The inspection took place on 17, 18 and 24 October 2017. This was an unannounced inspection. The service was last inspected in August 2016 and was rated ‘Requires Improvement’ overall. At this inspection we found improvements had been made and the service has been rated ‘Good’ overall.

Highborder Lodge is a residential care home providing support for up to 42 people. Nursing care and support is provided by district nurses and local GP’s as required. Several people at Highborder Lodge were living with the first stages of dementia. There were 31 people at Highborder Lodge at the time of the inspection.

There was a registered manager in post at Highborder Lodge. 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 inspection on 23 and 24 August 2016, we asked the provider to take action to make improvements around staffing levels, the management of complaints and the safety of the environment. We also asked them to take action where concerns had been identified to improve the quality and service provided to people. Following the inspection, the provided submitted an action plan detailing how they would address the shortfalls and meet the requirements of the regulations. The provider told us all of the actions would be completed by July 2017. At this inspection we found this action had been completed and the provider met the requirements of the regulations.

The service was safe. People were protected from the risk of abuse. Staff had received safeguarding training and had a policy and procedure which advised them on what to do if they had any concerns. Risks had been identified to people’s well-being and action had been taken to minimise these. There were safe and effective recruitment systems in place. Staffing levels were sufficient; people received high levels of support from staff who had a good understanding of their needs and preferences. Medicines were administered safely and people told us they received their medicines as prescribed.

The service provided to people was effective in meeting their needs. Staff had the relevant skills and had received appropriate training to enable them to support the people living at Highborder Lodge. Staff received good support from management through regular supervisions and appraisals. People were encouraged to make day to day decisions about their life. For more complex decisions and where people did not have the capacity to consent, the staff had acted in accordance with legal requirements. People and relevant professionals were involved in planning their nutritional support. People had access to a variety of healthcare professionals and appointments were arranged as required.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained people’s dignity. People were supported to engage in activities specific to their cultural or religious backgrounds and diversity was promoted throughout the service. People had end of life care plans which clearly reflected their wishes and preferences.

The service was responsive to the needs of people. People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported. The planning of people’s care, treatment and support was personalised to reflect people’s preferences and personalities. People were supported to access and attend a range of activities. Where complaints had been made, there was evidence these had

The inspection took place on 23 and 24 August 2016. This was an unannounced inspection. The service was last inspected in February 2014. There were no breaches of regulations at the time.

Highborder Lodge is a residential care home. Nursing care and support is provided by district nurses and local GP’s as required. Several people at Highborder Lodge were living with the first stages of dementia. There were 34 people at Highborder Lodge at the time of the inspection.

There was a registered manager in post at Highborder Lodge. 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.’

Our inspection highlighted shortfalls where a number of regulations were not met and improvements were required. People did not always receive a service that was safe. Staffing levels were not always sufficient to ensure the safe care and treatment to support people. Staff also told us they struggled to spend quality time with people due to short staffing levels.

The service was not always responsive. Complaints had been dealt with but people said they were not always satisfied with the outcome of their complaint. Care plans were person centred and provided sufficient detail to provide safe care to people. Care plans were reviewed and updated regularly.

The service was not always well-led. The majority of the staff we spoke with stated the registered manager’s approach when speaking with staff was poor and this had resulted in low staff morale across the home. Staff stated the registered manager should be more hands on.

Risk assessments were implemented and these provided a clear framework for managing risk to people. People were protected from abuse and neglect. There were clear guidelines for staff to follow when reporting concerns. People were protected from the spread of infection through safe infection control practices. The administration, storage and recording of medicines was safe.

People were receiving effective care and support. Staff were receiving appropriate training related to their role. Staff received regular supervision or appraisals. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and where people’s liberty had been deprived Deprivation of Liberty (DoLS) applications had been made. People’s personal living areas were personalised.

The service was caring. People and their relatives spoke positively about the staff at the home. Staff demonstrated a good understanding of respect and dignity and were observed providing care which maintained people’s dignity. People had end of life care plans which clearly reflected their wishes and preferences.

Quality assurance checks and audits were completed on a regular basis. Where issues had been identified, these had been actioned. People and their families were asked to provide an opinion through surveys.

We found a number of breaches 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 this report.