This inspection was carried out on 13 June 2018 and was unannounced. At our previous inspection on 23 August 2017 we rated the service as requires improvement. This was because people were not protected from harm, staffing levels were not monitored effectively, staff did not receive sufficient training and people’s nutritional needs were not met. We found the provider had made improvements in a number of these areas, but continued to require further improvement in relation to activity provision and monitoring the quality of care people receive.

Heath 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.

Heath Lodge provides accommodation for up to 67 people. Some people live with dementia, old age and physical disability. The home is not currently registered to provide nursing care. At the time of the inspection there were 37 people living there.

The service had a manager who had applied to register with the Care Quality Commission (CQC). 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.

The service was run by a management team that knew people well. People, relatives and staff were positive about the management of the service. Staff felt supported by the management team and able to voice their opinions about the running of the home. There were quality assurance systems in place which did not always identify shortfalls or when they did identify areas for improvement did not always ensure appropriate remedial action was taken.

People felt safe and were supported by sufficient staff who had undergone a thorough recruitment process. Risks to people’s safety and welfare were generally identified and responded to appropriately. Equipment to support people’s independence or skin integrity was sought. Medicines were managed safely and risks were identified with management plans in place to mitigate these risks. The management team shared learning from any events such as medicine errors, safeguarding investigations or complaints.

Staff were provided with appropriate training and felt supported by the manager. People were supported in accordance with the principles of the Mental Capacity Act. People were supported by staff who were trained and had opportunities for supervision. People were encouraged to eat a healthy and balanced diet and there was appropriate access to health and social care professionals. We found the design of the building promoted a friendly and welcoming environment although was continuing to undergo extensive improvement.

People’s care needs were met and responded to promptly by staff who were aware of their individual needs and preferences. People told us care was provided to them in a manner they preferred. Care records contained sufficient information that allowed for effective review of people’s wellbeing. There was a need for further development in relation to activities. People’s feedback was sought.

Heath Lodge is registered to provide accommodation and personal care for up 67 older people some of whom live with dementia. At the time of our inspection 37 people were living at Heath Lodge. This inspection took place on 23 August 2017 and was unannounced. At our last inspection of Heath Lodge on 31 January 2017 we found the service was not meeting the required standards. At this inspection we found although the service continued to not meet the required standards, improvements had been made in some areas.

The service did not have a registered manager. 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. A manager was in post who told us they were intending to register.

The service had staff vacancies and as a result was using high level of agency staff. Some staff recruited by the provider were not able to demonstrate to us a good understanding about their roles and responsibilities regarding all the aspects of care they delivered to people using the service. Risks to people's safety and wellbeing were safely managed with appropriate equipment in place to support people's health needs. Staff were aware of how to keep people safe and were aware of when to report a concern. People were supported by staff who had undergone a robust recruitment process to ensure they were suitable to work with vulnerable people. People's medicines were administered as intended by the prescriber.

People were supported by staff who were trained to develop their skills and provide effective care. Staff received regular supervision of their conduct and practice. People's consent was sought and staff worked within the principles of the Mental Capacity Act 2005 when people lacked the capacity to make their own decisions. People were happy with the food and drink provided to them and where people were at risk of weight loss, staff took appropriate actions. People were supported by a range of health professionals who were positive about the care provided to people.

Staff spoke and interacted with people in a kind and friendly manner, and permanent staff clearly demonstrated a caring approach to meeting people's individual needs. However this approach was not consistently followed by agency staff. Permanent staff ensured people's dignity and privacy was maintained at all times and supported people's social needs, however this was not always done by the agency staff working at the home.

People told us they felt staff listened to their needs and responded to these when required, however we observed that agency staff did not consistently respond to people`s individual needs or wishes. People felt able to raise a concern or complaint with staff who they felt would take appropriate action to resolve these. People were provided with regular opportunities to meet in order to discuss their concerns regarding the day to day issues in the home. However they were not always kept up to date of significant changes affecting the home.

People, staff and relatives felt the previous registered manager was not visible or responsive to their concerns, however were positive of the current management arrangements.. Governance systems were in place to monitor the quality of care people received but did not always effectively respond to issues identified. People's views and opinions regarding the quality of care had been sought and acted upon. People's care records were not consistently updated to reflect changes in their care needs.