This inspection took place on 23 and 27 November 2017 and was unannounced. This meant the staff and provider did not know we would be visiting.

Dinsdale Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing 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.

Dinsdale Lodge Care Home accommodates 26 people in one adapted building across two separate floors. Both floors accommodate people with residential care needs, some of whom have a dementia type illness. On the day of our inspection there were 23 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Dinsdale Lodge Care Home was last inspected by CQC on 29 September 2016 and was rated Requires improvement. No breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified at the previous inspection but some improvements were required in the Responsive and Well-led key questions.

At this inspection we checked to see whether improvements had been made and we found improvements had been made in all the areas identified at the previous inspection.

Accidents and incidents were appropriately recorded and investigated.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out. A refurbishment programme was ongoing at the home, which included incorporating design that was dementia friendly.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals.

People’s needs were assessed before they started using the service and continually evaluated to develop support plans.

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 were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Dinsdale Lodge Care Home. Staff treated people with dignity and respect and helped to maintain their independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local communi

The inspection took place on 29 September and was unannounced. This meant the registered provider did not know we were coming. We last inspected Dinsdale Lodge in April 2016 and found the registered provider had breached a number of regulations we inspected against.

We identified multiple concerns in respect of the safe care and treatment of people using the service. The registered provider failed to follow instructions and advice from other health care professionals. People’s health and nutritional needs were not being met in a safe manner. The registered provider did not ensure staff received appropriate training and development to enable them to carry out the duties they were employed to perform. The registered manager failed to ensure people were protected from the risk of financial abuse. Care records did not reflect people’s needs and preferences. People were not treated with dignity and respect. People’s confidential information was not held securely. Health and safety requirements in relation to water temperatures had not been addressed. The registered provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and failed to ensure that people received appropriate care and support.

We undertook this comprehensive inspection to check that the registered provider now met legal requirements. During this inspection we found the registered provider had implemented actions and some improvements had been made.

Dinsdale Lodge is a care home with accommodation for up to 28 people who require personal care, some of whom are living with dementia. At the time of our inspection 16 people were receiving a service. The service was no longer providing accommodation for people who required nursing care.

The service did not have 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.’

The registered provider had employed a manager who had submitted an application to be the registered manager for Dinsdale Lodge. The application was being processed at the time of the inspection. Staff gave positive feedback about the manager and the improvements in the home.

We reviewed the development plan introduced by the registered provider to ensure all the concerns we found in the previous inspection were addressed and quality was monitored. We found the registered provider had made progress against the development plan to ensure people were safe, but it was too early to assess the effectiveness of the audit process in driving continuous improvement.

Systems and processes were in place to manage safeguarding alerts, accidents and incidents. The registered provider had records of monthly analysis, investigations and lessons learnt. Statutory notifications had been submitted to the Care Quality Commission (CQC) appropriately. People’s monies were being kept in a locked safe with measures to audit monies coming in and out of the home. We found financial records had been completed accurately. Office doors were secure and had been fitted with key pads for entry.

We found people’s medicines were being managed safely. The registered provider ensured competency checks were completed for staff who had responsibility for administering medicines. Care workers had completed training in safeguarding, moving and handling, fire safety, food safety and care plan training. Some staff had not completed training for epilepsy and medicine management however this had been booked.

Care plans and risk assessments contained information about people’s care needs, these were reviewed on a regular basis. We found two care plans which required updating. We found advice and recommendations from healt

This inspection took place on 12, 14 and 26 April and 10 May 2016 and was unannounced. Following the second day of inspection we requested the provider send an urgent plan in response to the concerns that we had identified. We visited again on the 26 April 2016 to check the action they said they had taken. We also visited on 10 May 2016 to ensure people were receiving safe and appropriate care.

We completed an unannounced inspection of this service 25 June and 15 July 2015. The provider received a rating as Requires Improvement at that time.

Dinsdale Lodge Care Home is registered to provide nursing or personal care for up to 28 people. At the time of our inspection there were 20 people living at the home, some of whom were living with dementia.

The home had 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 2008and associated Regulations about how the service is run.

