The inspection took place on 17, 19 and 25 September 2018, and the first day was unannounced. Ernehale Lodge Care Home 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. Nursing care is provided at this service.

Accommodation for up to 30 people was provided over two floors. The service has 20 bedrooms, ten of which are intended for shared use. There were 26 people using the service at the time of our inspection. Ernehale Lodge Care Home is designed to meet the needs of older people living with or without dementia.

The last inspection was on 5 and 6 June 2017, when we rated the service as Requires Improvement. 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 Safe, Effective, Caring, Responsive and Well-Led to a rating of at least Good. On this inspection, we found these improvements had not consistently been made.

People were not protected from risks associated with their health needs. Risks associated with the service environment had not always been assessed and mitigated. There was no comprehensive system to enable the registered manager or provider to review accidents and incidents. People’s medicines were not always managed safely. People were not kept safe from the risks associated with infection. The provider had not carried out thorough recruitment checks to ensure staff were suitable to provide personal and nursing care. Staff did not have training the provider identified as necessary to do personal and nursing care effectively.

People were not consistently supported to have enough to eat and drink to maintain a balanced diet. People were not always supported to have their daily personal hygiene needs met. People sharing bedrooms did not have their privacy and dignity needs considered. People did not always have their privacy and dignity considered when receiving care. Written information about people’s care was not stored securely.

People and relatives were not consistently supported to participate in making decisions about planning or reviewing of their or their family member’s care. Information in people’s care plans was not consistently kept up to date. This meant there was a risk staff did not have the information they needed to provide personal or nursing care people were assessed as needing.

There was limited evidence the provider undertook any surveys with people or staff at the service to identify what was working well and what improvements they would like to see. There was a risk that the views or people, relatives and staff were not used to drive improvements in the service.

The service was not well-led. During this inspection we identified shortfalls across all of the key questions we ask about services. Systems in place to identify whether people were receiving the care they were assessed as needing had not identified the issues we found on this inspection. Feedback had not been acted on to improve the quality of care for people living at the service. The provider had not taken steps to demonstrate the quality of the care people received was reviewed as part of an effective governance process.

People and relatives said they felt safe living at the service. People were kept safe from the risk of abuse. The systems in place to identify and deal with concerns worked to safeguard people from abuse. People and relatives had mixed views about staffing levels. The provider reviewed people's care needs and adjusted staffing levels to ensure people received the care they required. People were supported to access their GP and other external healthcare when they needed. Feedback from external healthcare professionals was positive regarding staff seeking medical advice in a timely way. People and relatives knew how t

We inspected Ernehale Lodge Care Home on 5 and 6 June 2017. The inspection was unannounced. The home is a situated in Arnold in Nottinghamshire and is operated by Ernehale Lodge Care Home Limited. The service is registered to provide accommodation for a maximum of 30 older people. The service has 20 bedrooms, ten of which are intended for shared use. There were 24 people living at the home on the days of our inspection visit.

Ernehale Lodge had been taken over by a new provider at the start of April 2017. The registered manager and staff team had been transferred over from the previous provider.

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 2008 and associated Regulations about how the service is run.

During our inspection we found the systems in place to reduce the risks associated with people’s care and support were not always effective. People were not protected from risks associated with the environment and the service was not clean and hygienic in all areas. People received their medicines as prescribed; however medicines were not always stored or managed safely.

There was a risk that people may not receive the support they required as there were not always sufficient numbers of staff deployed. Safe recruitment practices were not always followed. Staff did not always receive suitable training or support to enable them carry out their duties effectively and meet people’s individual needs. Staff were provided with regular supervision.

People’s rights under the Mental Capacity Act (2005) were not respected at all times. In addition, people could not be assured that they would be supported in the least restrictive way possible. Where people had capacity they were enabled to make decisions and their choices were respected.

People were not protected from the risk of dehydration and malnutrition as people’s food and fluid intake was not always appropriately monitored. However people told us they enjoyed the food and had enough to eat and drink. People had access to healthcare and their health needs were monitored and responded to.

People’s right to privacy was not respected at all times and they were not always treated in a dignified manner.

Staff were kind and caring and had an understanding of what was important to people living at the home. People felt involved making choices relating to their care and were supported to maintain their independence. People were supported to maintain relationships with family and friends and visitors were welcomed into the home.

People could not be assured that they would receive the support they required as care plans did not always contain accurate, up to date information. People were not consistently provided with the opportunity for meaningful activity. However there were plans in place to make improvements in this area.

People were supported to raise issues and concerns and there were systems in place to respond to complaints. People and staff were involved in giving their views on how the service was run.

Systems in place to monitor and improve the quality and safety of the service were not effective. Action had not been taken to review and update important policies and documents relating to the running of the home. Sensitive personal information was not always stored securely. The provider had plans in place to improve some aspects of the service.

The above concerns in relation to the quality and safety of the service resulted in us finding multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to privacy and dignity, safe care and treatment, staffing, consent and good governance. You can see wha