This inspection took place on 19 and 20 September 2018 and was unannounced. Gibson’s Lodge 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.

Gibson’s Lodge is located in a quiet residential road in Streatham close to transport links and shops. The service is registered to accommodate up to 53 elderly people. At the time of this inspection 41 people were living at Gibson's Lodge. The majority of the people at Gibson's Lodge were living with dementia.

At our previous inspection of the service in March 2017 the service was rated good. During this inspection we found breaches of the regulations relating to safe care and treatment, staffing, the lack of effective recruitment procedures, the suitability of the premises and the provider's failure to protect people from abuse and improper treatment. We also found breaches in relation to the lack of person-centred care; failure to respect people’s privacy and dignity, the provider's failure to support staff, the provider's failure to submit statutory notifications and the lack of good governance.

The inspection was prompted by information shared with CQC about incidents which indicated a cause for concern regarding the management of risk relating to people using the service. This inspection examined those risks.

The home had 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 provider had safeguarding policies and procedures in place but the registered manager and some staff did not have a clear understanding of these procedures. This meant that incidents which should have been reported to local authority safeguarding teams and the CQC were not always reported.

Management plans were in place to support people where risks associated with their health and care needs had been identified. The provider recorded accidents and incidents but did not always take action to prevent recurrence. The equipment people required to be kept safe was not always available.

People’s medicines were not always stored safely. People received their medicines when they were due and in the correct dosage. People had a sufficient amount to eat and drink and were satisfied with the variety and quality of their meals.

People were not adequately protected from the risk and spread of infection because staff were not following the provider’s infection control procedures. Many areas of the home were not hygienically clean. This included equipment and soft furnishings. There were ongoing building works which posed a risk to people’s safety. Building materials and tools were left in an unlocked room to which people had access on both days of our inspection despite this being pointed out to the registered and area managers on the first day of the inspection.

The provider's recruitment process was not sufficiently robust to ensure the staff employed had the competence, skills and experience to perform the role for which they were employed. Additionally, once recruited staff did not receive appropriate support from the provider through an induction or regular supervision. Staff training was inconsistent with some staff not receiving the training they needed to meet people’s needs. The provider did not always deploy a sufficient number of staff to meet people's needs and this impacted the care people received.

People’s needs were assessed with their or where appropriate their relatives input. Care plans comprehensively covered people’s health needs but contained little information in relation their social ne

Gibson's Lodge Limited is a residential nursing home that provides accommodation and personal support for up to 53 older people some of whom were living with dementia. There were 50 people at the home receiving care when we visited.

The home had 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.’

We carried out an unannounced comprehensive inspection of this service in May2016. Although people received the medicines they were prescribed the arrangements for the management of medicines were unsatisfactory and a breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what actions they would take to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. We found improvements had been made and the home had sustained this improvement in the management of medicine. and we have revised our rating to good for the Safe section.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Gibson's Lodge

This inspection took place on 29 April and 3 May 2016, the first inspection day was unannounced.

Gibson's Lodge Limited is a residential nursing home that provides accommodation and personal support for up to 53 older people some of whom were living with dementia. There were 46 people using the service at the time of our inspection.

We inspected the service in February 2015, at the time we found the service required improvements in three areas. We returned in September 2015 and completed a focused inspection; the home had made the necessary improvements. At that inspection we found the service was meeting all the regulations that we assessed.

There was a registered manager in post 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.

Although people received medicines prescribed there were aspects of the medicine practices that were unsafe. This constituted a breach of the regulation 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.

People told us they felt safe, and relatives felt reassured their family members were well cared for. Staff were trained and knowledgeable in safeguarding adults and followed the policies and procedures in place. They responded appropriately to allegations or suspicions of abuse. The service ensured that people’s human rights were respected and took action to identify and minimise risks to people.

Staffing levels promoted safety during the day and at night; these were based on the numbers and needs of the people who lived at the service and on the layout of the premises. People were cared for by motivated and well-trained staff that had completed essential training and responded to their individual training needs and the needs of the service. The learning opportunities were good and enabled staff to carry out their roles and responsibilities.

