This inspection took place on 5 December 2018 and was unannounced. Homer 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. It provides accommodation for older people and those with mental health conditions or dementia. The home can accommodate up to people in one adapted building. At the time of our inspection there were 26 people living in the home.

At the time of our inspection 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 in the Health and Social Care Act 2008 and associated regulations about how the service is run.

The service had previously been rated as ‘requires improvement’ in 2017. At this inspection the service was rated as ‘Good’.

The provider had ensured that there was usually a sufficient number of staff on duty. People told us that they received person-centred care. Sufficient background checks had been completed before new staff had been appointed according to the provider’s policy. A system was in place to carry out suitable quality checks and appropriate checks had been regularly carried out.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. The environment was clean. Staff followed arrangements to prevent and control infections.

Guidance was in place to ensure people received their medicines when required. Processes were in place to manage medicines.

Where people were unable to make decisions, arrangements were in place to ensure decisions were made in people's best interests. Best interests decisions were specific to the decisions which were needed to be made.

Care was not always delivered in line with current best practice guidance.

Arrangements were in place to ensure staff received training to provide care appropriately and effectively. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were not treated consistently with dignity and respect. People were usually treated with kindness and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access a range of activities. People were supported to access local community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to improve the quality of care. Arrangements were in place to support people at the end of their life.

The registered manager encouraged a positive culture in the home. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been consulted about making improvements in the service. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detai

This inspection took place on 12 September 2017 and was unannounced. At our previous inspection in 2016 we found that the provider did not have effective systems to assess and monitor the quality of service provided to people. We also found that there were not effective and safe systems in place for the management and administration of medicines. After the inspection, the provider wrote to us on 9 December 2016 to say what they would do to meet legal requirements in relation to the breaches. On the 24 January 2017 the registered manager wrote to us and told us the home was now meeting legal requirements. We undertook a focussed inspection on 16 March 2017 and found the provider had not made the necessary improvements. As a consequence we told the provider to take specific action to address the issues.

At this inspection we found the provider had made some improvements in the management of medicines but identified further issues relating to the management of medicines. We also found the provider had failed to meet a recommendation we made in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider had failed to address all the issues raised at previous inspections.

We found 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 the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Homer Lodge provides nursing and residential care for older people. It provides accommodation for up to 47 people who require personal and nursing care. The service provides care on three floors. At the time of our inspection there were 31 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 in the Health and Social Care Act 2008 and associated regulations.

The provider’s audit processes had failed to identify the issues we found at our inspection regarding medicines and MCA. The provider had also failed to fully address the issues raised at our previous inspection in September 2016 in relation to the MCA and best interest assessments.

Systems and processes were not for the safe management of medicines were not consistently effective.

Where people could not consent assessments to ensure decisions were made in people’s best interest had not been consistently completed. We saw that staff obtained people’s consent before providing care to them.

People told us there were not always sufficient staff available to meet people’s needs. Staff responded in a timely and appropriate manner to people during our inspection. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received supervision and appraisals. People were pro

We carried out an unannounced focussed inspection of this service on 16 March 2017. Breaches of legal requirements were found.

At our previous inspection on 21 September 2016 we found that the provider did not have effective systems to assess and monitor the quality of service provided to people. We also found that there were not effective and safe systems in place for the management and administration of medicines. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focussed inspection on 16 March 2017 to check that they had followed their plan and to confirm that they now met legal requirements. At our inspection on 16 March 2017 we found the provider had not made the necessary improvements.

This report only covers our findings in relation to those requirements. You can see what action we have told the provider to take at the back of the full version of this report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Homer Lodge on our website at www.cqc.org.uk.

Homer Lodge provides care for older people who have mental and physical health needs. It provides accommodation for up to 47 people who require personal and nursing care. At the time of our inspection there were 31 people living in the home.

At the time of our inspection 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not managed safely. Arrangements were not in place to ensure people received their ‘as required’ medicines (PRN) appropriately. Medicine records were not completed fully.

