About the service:

Earls Lodge Care Home is a 'care home'. The care home is purpose-built and is registered to provide care for up to 50 people. The home was providing personal care to 40 people at the time of the inspection.

People's experience of using this service:

• People were safe.

• There was a robust governance system in place to ensure the provider checked and audited the safety of the home and the quality of the care delivered.

• Prompt action was taken when things went wrong to reduce the risk of future incidents.

• During the inspection we observed care staff to be kind, caring and respectful. People were encouraged and supported to engage in a range of activities of their choosing.

• People told us the food was good and people had choice about when and what they ate.

• Staff offered people choice in all aspects of their lives, encouraged independence and provided support when needed. Staff supported people in the least restrictive way possible.

• People's care records were person centred and detailed, there was good information about people’s life histories and preferences.

• Staff were skilled and knowledgeable and training was up to date.

Rating at last inspection:

At our last inspection the service was rated requires improvement (24 October 2018).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Our inspection took place on 16 and 21 August 2017. On the first day our visit was unannounced. At the end of the first day we told the provider we would return to complete the inspection, but did not inform them of the date. Earls Lodge provides nursing and residential care for up to 50 people, some of whom were living with dementia. At the time of our inspection there were 34 people using the service.

At our last inspection on 11 May 2017 and 1 June 2017 we rated the service as ‘Requires Improvement’ and identified three breaches of regulations related to safe care and treatment, consent and governance.

This inspection took place two months after our last inspection as we wanted to ensure people were safe using the service. We found the provider had put in place a number of improvements and had a clear vision for how to ensure the service sustained and built on these improvements.

There was a manager in post who had submitted their application to register with the Care Quality Commission. 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 manager was on annual leave when we inspected the service, however we spoke with them by telephone after the inspection was concluded.

People told us they felt safe using the service, and we saw there were sufficient staff deployed to meet people’s needs. Staff had been recruited safely, and understood how to recognise and act on concerns about any abuse which people may be at risk of.

We saw improvement in the management and recording of medicines. We identified some issues with recording of information relating to medicines on the first day of our inspection, however the provider undertook an audit which enabled them to have taken action to rectify this by the second day of our visit.

The management of risks associated with people’s care and support had also improved, although we found some known risks had not been well documented in people's care plans. We found the management of the cleanliness premises had continued to improve.

There was a robust approach to training and staff support in the home. There was a plan in place to ensure feedback from supervision and appraisal activities was used as a driver for further improvement in the service.

We saw some improvement was still needed in the approach to the requirements of the Mental Capacity Act 2005 (MCA) to ensure this was robust, and we made a recommendation about reviewing the MCA code of practice to enable the required improvements to be made.

There was improvement noted in the approach to management of people’s nutrition and hydration, although improvement to the quality of some records was still needed. People gave good feedback about the food served, however we gave some feedback about some further improvement that could be made to the dining room layout.

People said they were happy living at Earls Lodge and were complimentary about the caring nature of staff, and we observed a relaxed and happy atmosphere in the home during our inspection. We saw a good approach to the promotion of independence and diversity, and we found care plans were written in a person centred way which evidenced people and their families had been involved.

We saw improvement in the way people’s needs were assessed before they began using the service. Care plans were written to show how these needs would be met, however we found there was still some improvement required to ensure staff had access to clear guidance to show how risk could be minimised. Staff told us they were given clear information to enable them to stay up to date with changes in people’s needs.

We received good feedback about activities in the home. The activity co-ordinator had a good u

This inspection took place 11 May and 1 June 2017. The inspection on the 11 May was a focused inspection looking at the Caring and Well-led domains, this was carried out in response to the registered provider removing a voluntary hold on admissions following the concerns found at the previous inspection. No significant concerns were identified during our site visit on the 11 May 2017. However following our site visit we received information of concern and we returned to the home on the 1 June 2017 to resume the inspection and expand it to a comprehensive inspection looking at how the home ensured people received a Safe, Effective and Responsive service.

The home was last inspected in February 2017, at which time we found the home was failing to meet the requirements of two of the Health and Social Care Act 2008 regulations. These were in relation safe care and treatment and good governance.

At this inspection although some improvements had been made we found continued breaches in relation to safe care and treatment and good governance and a new breach in relation to the need for consent.

Earls Lodge provides care for up to 50 older people some of whom live with a diagnosis of dementia and all of whom require nursing or personal care. The accommodation is offered over two floors. On the ground floor is the Glenn unit which offers residential care for up to 23 people living with dementia beds and on the first floor is the Dale unit which offers 27 nursing beds. The home has a secure external garden and patio areas, which can be accessed by people who live at the home on the ground floor.

There was no registered manager at the time of the inspection, and the service had not had a registered manager since September 2016. 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. There had been a number of manager’s in post since this time however they had not registered with the Care Quality Commission. There was a newly appointed manager in post who had been promoted from the position of deputy manager between the first and second days of the inspection. The newly appointed manager had been employed by the provider for 12 months. There was also a Head of Clinical Governance, an operations manager, an HR Director and the Managing Director who were offering support to the new manager.

Medicines management was not safe in all cases, and there was evidence people had been without prescribed medicines as these had not been ordered in a timely manner.

Staff had undertaken training including safeguarding and could demonstrate their understanding of the training they had undertaken.

The home was not always working with the Mental Capacity Act 2005 as information about people’s mental capacity was conflicting, and people’s rights were not always protected as a result. There were Deprivation of Liberty Safeguards in place for people in the home who had been assessed as needing these.