We concluded people were not being protected against the risks of receiving care that was unsafe or inappropriate. People were not fully protected against the risks associated with unsafe administration of medicines because the provider failed to ensure staff administering medicines were competent to do so.

Clinical staff and non-clinical staff had not received appropriate training to meet the needs of the people using the service. Staff had not completed the courses identified as being required on the training matrix. We found no refresher training booked for staff. Staff had not received regular supervision and appraisals appropriate to their role. The provider did not have effective systems in place to enable people using services to complain.

We found the registered manager had failed to make safeguarding referrals despite incidents falling within the threshold of safeguarding. The registered manager had not conducted their own enquiries into safeguarding incidents.

Mental Capacity Act 2005 (MCA) was not understood by the registered manager. We found the provider had not completed capacity assessments in relation to the Mental Capacity Act 2005.

Risk assessments for the building were ineffective and did not identify risks or control measures to keep people safe. The provider had failed to act on advice from their own contractor responsible for the management of legionella.

Care plans and risk assessments contained inaccurate information about people’s care needs. We found that recommendations from other health care professionals were not captured in people’s care plans. Recording practices in the service were poor.

There were not enough staff to meet people’s needs as detailed in care plans. A number of people required two staff to support them with moving and handling which meant people spent time waiting to be supported.

We saw people were not being supported to eat and drink safely. People were left unattended for long periods, with no ability to summon assistance.

There was no effective quality assurance system in place. The registered manager did not have any development plans to drive improvement, or act upon areas whereby changes had been identified.

People’s choices in relation to their care were not respected

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals hav

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Mrs Nora McKittrick's name appears because she was still a registered manager on our register at the time of our inspection.

The provider had not made sufficient progress with the action plan they had submitted following our last inspection in April 2014. During this inspection we found gaps in signatures on medication administration records (MARs) for 13 people and in other essential care records for three people. We also found that systems to check the quality of care records, including medication records, were still ineffective in identifying and investigating concerns with record keeping.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Mrs Nora McKittrick's name appears because she was still a Registered Manager on our register at the time of our inspection.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report. This is a summary of what we found:

Is the service safe?

The provider had developed systems to ensure potential risks were assessed and managed. Where staff had identified a potential risk, either during the initial assessment or after admission, a risk assessment had been completed to ensure people remained safe. We also found the provider assessed people, using recognised tools, against a range of potential risks. For example, the risks of poor nutrition, skin damage and falls.

The provider had effective systems in place to ensure that people received their medication safely and in a timely manner.

A range of health and safety related checks were in place to ensure the premises were safe. For example, weekly hot water checks, night-time security checks and a building safety audit. Most people had a personal emergency evacuation plan (PEEP), which provided staff with information about each person’s needs should there be an emergency.

We viewed records that confirmed that the provider had implemented a range of checks of the equipment used by people in the home. For example, wheelchair safety checks and checks of specialist equipment, such as hoists,slings and specialist mattresses.

Staff had access to accurate and up to date records to enable them to provide appropriate care for each person.

Is the service effective?

Family members told us staff had spent time sitting and chatting with their relative about their life history. One family member commented, “The staff made a tremendous effort to get to know my relative and find out what they like”, and, “Staff have time to spend with residents.” This meant staff had access to detailed information to help them better understand people’s needs.

Staff had completed a ‘This is your life’ booklet for each person. This included important information about them, such as their life history and personal preferences.

Information gathered during the initial assessment was used to develop detailed care plans. Care plans clearly identified the goal or expected outcome of the care plan and identified the interaction and support required to achieve the goal.

We spoke with three people who used the service. They told us that staff asked them for permission before delivering any care. One person said, “I am asked for my opinion.” Family members we spoke with were happy with how staff communicated with their relative. One relative commented, “The staff have worked out the best method of communication for my relative.” People who were able to sign had signed their care plans to give valid consent to their care.

Is the service caring?

People said they received good care. One person said, “Excellent, the care is good. The staff are very professional, nothing I ask of them is too much trouble.” Another person said, "The staff treat me great, it is like home from home.”