Systems were not consistently in place to assess and monitor the quality of the service provided for people. The provider told us what actions they would take to make improvements and we found at this inspection that the improvements had not been sufficient to meet legal requirements. The provider had started to carry out some audits on a regular basis however medicine audits did not identify some of the issues we found at this inspection. The provider had not complied with their medicines policy. The provider did not have systems in place to ensure that people received their medicines as prescribed.

This inspection took place on 21 September 2016 and was unannounced. Homer lodge provides care for older people who have mental and physical health needs. It provides accommodation for up to 47 people who require personal and nursing care. At the time of our inspection there were 30 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 in the Health and Social Care Act 2008 and associated regulations.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe. However risk assessments had not always been completed. We have made a recommendation about the use of slings.

Medicines were not consistently administered safely. We saw that staff obtained people’s consent before providing care to them. The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find. We have made a recommendation about MCA & DoLS.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People did not always have their dignity considered. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. The process had failed to identify some of the issues we found at inspection. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

This inspection took place on 28 May 2015 and was unannounced. Homer Lodge provides care for older people who have mental and physical health needs. It provides accommodation for up to 47 people who require personal and nursing care. At the time of our inspection there were 37 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that staff interacted well with people and people were cared for safely. People felt safe and well cared for. Staff were able to tell us about how to keep people safe. The provider had systems and processes in place to keep people safe.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered

to meet those needs. People had access to other healthcare professionals such as a dietician and GP.

People had their privacy and dignity considered and staff responded in a timely and appropriate manner to people. We saw that staff obtained people’s consent before providing care to them. Care was not always provided in a sensitive manner. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

People had access to activities however, at the time of our inspection there was a limited range of activities.

People were supported to eat enough to keep them healthy. People were offered drinks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided.

Staff felt able to raise concerns and issues with management but that these were not always addressed in a timely manner. We found relatives were clear about the process for raising concerns. The complaints process was available in a service user guide.

Audits were carried out on a regular basis and action plans put in place to address any concerns and issues, however these had failed to identify the risks we found on inspection. Accidents and incidents were monitored and the provider had informed us of incidents as they are required by law to do so.

The summary is based on our observations during the inspection, speaking with seven people who used the service, two relatives, the deputy manager and six staff. In addition, we looked at care records, the management of medication, the recruitment and selection of staff, staffing arrangements and quality assurance.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We found that the service was caring. This was because people said that staff were respectful, kind and attentive. They considered staff to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.

People were offered the opportunity to engage in a range of social activities. These included having one to one sessions with the activities coordinators, taking part in small group activities such playing board games and going on trips out.

Is the service responsive?

We found that the service was responsive. This was because staff knew about each person’s choices and preferences about the care they wanted to receive. People said that their care needs were met in a flexible way. This involved staff being happy to adjust the assistance they provided according to people’s changing needs and wishes.

However, we identified some defects in the accommodation. These reduced people’s ability to receive care in a comfortable and dignified setting. We have said that the provider may find it useful to make some improvements to further develop the service. These involve completing the repairs and redecoration necessary to ensure that all parts of the accommodation are finished to a normal domestic standard.

Is the service safe?

We found that the service was safe. This was because the provider had made arrangements to reliably implement the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. These measures are designed to ensure that people who have reduced capacity to make decisions receive the support they need so that they are protected from abuse.

We found that a number of important checks had been completed to ensure that new staff were trustworthy to care for vulnerable people. However, we have said that the provider may find it useful to make an improvement to further develop the service. This involves making additional checks on applicants who have previously worked in care settings. This is necessary so that assurances can be obtained about their good conduct.

Is the service effective?

We found that the service was effective. This was because people's individual needs for care had been properly assessed and they were receiving all of the nursing, rehabilitation and care services they needed. In addition, staff had ensured that people had seen their doctor and other healthcare professionals when necessary.

There were safe systems for ordering, administering and dispensing of people’s medication. However, we found that some of the storage facilities in the medication room were not robust. We have said that the provider may find it useful to make an improvement to further develop the service. This involved ensuring that all medicines are stored in metal cabinets.

