We undertook an inspection of Eastwood Lodge on 6 August 2018. The inspection was unannounced. Eastwood Lodge is situated in the village of Woodhall Spa in Lincolnshire. Eastwood 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.

The home offers accommodation for up to 19 older people. There were 16 people living at the home at the time of the inspection, some of whom had needs associated with memory loss and dementia.

At the last inspection, in 27 January 2016, we rated the service as ‘Good’. During this inspection we found concerns about the safety of home. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. This is the first time the service has been rated as Requires Improvement.

At the time of our inspection there was a registered manager in place. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons”. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

During this inspection we found this service was not consistently safe. There were several concerns about how medicines were managed. This placed people at risk of not receiving their medicine as prescribed. Overall risks associated with people’s care and support were managed safely. Further work was needed to ensure behaviour support plans contain all the required information to guide staff support.

Staff had good knowledge of safeguarding processes. There were enough staff to keep people safe; however, people reported some short delays to their care. Safe recruitment practices were followed. The home was kept clean and infection control procedures were followed.

Mental capacity assessments were in place for people who were unable to consent to their care; however, further work was required to ensure people’s rights were fully protected. Some staff training was out of date and staff did not always receive regular supervision. There was a risk people may not receive the support they required with their health as some care plans lacked information and staff did not always have a good knowledge of people’s health needs. People told us that they were given choice of meals and said the food was good quality.

We found the service was caring. People were treated with respect and encouraged to make decisions. They were supported to live as independently as possible. People were given privacy and treated with dignity.

Most of care plans we reviewed clearly reflected people’s needs and staff had a good understanding of the support people required. There were detailed end of life care plans in place. People’s feedback about the activities available inside the home was positive. People told us that they liked visiting the local community with staff and that these trips were individual to them. Some people told us that they would like more opportunities to go into the community.

We found the service was not consistently well led. Audits were not consistently effective in identifying or addressing areas for improvements. The registered manager was responsive to feedback and took swift action to act upon our concerns. We received positive feedback on the leadership of the home. There was a positive atmosphere with in the service and evidence of cross-agency working. People, their representatives and staff had opportunities to feedback on the running of the service.

Eastwood Lodge is situated in the village of Woodhall Spa in Lincolnshire. The home offers accommodation for to up to 19 older people some of whom have needs associated with memory loss and who live with conditions such as dementia.

We inspected the home on 27 January 2016. The inspection was unannounced. There were 19 people living in the home at the time of this inspection.

At the time of our inspection there was an established registered manager in place. 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.

The registered provider had safe recruitment processes in place and background checks had been completed before new staff were appointed to ensure they were safe to work at the home.

Staff were well supported and had received training in order to enable them to provide care in a way which ensured people’s individual needs were met. Staff also knew how to recognise and report any concerns they had regarding people’s safety so that people were kept safe from harm.

People were involved in making decisions about their care and how they wanted to be supported. The registered manager had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of this inspection DoLS applications had been completed by the registered manager for four people living in the home and was waiting for these to be assessed by the local authority.

Staff provided the care described in each person’s care record and had access to a range of visiting healthcare professionals when they required both routine and more specialist help. Clear arrangements were also in place for ordering, storing, administering and disposing of medicines.

Staff understood what was important to people and worked closely with people, each other and with families to ensure each person had a meaningful and enjoyable life. An activities team organised a planned and varied programme of individual and communal activities for those who wished to participate.

People were provided with a good choice of nutritious meals. When necessary, people were given any extra help they needed to make sure that they had enough to eat and drink to keep them healthy.

People their relatives and staff could voice their views and opinions. The manager listened and took action to resolve any issues or concerns identified. Formal systems were in place for handling and resolving complaints. The registered manager ran the home in an open and inclusive way and the registered provider encouraged staff to speak out if they had any concerns.

The provider and registered manager had systems in place to regularly assess and monitor care practice and to ensure people received a good quality of care. The systems in place meant that any shortfalls in quality could be quickly identified and improvements made.

Prior to our inspection we reviewed all the information we had received from the provider about the home.

As part of our inspection visit we spoke with five people who lived at the home and a relative who visited the home. We also spoke with the manager, three staff members and a professional training assessor who visited the home.

People told us staff were caring and responsive to their needs. One person said, “Good staff equals good care.” A visiting relative said, “It’s like coming into someone’s home. Staff are casual but always caring.”

People told us they enjoyed all the meals at the home. One person we spoke with said, “I don’t like too much food so for each meal they balance it out so I get exactly what I want. I don’t like waste and they (staff) respect my wishes.”

We saw the environment was maintained appropriately and the manager responded to changes that were identified as needed to ensure the safety of people who lived there.

The home owners and manager demonstrated they had effective systems in place in order to respond to any or concerns complaints raised with them.

As part of our inspection we spoke with two people who used the service. We also spoke with staff, relatives,visiting professionals and looked at records.

Overall we observed that people were supported by skilled and experienced staff who understood their roles and responsibilities.

We saw staff had received the appropriate checks before commencing employment and subsequently received training and support to enable them to provide the appropriate support to people.

We saw people were treated with dignity and supported to make decisions about their care. Care records were up to date and we saw care reflected what was written in the care plans.

The quality assurance systems in place enabled people to express their views about the services and care they received. People were encouraged to comment on how the home was run at meetings and on a day to day basis.

People told us they liked living at the home and they were well cared for. One person said, “Very nice,” and ”It’s lovely

People said the food was good and were given a choice at mealtimes. A relative told us, ”Food is ok” and “Staff are great.” They told us if they had any issues they would be able to discuss them with the staff.

When we spoke with a nurse visiting the home they told us the home provided good care and they had a good relationship with the home. They told us care was carried out as they recommended for people. They also said communication was good.