Family members told us that staff treated their relative not only with dignity and respect but also with affection. Family members confirmed that they had seen and read their relative’s care plans. "The care is absolutely brilliant"; "The staff are very caring, I have seen first hand how much they try and engage people in conversation"; "The staff are so well mannered. They take time to talk and explain things to you", and, "The care is very good, I like my relative being in there."

Our observations during our inspection confirmed that staff delivered care in line with people’s care plans. We saw that staff were attentive, kind and gentle whilst delivering care and continually explained to people what they were doing.

Is the service responsive?

One family member commented, “Staff pick up changes in my relative’s physical condition and act on it.”

People's dependency levels were monitored each month, which allowed staff to quickly assess whether a person's needs were changing.

Care plans were evaluated each month to ensure they remained current. The record of the review included a summary about each person’s current situation. We saw from viewing care records that staff had taken action to respond to people’s changing needs. For example, one person’s care plan had been changed as they needed more assistance with moving and handling.

Is the service well-led?

The provider did not have a robust system of quality audits in place to identify gaps in care records, including medication records, and take appropriate action to address these gaps.

The current systems of medication audits or checks were ineffective in identifying gaps in medication records. During our inspection we found gaps in MARs that had not previously been identified and investigated.

Although the provider logged relevant information, such as details of incidents, accidents and complaints, we did not find evidence that this was analysed to identify trends and patterns in order to improve the care that people received.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We found that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. People were not protected from unsafe or unsuitable equipment.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

People we spoke with told us that they were very happy with the care they were provided with at the home. They said, "They are great” and "I would not want to be anywhere else".

We visited in the early hours of the morning and for most parts only two people were awake. Both people told us that they chose what time to get up and when to go to bed. We stayed until a number of people got up and spoke with four people and spent time observing staff practices. People told us that the staff respected their choices and enabled them to live fairly independent lifestyles. They told us that the staff were caring and attentive and helped them whenever they needed help. One person told us that although they didn’t get a chance to go out as often as they would have liked, they did often play cards or dominoes with other residents. One person told us that they enjoyed going on to the internet. We found that staff were very courteous to people and ensured people were able to make various choices. Staff said they always tried to ensure that people's wishes were met.

During the inspection we spoke with four people who used the service and one relative. People who used the service told us they were happy with the care and service that they received.

One person said, "Staff are brilliant"; They always have time for me" Another person said, "I am glad I am here; the food is lovely". The relative spoken with said, "The staff are nice; my relative is safe and that is good‘’ and ‘’The food is good, plenty of it and a good variety‘’. People did note that at times issues were not raised with them in a timely fashion, stating "We do have to be pro-active when we want updates on care". One person spoken with during the visit informed us that there was very little in the way of activities and outings. Another said that they preferred to spend time on their own.

The inspection took place on 23 June 2015 and 15 July 2015, both visits were unannounced. Following our last inspection of Dinsdale Lodge Care Home in December 2014 we found the registered provider had breached four regulations. During this inspection we found the provider had made progress with the assurances given in their action plan. We found the registered provider was now meeting these regulations.

Medicines were managed safely and people received their prescribed medicines on time. Recruitment checks were in place to ensure prospective new staff were suitable to work with vulnerable adults. A final referral to the Disclosure and Barring Service (DBS) had not been made. We have since had confirmation from the registered manager that this has now been done. Where there were doubts about a person’s capacity to make decisions, an assessment had been undertaken to determine whether a Deprivation of Liberty Safeguards application to the local authority was required. We found that 12 out of 13 people had a DoLS authorisation in place. Staff had completed training on the Mental Capacity Act 2005 (MCA) and now had a better understanding of MCA. We viewed training records which confirmed staff had completed the training courses specified in the registered provider’s action plan.

Dinsdale Lodge Care Home is registered to provide nursing or personal care for up to 28 people. At the time of our inspection there were 13 people living at the home, some of whom were living with dementia.

The home had 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.

People told us they felt safe living in the home. One person said, “The staff are very good and helpful.” Another person said, “Listen, there is nothing I want, staff are nice and pleasant, I go out regularly and the food is good.” People told us they were very happy with the care they received and with their key worker. One person said, “It could not be better. Staff are great and like a bit chat.” Another person told us, “The staff will help straight away, nothing is a trouble.” Another person said, “Yes I have a keyworker but I really don’t need one. I can chat to all staff.”

Some areas of the home were not secure, potentially impacting on the safety of people using the service. For example, some areas that should be secure were not. We also found some areas, such as sluice rooms were not clean. We raised our concerns about these issues during the inspection. Cleaning audits were basic and indicated these areas hadn’t been cleaned for a month. The registered provider took action straightaway to deal with these concerns. Communal areas and people’s rooms were clean.

Staff members had a good understanding of safeguarding and whistle blowing. They knew how to report concerns. Detailed risk assessments were in place to help manage potential risks. We saw evidence of action taken to keep individual people safe, such as referrals to health professional for advice and guidance. We noted the provider had other more generic health and safety risk assessments in place.

There were enough staff to see to people’s needs. ‘Call bells’ were answered in a timely manner. We saw plenty of staff on duty and found people did not have to wait to receive the care and support they needed. The registered manager reviewed staffing levels monthly.

Accidents and incidents were analysed to identify any particular trends and patterns. The registered provider had emergency procedures in place to ensure people continued to receive care following an emergency. Regular checks were carried out to check the premises were safe for people to use.

Staff asked people for permission before delivering any care and respected people’s decisions.

People were supported to have enough to eat and drink. Staff provided the support people needed, which ranged from prompts through to practical assistance with eating and drinking. People were supported to meet their healthcare needs. Where required staff had made referrals to health professionals for advice and guidance. This included dietitians and speech and language therapists. People said staff contacted their GP when they were unwell.

People were treated with dignity and respect. We observed staff knocked on people’s doors before entering their room. During our observations we saw people received regular positive interaction from staff. Staff checked that all people were alright and if they needed any assistance. Staff were kind and considerate and supported people in a calm and relaxed manner. Drinks were readily available at all times in the lounge for people to help themselves. At other times during the day of our inspection we saw good interaction between people and staff.

Staff encouraged people to be independent. Some people accessed their local community independently. One person said, “I am a local chap so I like to go out and see people I know. One of the staff takes me to the market every week and I see old friends”. Other people chose how to spend their time in the home. For example, playing games, watching TV or taking part in a quiz.

People had up to date person centred care plans which included details about the care preferences. Care plans covered a range of areas including daily living, personal hygiene, medicines, nutrition, mobility, communication and activities. Staff were required to read people’s care plans.

People were able to choose whether to take part in activities both inside and outside of the home. Activities included bingo, playing cards, taking part in quizzes, cinema trips or out shopping. Some people attended a local luncheon club. When time allowed staff sat and chatted with people. People told us they were taken out on outings both in groups and individually. One person told us, “I go on my own to play bowls which I enjoy.” We saw people using adapted computers to access the internet or to watch movies.

The registered provider had a complaints policy and procedure. There had been no recent complaints made about the service. People and family members had the opportunity to attend regular meetings. One person told us, “Yes meetings are held regularly and we had one last week. We discuss what we would like to do.”

Staff told us the registered manager was supportive and approachable. People told us they regularly meet with the manager as well as the nurse. Staff told us they felt able to give their views about the service within regular team meetings. We observed there was a nice calm atmosphere in the home. One staff member commented there was a, “Good atmosphere, the residents get good care.” Another staff member said the atmosphere was, “Good, everybody gets on.”

There was a system of quality assurance checks in place including checks on fire safety, health and safety, supervision, complaints, staffing levels and care plans. We saw quality assurance checks had identified areas for improvement. The registered provider carried out external quality checks of the service. Since our last inspection the three monthly safeguarding analysis had been further developed to consider DoLS.

The registered provider regularly sought people’s and family member’s feedback about the quality of care delivered at the home. Feedback from the most recent survey was positive.

However, it was too early to assess whether these quality checks will be successful in delivering long term sustained improvement in the quality and safety of people’s care.