This inspection took place on 2 and 3 August 2018 and was unannounced. The previous inspection was carried out on 20 and 21 June 2017, there had been several breaches of legal requirements at that time. We rated the service requires improvement in three of the key questions, safe, caring and well led. We found at this inspection significant improvements had been made since the last inspection. The registered manager had submitted an action plan to the Commission so that we could monitor the improvements made.

There was 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 of the Health and Social Care Act 2008.

Granville Lodge provides accommodation for people who require nursing or personal care for up to 81 people. At the time of our visit there were 73 people living at the service.

People were protected from abuse because staff understood how to keep them safe, including understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

There were enough suitable staff to meet people's needs.

People's safety had been considered by the service, risk assessments both for care and the environment had been completed.

Staff recruitment procedures were safe and the employment files contained all the relevant information to help ensure only appropriate staff were employed to work at the service.

People received their medicines when they required them and in a safe manner. Staff received training and guidance to make sure they remained competent to handle people's medicines.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 (MCA) and the DoLS. Staff had the right skills and training to support people appropriately.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to eat and drink according to their likes and dislikes. People's nutritional needs were reflected in care plans and we observed staff supporting people to ensure their health and wellbeing was maintained.

Staff were caring, kind and treated people with respect. Staff were described as caring by people's relatives. The registered manager and staff were held in high regard and we received positive comments about the service they provided.

People's personal and health care needs were met and care records guided staff on how to do this. There was a variety of activities for people to do and take part in during the day, and people had enough social stimulation.

The service supported people to maintain their health and wellbeing and people were supported to access healthcare services and any treatment required promptly.

There was a system in place for responding to and acting on complaints, comments, feedback and suggestions.

People and their relatives praised the management of the service. They said the team were approachable and had a visible presence at the service. The views of people and their relatives and staff had been actively sought to develop the service. Effective arrangements were in place for the service to learn, improve and assure its sustainability. Strong partnerships had been developed with other agencies for the benefit of people who used the service.

Quality assurance systems were in place to assess and monitor the quality of service that people received and identify any areas that required improvement.

This inspection took place on 20 and 21 June 2017 and was unannounced. This was the homes first inspection and rating.

Granville Lodge is a care home with nursing care for up to 81 predominately older people. People have general nursing care needs and some are living with dementia. At the time of our visit there were 75 people living at the home.

There was 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 of the Health and Social Care Act 2008.

We found a number of breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Appropriate moving and handling techniques were not used by staff. Moving and handling equipment was not used safely by staff.

Checks were not always carried out on some equipment within the premises. Some safety equipment had not been maintained and repaired in a timely manner.

We observed poor care practices in relation to dignity and respect. People’s dignity and wishes were not always respected by staff.

We found that the home had systems in place to assess and monitor the quality of service. However, they were not always effective. We had identified areas that require improvement, which were not picked up by the quality assurance processes.

Staff were knowledgeable about recognising the signs of abuse. All staff had received training in safeguarding adults.

Medicines were administered to people safely by staff that had been trained.

There were sufficient numbers of staff to ensure people's needs were met. The registered manager carried out pre-employment checks on staff before they worked with people to assess their suitability.

The home was meeting the requirements of the Deprivation of Liberty Safeguards. Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Staff received induction and training. A training programme was in place and staff had been encouraged to complete all mandatory refresher training. Staff had supervision meetings and team meetings were held to support them in their role.

People were satisfied with the quality of the food and drinks provided. Food and fluid intake was monitored where risks of weight loss or dehydration had been identified. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People said they were treated in a kind and caring manner. People were able to make choices about the way they were cared for.

Activities were personalised for each person. People made suggestions about activities they wanted to participate in each day.