The number of staff employed and the way in which their work was organised enabled the provider to meet people’s needs for care. However, the provider did not have a robust system for deciding when staffing levels needed to be altered in order to respond to people’s changing needs. We have said that the provider may find it useful to make an improvement to further develop the service. This involves developing a clear and recorded system to assess how many nurses and care assistants are needed at any particular time.

Is the service well lead?

We found that the service was well led. This was because people had been consulted about their experience of using the service. This meant that they could contribute ideas for improving the service.

There was a clear line of management. This meant that important decisions about organising someone’s care were made by nurses. At the same time care assistants could use their own judgement for routine matters in order to provide a flexible service.

Records showed that a number of quality checks had been completed. These included care records and various health and safety matters. However, we concluded that checks of accommodation were not robust. This was because they had not always identified and quickly resolved obvious problems. We have said that the provider may find it useful to make an improvement to further develop the service. This involves ensuring that effective checks are completed of the environment so that any defects can be quickly put right.

During our inspection on 07 February 2014, we spoke with six people living in the home and five relatives or friends who were in the home at the time. Everyone we spoke with said they were very happy with the care and support they received and told us that staff were very good. One person told us: "The staff are very nice".

People who lived at Homer Lodge Care Centre were treated with dignity and respect. One person said: "They check me but close the doors so that I have my dignity".

We checked care plans and risk assessments but found the information was not person centred and did not provide the detailed guidance necessary for staff to ensure people’s care and support needs were met.

Prescribed medication for some people was not available in the home, which meant people's health care needs were not met.

Staff we spoke with said they felt there were enough staff available to meet people's needs most of the time, but when sickness and holiday cover was needed it meant staff worked long hours. They all said they had received the training they needed to ensure people's care needs could be met.

There was a complaints system in place to ensure people could raise concerns and that they would be dealt with appropriately.

People told us they were able to make their own decisions about the care and support they received. For example, we were told, “I can get up when I like and if I say I’m sorry I’m in bed early they (the staff) say that’s alright its up to you."

Where people were unable to give consent, we saw appropriate discussions were held with people such as relatives who knew them well.

People said they were satisfied with the care they received and said their privacy and dignity was respected. Relatives also commented positively. For example, a relative said, “We can’t thank them (staff) enough they are wonderful, I can go home and sleep at night.”

People told us they felt safe and comfortable to talk to staff if they had any problems and thought they would be dealt with.

People said they were satisfied with the cleanliness of the home and we saw there was a programme in place to redecorate and refurbish bedrooms and communal areas. A relative said, “Staff always wear aprons and gloves, use the hand wash and encourage us to do the same.”

People told us they were well looked after and the staff were “Lovely.” Staff said they were well supported. However we spoke with the manager about making sure staff learning and development records were up to date and accurate.

There were satisfactory systems in place to monitor the quality of the service which took into account people's views. People said they knew how to and felt comfortable to raise concerns.

People told us they were able to make decisions about their daily routines and felt their independence was encouraged. One person told us, “I am asked what I would like to wear. I make choices I want to. I can do a lot for myself, they encourage me to.”

Another person said, “I asked when I moved here what time do I have to get up and was told I could get up when I liked. We can have a bath or a shower when we want one.”

People told us their needs were being met by the support they received and this was provided in a way they wished it to be.

People told us that staff spoke with them and supported them in an appropriate way and they did not have any concerns about how they were treated.

We asked people if they felt safe in the home and they said they did, and they did not feel they had ever been put at risk. One person told us, “It’s the company that helps” and another person said, “Having someone to walk with you really helps.”

People told us the staff who supported them knew what they were doing and were able to provide them with the support they required. One person told us, “I get help when I want it. I can’t wash my back so they do it for me.”

A person told us about residents’ meetings that took place and how they enjoyed getting together to discuss things. They said, “We come up with ideas, I started a library.”