People gave us mixed feedback about the food.

Staff were observed to be kind and caring when supporting people and we saw they knocked on people’s doors before entering.

Care records were not completed in a timely or accurate manner. Care staff were creating daily care records for people from memory as they had not recorded key information at the point of care. This meant some daily care records were incomplete and inaccurate.

There were some processes in place to monitor the quality and safety of the service.

Earls Lodge is a care home for up to 50 people. It consists of one building with two floors. The ground floor Dale Unit specialises in residential care for people living with dementia and can accommodate up to 23 people. The first floor Glenn Unit specialises in nursing and palliative care and can accommodate up to 27 people.

All bedrooms are single and include en-suite facilities. Each floor has a communal lounge and dining room, as well as shared bathrooms, toilets and shower rooms. At the time of this inspection there were 44 people living at the home.

Earls Lodge was last inspected in April 2016. At that time it was rated as ‘Requires Improvement’ overall, with a ‘Good’ rating in the domains of caring and responsive.

The home did not have a registered manager. The current home manager had been in place since May 2016; they were in the process of applying to be registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

Not all issues with medicines documentation identified at the last inspection had been addressed. The home did not have meaningful protocols for ‘when required’ medicines and could not evidence people were receiving some of their topical medicines as prescribed. Other aspects of medicines administration and management were done well.

Issues with inconsistency in how risks to people were assessed and managed identified at the last inspection persisted. We saw examples of poor moving and handling practice.

We found numerous instances where people’s care plans did not reflect the care and support they needed. This was a finding at the last inspection. We noted this was more of an issue on the first floor. The home manager told us they were aware of this and were already taking action.

A system of audit and monitoring for safety and quality was now in place at the home. There was regular quality monitoring by the registered provider. However, we found issues that had not been identified and addressed by the audit process; some of these had been identified at the last inspection.

People told us there were enough staff; however, two people who use the service felt that it would be unfair to request a bath more than once a week because of the number of people staff had to care for. A dependency tool was in use at the home which showed there were sufficient staff. We observed that whilst staff were busy, people’s needs appeared to be met. The home manager said they would encourage people to ask for a bath or shower whenever they wanted one.

We found people’s personal emergency evacuation plans were not sufficiently detailed or person-centred to be useful.

However, we found not all people who lacked capacity to consent to care and treatment had assessments and best interest decisions in place for the support they received.

People’s care records did not always evidence their relatives who said they had lasting power of attorney, had been granted this by a court. We also noted a person with behaviours that may challenge others did not have a person-centred behavioural management care plan in place.

People enjoyed the food and drinks served at the home; kitchen staff could describe how they accommodated people’s specialist dietary requirements. However, we found people’s nutrition care plans did not always detail their specific needs and could thereby put people at risk of unsafe care.

People told us they felt safe. Staff could demonstrate they had the knowledge they needed to keep people safe from abuse. Recruitment procedures at the home were robust.

Accidents and incidents had been documented and investigated properly. Regular checks had been made on the home’s equipment, utilities and facilities to make su

The inspection took place 21 April 2016 and was unannounced. There had not been a previous inspection of the service since the registered provider took over the service in November 2015.

Earls Lodge provides care for up to 50 older people some of whom live with a diagnosis of dementia and all of whom require nursing or personal care. The accommodation is offered over two floors. On the ground floor is the Glenn unit which offers 23 residential EMI (Elderly Mentally Infirm) beds and on the first floor is the Dale unit which offers 27 nursing beds. The home has a secure external garden and patio areas which can be accessed by people who live at the home on the ground floor.

There was no registered manager at the time of the inspection; however there was a manager in post who had applied to become registered with the Care Quality Commission. 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 had a good understanding of how to safeguard people, however there was one person for whom consistent reports had not been made for each incident, which made them vulnerable.

There were current safety checks and certificates in place which showed the building and the environment were safe and well maintained.

Accidents and incidents were recorded appropriately and the manager reviewed each incident and the action taken by staff to ensure this was appropriate and thorough.

There were sufficient numbers of staff on duty to meet people’s needs safely and in a timely manner.

Medicines were managed safely. There were regular checks carried out on the storage areas for medicines to make sure they were of the correct temperature to maintain the efficacy of the medicines.

The home was clean and there was personal protective equipment throughout the home for staff to use. The home was pleasantly decorated and presented.

Staff were appropriately trained and skilled to carry out their roles effectively. Staff were well supported by the management team.

There were not always appropriate assessments of people’s mental capacity to make their own decisions and people whose liberty was being restricted were not always subject to an authorisation from the local authority to ensure the restriction was being carried out legally

This was a breach of Regulation 13 (5) Safeguarding service users from abuse and improper treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as action had not been taken to ensure assessments had been carried out adequately and applications for Deprivation of Liberty Safeguards had been made in line with the Mental Capacity Act 2005

People had access to a good range of nutritious food and drinks, to maintain their nutrition and hydration needs.

Staff were kind, caring, thoughtful and considerate in their interactions with people. People were treated with dignity and respect and their privacy was maintained.

People who were approaching the end of their lives had detailed care plans which recorded their personal wishes to ensure staff complied with their choices.

Care plans were detailed and person centred. There was evidence care plans were reviewed regularly, although changes were not always made to the care plans to reflect alterations to the support needed.

There was leadership and management presence visible throughout the inspection. Staff felt the management team were supportive and approachable.

There were no processes in place to monitor the quality and safety of the service provided to people who lived at the home. There were health and safety checks taking place.

This was a breach of Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations