This inspection took place over two days on the 11 October and 13 October 2017, was unannounced on day one, and announced on day two.

Humfrey Lodge provides accommodation and personal care support for up 48 people including people living with dementia. The service is provided from within a purpose built building, with rooms and communal areas all on one level and located within a residential area. The service has a number of courtyard gardens which people are able to access if they choose. On the day of our inspection there were 47 people living at the service.

Humfrey Lodge had been through a period of instability with a change of three managers within the last three years. Since our last inspection, a new manager had been appointed and had registered with the Care Quality Commission (CQC). 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 our last inspection in October 2016, this service was rated as Requires Improvement as we found that the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to provide and deploy sufficient numbers of suitably qualified, competent, skilled and experienced staff to make sure that they met people’s care and treatment needs. We also found the nutritional needs of people were not always being met, as there was inadequate monitoring of people at risk of losing weight and inadequate fluid intake. We asked the provider to take action to make improvements. They sent us their action plan which told us what steps they would take to improve and ensure compliance with legal requirements.

At this inspection, we found some improvement. Whilst the provider told us that the recruitment and retaining of staff continued to be a challenge, we found sufficient numbers of suitably qualified, competent, skilled and experienced staff available to meet people’s needs.

The monitoring of people’s food and fluid intake had improved. However, further work was needed to ensure where people gained excessive weight which could impact on their health and wellbeing, this was monitored and appropriate referrals made to specialists for advice and guidance.

We found some discrepancies with contradictory information recorded by night staff in relation fluid balance charts and repositioning records. We could not be assured that care and support recorded had actually been provided. Whilst care plans were person centred and detailed in places, some lacked specific information about people’s care. For example, care plans did not consistently reflect the needs of people who required staff to support them with moving and handling, safely using specialist equipment. In response to our feedback, the registered manager responded promptly to our concerns and by the second day of our inspection had taken immediate action to rectify the shortfalls we identified.

The registered provider had a system in place to ensure appropriate recruitment checks had been carried out before staff started working at the service. Staff received training to equip them for the roles for which they were employed.

Staff had received training to enable them to recognise signs and symptoms of abuse and said they were confident in how to report any concerns they might have. In relation to risk, we found the quality of information recorded in care plans varied.

People told us they felt safe living at Humfrey Lodge. They were satisfied with the way staff provided care and support and told us they were treated with dignity and respect. People’s needs and choices had been assessed and care and treatment delivered in line with people’s wishes and preferenc

This inspection took place on the 12 October 2016 and was unannounced.

Humfrey Lodge provides accommodation and personal care support to 48 people including people living with dementia. On the day of our inspection there were 47 people living at the service.

At the last inspection the service was rated as requires improvement. The provider sent us their action plan where they told us what they would do to meet regulatory requirements. At this inspection we identified several areas of improvement. However, as further action was required to ensure the provider met requirements the service remained as requires improvement.

Since our last inspection in February 2016 the previous manager has left the service and a new manager employed within the last four months. The current manager had applied to be registered with the Care Quality Commission (CQC) and their application was currently being processed. 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 provider had systems in place to ensure people were protected as far as reasonably possible from abuse. Staff were trained in identifying acts of abuse and knew what steps to take to reduce the risk of people experiencing abuse. Staff had been provided with procedural guidance in steps they should take to report issues of concern through safeguarding and whistleblowing processes in place.

Improvements had been made with the implementation of systems in place to audit, risk assess and protect people from the risk of cross infection. Actions had been taken to improve the standard of hygiene appropriate for the purposes for which the premises were being used, in line with current legislation. However, further work was required to ensure the risks of acquiring health related infections were mitigated through a regular audit of mattresses and bedding to check cleanliness and ensure replacement of items took place as and when required.

The provider had established and operated effective procedures for the management of people’s medicines.

The provider had system in place for safe staff recruitment processes such as disclosure and barring checks as well as references obtained from the most recent employer prior to their starting work at the service to reduce the risk of employing unsuitable staff. However, we found staff recently employed who were unable to speak, write and understand the English language. We observed this impacted on people’s ability to be heard, understood and put people at risk of not having their care and treatment needs met.