New staff completed an induction training programme and there was a training and development programme for staff. The support network in the home was good, staff felt supported, they had their practice appraised.

There was sufficient information in people’s care records to guide staff on the care and support needs. Care was arranged and delivered in a way that promoted equality and diversity.

Risks associated with people’s health and well-being were identified and appropriate management plans were developed to help minimise these risks.

Staff had a good understanding of people’s individual needs and the support they required. Care was delivered consistently by a team of workers who knew how to support people. New staff worked alongside experienced trained staff to get to know people and their individual ways.

We saw that arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

People told us they were happy with the service and found staff kind and compassionate. Staff interacted with people in a patient and sensitive manner.

People were provided with a range of activities in the service but these were not well developed and did not fully consider the needs of people with cognitive impairment.

People felt assured by staff and were informed promptly of any changes to their relative’s conditions. People were encouraged to continue to see friends and relatives and access the community with staff or relatives.

The service had systems in pla

We carried out an unannounced comprehensive inspection of this service on 18 and 20 February 2015. We found breaches of legal requirements. This was because there was a lack of stability in the service. The home had experienced a high turnover of staff in the last two years. Care staff had not received the training they required to carry out their roles effectively and staff who cared for people who lived with dementia had not received formal training in that area. Without training being provided staff may not have had the appropriate skills and knowledge to support people effectively.

The service did not have efficient or effective systems in place to monitor the quality of the service and drive improvement. Information was not always kept up to date, internal audits of care and staff records were not completed. There was no evidence that out of hours checks were made on staff practice and we could not be assured that systems were in place to regularly assess and monitor the quality of service or that there was a system to drive continuous service improvement.

The service was not consistently well-led. There had been no registered manager in post for two years. It had experienced a number of managerial and staff changes in the past eighteen months which had destabilised the service.

After the comprehensive inspection in February 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook an unannounced focused inspection on the 25 September 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gibson's Lodge Limited on our website at www.cqc.org.uk.

Gibson's Lodge Limited is a residential nursing home that provides accommodation and personal support for up to 53 older people living with dementia. There were 46 people using the service at the time of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

During our focused inspections on the 25 September 2015, we found that the provider had followed their plan and legal requirements had been met.

The registered manager was in post 14 months and in this time provided inspirational leadership and direction for staff. Stability was experienced in the home. Staff spoke of the improved morale among staff and good teamwork that was now present. Staff enjoyed working at Gibson’s Lodge and took pride in their work and caring well for the people who used the service. People using the service and their relatives told of having confidence in the service. A relative visiting said, “When I leave I know our family member is in a nice place and being looked after well, it’s such a relief to know she’s here”.

Effective quality assurance processes had been introduced and identified areas that needed to be addressed. Regular unannounced weekend and night visits took place to monitor practice and to offer support to staff. The registered manager was open and direct, acknowledging where improvements were needed and the ways they planned to achieve these.

Staff felt motivated and inspired to participate in learning and development opportunities. They were well supported and staff performance issues were addressed appropriately. Staff members told of feeling valued and enjoying a good range of training and development which helped them develop the skills and competencies needed for their roles.

Records were well organised and important information required for robust staff recruitment was sought and maintained on individual records.

This inspection took place on 18 and 20 February 2015; the first inspection day was unannounced.

Gibson's Lodge Limited is a residential nursing home that provides accommodation and personal support for up to 53 older people living with dementia. There were 47 people using the service at the time of our inspection.

We last inspected the service in August 2013. At that inspection we found the service was meeting all the regulations that we assessed.

There was no registered manager in post at the time of our inspection, a person was appointed to manage the service in August 2014, but the application to register as a manager was not completed. 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 home’s recruitment procedures were not robust and did not ensure thorough checks were completed on staff prior to employment; only one reference was sourced for some applicants. All staff had a disclosure and barring check (DBS) completed by the provider before working in the home.

People told us they felt safe using the service and trusted staff. Staff were trained in safeguarding adults and the service had policies and procedures in place to ensure that the service responded appropriately to allegations or suspicions of abuse. The service ensured that people’s human rights were respected and took action to assess and minimise risks to people.

Staffing levels promoted safety; these were based on the numbers and needs of the people who lived at the service and on the layout of the premises. The staff rota was planned to provide sufficient numbers of staff in both of the units during the day and at nightime.

Staff were present in communal lounges, supporting people and ensuring they were safe. Call bells were placed closeby to people that remained in their bedrooms, when people asked for assistance staff attended to them quickly.

The provider had appropriate arrangements in place to manage medicines safely.

The service has experienced a high turnover of staff in the last two years, including managers. Care staff have not received the training they required to carry out their roles effectively and staff who cared for people who lived with dementia had not received formal training in that area. Without training being provided staff may not have had the appropriate skills and knowledge to support people effectively.

People told us they were happy with the service and found staff kind and compassionate. We saw staff interacting with people in a patient and sensitive manner.

People were provided with a range of activities in the service which met individual needs and interests, but did not fully consider the needs of people with cognitive impairment. Staff responded to what people wanted to do on a daily basis.

People were encouraged to continue to see friends and relatives and access the community with staff or relatives.

The service did not have efficient or effective systems in place to monitor the quality of the service, information was not always kept up to date, internal audits of care and staff records were not completed. There was no evidence that out of hours checks were made on staff practice and we could not be assured that systems were in place to regularly assess and monitor the quality of service or that there was a system to drive continuous service improvement.

We found breaches of the regulations relating to staff support systems, and systems to monitor the quality of the service and records. You can see what action we told the provider to take at the back of the full version of the report.

Due to people’s complex needs some people were unable to share their views in a meaningful way. However, we spoke to four people that use the service and their relatives that were visiting on the day of the inspection. People's comments about the staff were positive including “staff are nice”, “they are kind,” “they are always helpful” and “staff are lovely.” Most people we spoke with said there were enough staff on duty.

One of the relatives we spoke to on the day said “We looked at other care homes, but this one stood out for us. I was impressed with the way care was provided.”

We found the care plans to be comprehensive. When we spoke to the relative of another person who used the service they told us they were kept informed by the staff about their care and treatment plans.

We observed positive interactions between the staff and the people who lived in the home and also between staff and relatives visiting.

We looked at people’s records and saw where appropriate, the service had worked proactively with other external healthcare professionals to improve the overall health and wellbeing of people using the service.

We saw improvements had been made around administering medication since our last visit. Appropriate arrangements were in place to ensure medicines prescribed to the people who use the service were being managed effectively.

We spoke to five members of staff who all told us there were enough staff working at the home. They told us “We are a good team here,” “We all work well together and if anyone needs help we get involved.”

We spoke with seven people who use the service, six members of staff, the manager and provider during this unannounced inspection. People who use the service said "it's ok here", "perfect" and "I have all I need". Comments about the food included "we choose what we eat", "the food is good", "we have enough to eat" and "some of lunch was cold, but it was good". "The staff are good", " they listen", "they always help", "they're good here" and "they come to see me every morning" were some of the comments people made about the staff. People we spoke with had not made a complaint but would speak with the manager or staff if they had any concerns or worries.

Staff told us that they had the required checks before they started work and had an induction and training that helped them do their job. Staff said that there were enough staff to help the people who lived at the home, especially at mealtimes, which ensured people's needs were met. Staff we spoke with felt that they worked well as a team and provided good care to people who use the service saying "I like the way people are looked after", "they get good care here" and "I like the team spirit".

We saw some good interactions between staff and people who use the service, with staff speaking to people in appropriate ways, explaining what they were doing.

Although policies and procedures were in place, we found that improvements were needed to the recording and administration of medication to ensure people were safe.

People who use the service told us during our visits on the 7th and 15th June 2011 that they are generally happy living at the home. People told us staff listen and help and are available when required. People's comments about the food indicated they are happy with the choice, quality and quantity of food provided. Some people said there could be more to do. People said the home is always clean and fresh and said they have all they need in their bedrooms. People feel that they are safe living at the home.