The inspection took place on 12 and 13 July 2016. The visit was unannounced on 12 July 2016 and we informed the care manager we would return on 13 July 2016.

Groby lodge is a residential home which provides care to older people including some people who are living with dementia. Groby lodge is registered to provide care for up to 12 people. At the time of our inspection there were 12 people living at the home, however one person was in hospital.

A registered manager was in post. The registered manager was also the provider, and they were supported by a care manager at the home. 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.

At the last two inspections of the service in October 2013 and June 2014 we asked the provider to take action. We asked the provider to make improvements in the storage of and administration of people’s medicines. We received an action plan from the provider which outlined the action they were going to take which advised us of their plan to be compliant by October 2014. We found that the provider had taken the appropriate action. Medicines were ordered and stored safely, and staff were trained to administer the medicines people required. There is still some action needed where PRN or as required medicines were not administered consistently. Staff sought medical advice and support from health care professionals.

At the last inspection of the service in June 2014 we asked the provider to take action. We asked the provider to make improvements and provide accessible personal evacuation plans. We received an action plan from the provider which outlined the action they were going to take which advised us of their plan to be compliant by October 2014. At this inspection we found that improvements had been made. We looked at the personal evacuation plans (PEEP’s) which were kept securely along with other documents and were placed near the fire board and main exit from the home. Copies of the PEEP’s were also kept in each person’s file and reviewed regularly.

At the last inspection of the service in June 2014 we asked the provider to take action. We asked the provider to make improvements to the audits, checks and governance in the home. We received an action plan from the provider which outlined the action they were going to take which advised us of their plan to be compliant by October 2014. At this inspection we found that improvements had been made. A series of checks had been introduced that were overseen by the care manager and then checked by the provider.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were also complimentary about the staff and the care offered to their relatives. People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions. People’s care and support needs had been assessed and people were involved in the development of their plan of care. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans included changes to peoples care and treatment, and people attended routine health checks.

People were provided with a choice of meals that met their dietary needs. The catering staff were provided with up to date information about people’s dietary needs, and sought people’s opinions to meet their individual meal choices. There were sufficient person centred activities provided on a regular basis. Staff had a good understanding of people’s care needs, and people were able to maintain contact with fami

We met nine people that lived in the home, two visitors and three staff. Some of the people we saw in the home had memory problems or difficulty with communicating their needs. We spoke directly with four people living in the home, but they did not pass comment on the home.

When we spoke with a relative they said, “When we walked in here the atmosphere was great, bright and open. X [name of person] has a lovely view from the window in her bedroom.” They went on to say, “The change is amazing, she’s brighter and more alert. [Person using the service named] seems to be better on her legs as she’s walking more here.” And added, “The staff are great, it’s certainly dispelled my fears of being cared for.”

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit an application.

Care plans reflected people’s needs and staff understood how to support people individual needs in line with their care plans. Care plans were written in an individual way ensuring people received personalised care from staff. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire.

Equipment in the home was well maintained and serviced regularly. We found medicines were signed for and distributed to people safely. However, we found the appropriate arrangements were not always in place around the recording, storing and management of medicines.

Is the service effective?

We noted that the toilet bowls in both the ground floor toilets were not adequately fixed to the floor, which could pose a risk to people. We also saw some of the tiled floor was missing below the rim of the toilet bowls. That meant that cleaning could not be done effectively and the area properly disinfected. Both these items were attended to by the staff whilst we were at the home. People’s health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. We saw that people were treated with respect and dignity by staff.

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw where people were supported by visiting doctors, specialists and district nurses on a regular basis. One relative told us, “The staff are great, it’s certainly dispelled my fears of being cared for.”

Is the service responsive?

We found that the periodic monitoring completed by staff was inadequate and required to be re-evaluated. This failed to identify issues on both the fire and evacuation and medication systems.

Is the service well-led?

Quality assurance systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. People using the service and their relatives, were invited to complete an annual satisfaction survey. Where shortfalls or concerns were raised these were recognised and a plan put in place for them to be addressed.

We spoke with five people using the service and two relatives visiting their family member. We also spoke to three members of staff.

We found that people were able to make informed decisions about their care and support. One person told us “it’s alright here. I am always respected and the staff always knock on my bedroom door before coming in.” One relative told us their family member “always looks well cared for. We are very satisfied with the care and support here.”

We found people experienced care and support that met their needs and protected their rights. Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines. People’s medication was not always stored safely and securely. Controlled drugs were not stored appropriately and the number of controlled drugs recorded did not match the number stored.

We found staff were supported in their work and were confident that they were able to provide the care required.

People were not always protected from the risks of unsafe or inappropriate care and treatment because appropriate information relating to people’s risks was not always being completed in a reliable way. We found the provider had systems in place relating to record keeping.

We did not speak with people as part of this inspection. We spoke with people at Groby Lodge at the previous inspection of July 2012 and the inspection report contains people's comments and views.

We found staff recruitment records had been updated to include confirmation of people's identity which included a photograph.

We spoke with people who use the service and asked for them for their views about the service they received. People’s comments included “The care is good, the staff are alright and if I need help I use my buzzer and staff come quite quickly. I just ask if I need anything, there’s nothing the home could do to make it better for me.” “The staff are very good, even though I’ve only been here a while. The meals are very good, you can’t fault them.”

We spoke with people and asked them about the care and support they received. One person said “I like it here I’ve been here a while and the staff are nice.” Another person told us “I like my place and I like my room.” Someone else we spoke with said “I’ve always been happy here and we had a good Christmas”. One person told us that they had received support from a district nurse who had applied dressings but that they were now better. One person told us “the foods good.”

People had access to a range of health care professionals. A visiting district nurse told us that they didn’t have any concerns about the care provided. People were not in all instances aware of their care plan and people’s care plans did not reflect all aspects of their care, welfare and health.

People and their relatives are invited to attend regular meetings held by the service. We found that issues raised by people had been acted upon by the service. People using the service were provided with an opportunity to comment on the service received however the outcome of their comments had not been shared with them.

People told us their routine was flexible and they got a choice over how they spent their time. They told us that they received the care they needed but would like more to occupy their time. They said “you never get asked to go out”; “there’s not a lot going off” and “every day is much the same, it’s very quiet”. Care workers were working well with other agencies where more than one provider was involved in a persons' care.

The environment people lived in was homely, clean and tidy. Gaps in staff training and management meant that people were not fully protected against risk of infection and that some care workers were not sufficiently trained in keeping people safe.

Although people were asked for their opinions, one said “the manager comes and asks how I am but it’s very rushed, he doesn’t come and talk”. They said that they did not get formally asked for their opinion on how the service was run. They told us they would like more opportunity to do this. When opinions had been sought we found there was no formal system for acting upon people's views.