Staff were supported with regular supervision and staff meetings. Staff worked well as a team, and had a good relationship with the manager.

Since our last inspection staffing levels had been increased. However, there continued to be a significant number of vacant staffing hours. This meant there was a high number of agency staff in use. Feedback from staff and people who used the service told us this had the potential to put people at risk of not receiving consistent care from staff knowledgeable about people’s individual care and support needs.

Steps had been taken to make sure that people were supported to receive adequate nutrition and hydration, and that people at risk of weight loss and, or dehydration were monitored and had access to specialist advice. However, staff did not always accurately record the food consumed by people. This meant that monitoring of people’s nutritional intake was ineffective. However, people’s weight was regularly monitored and action taken to refer to people to specialists for advice and support.

The manager had a good understanding of their roles and responsibilities with regards to the Mental Capacity Act 200

This inspection took place on the 3 February 2016 and was unannounced.

Humfrey Lodge provides accommodation and personal care support to 48 people including people living with dementia. On the day of our inspection there were 48 people living at the service.

There was a registered manager. 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 provider had systems in place and staff trained in identifying acts of abuse and steps to take to reduce the risk of people experiencing abuse. Staff had been provided with procedural guidance in reporting issues of concern.

There was ineffective systems in place to audit, risk assess and protect people from the risk of cross infection. The provider failed to maintain standards of hygiene appropriate for the purposes for which the premises were being used in line with current legislation as described in the Department of Health prevention and control of infections in residential care settings.

The provider had established and operated effective procedures for the management of people’s medicines.

The provider had followed staff recruitment processes to reduce the risk of employing unsuitable staff. Staff were supported with regular supervision and staff meetings. Staff worked well as a team, and had a good relationship with the manager, who worked hands on shift alongside staff. However, there were insufficient numbers of staff employed and available at all times to meet people’s needs. This put people at risk of not having their care and treatment needs met.

The provider did not act in accordance with the Mental Capacity Act 2005 and associated code of practice in failing to take steps where people lacked capacity to make an informed decision, or give consent to their care and treatment.

Further work was needed to ensure people were involved in the planning and review of their care. Care plans did not include assessment of individual’s wishes and preferences regarding their preferred day and night time routines. Staff did not have easy access to risk assessments and this meant they were not provided with recorded guidance to refer to with details of action they should take to mitigate risks to people’s health, welfare and safety.

Steps had not been taken by the provider to make sure that people were supported to receive adequate nutrition and hydration, and that people at risk were monitored and had access to specialist advice.

Staff received training, supervision and support to provide them with the knowledge and skills they needed to meet the needs of people living at the service. However, e-learning training to support staff with the required knowledge in understanding the needs of and supporting people living with dementia was insufficient.

During this inspection we identified 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 the report.

People told us that they liked living at Humfrey Lodge. One person said they had been living there many years and that they were very happy with the staff who provided personal care and support. Two people were complimentary about the meals saying that it was “Good home cooked food.” Another person said, “I like it here, I can have a shower when I want, staff care for me good.”

We saw there were activities for people to take part in. One person said they would like more outings but said there was enough to do including musical entertainment.

We found that although staff worked long hours that this was their choice and it was monitored by the manager. Staff told us there were usually enough staff to provide care that was required. The manager told us that bank staff were used to cover gaps and more staff were being recruited.

There were appropriate arrangements for the management of medications and sufficient equipment for staff to provide safe care.

The manager had systems in place to check that the quality of the service was maintained, met appropriate standards and was responsive to people’s views and changing care needs.

We spoke with six people who use the service and two relatives of people living in the service. One person said “I like being here; they do everything for me if I want”. Another person said “I feel happy here”. Relatives said they were very happy with the care provided and that they were supported to be involved if they wanted to. People said they enjoyed the activities and one person said “We do quizzes in teams”. One person told us they usually had prompt help but sometimes had to wait for help when they rang the call bell. This was particularly in the busy period in the mornings.