breakfast.

Corrina Lodge provides nursing and personal care for up to 58 people. There were 50 people living at the home at the time of the inspection who were living with a range of complex health care needs. This included people who have had a stroke, diabetes and Parkinson’s disease. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required a variety of help and support from staff in relation to their health, mobility and personal care needs.

Corrina Lodge is owned by Barchester Healthcare Homes Limited. Accommodation was provided over two floors with a passenger lift that provided level access to all parts of the home. People spoke well of the home and visiting relatives confirmed they felt confident leaving their loved ones in the care of staff.

There is a registered manager 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.

This was an unannounced inspection, which meant the provider and staff did not know we were coming, and took place on 22 and 23 June 2015.

At the last inspection 11 June 2014 we asked the provider to make improvements in relation to the number of staff working each shift. The provider sent us an action plan stating they would have addressed all of these concerns by September 2014. At this inspection we found the provider was meeting this regulation.

Care plans were personalised however they did not always demonstrate that people were involved in their development or reviews. They did not always reflect people’s individual needs. There was a busy activity programme in place but there was limited information about what people who remained in their rooms done throughout the day. This is an area that needs to be improved.

People were looked after by staff who knew them well and had a good understanding of their physical and psychological needs, their choices and preferences. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity.

People were involved in the day to day running of the home through regular meetings and discussions. People’s opinions were valued and used to improve and develop the home.

Risk assessments were in place to keep people safe. These were used appropriately and did not prevent people who wished to, take well thought out risks as part of maintaining their independence and lifestyle.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They had a clear understanding of DoLS and what may constitute a deprivation of liberty.

Medicines were managed safely and staff made sure people received the medicines they required in the correct dosage at the right time.

There was enough staff to look after people. They had been safely recruited and were safe to work with people. Staff were well supported by the managers and colleagues. They received appropriate training to enable them to meet people’s individual needs.

There was a busy activity programme in place. People were supported to take part and maintain their own friendships and relationships. However, there was limited evidence that people who remained in their rooms participated in any activities.

People had their nutritional needs assessed and monitored and were supported to enjoy a range of food and drink of their choice throughout the day.

There was an open culture at the home and this was promoted by the registered manager who was visible and approachable. People and staff spoke positively about him.

There was an action plan in place where the registered manager had identified areas that required improvement. This included the mealtime experience and aspects of record keeping.Summary here>