This inspection took place on 9 May 2017 and was unannounced. At our last comprehensive inspection in January 2015 we rated this service ‘Good’ as we found they were meeting all legal requirements.

Lodore Nursing Home provides accommodation with nursing and personal care for up to 36 people. This includes palliative and end-of-life care. At the time of our inspection there were 29 people using the service.

The service was required to have a registered manager in post but did not have one at the time we carried out this inspection. A manager had been in post since November 2016 and was undergoing the process of registration with the Care Quality Commission.. 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.

There were a range of checks and audits to monitor the quality of the service. However, one of these audits had not identified an anomaly with medicines’ recording which we found during this inspection. The manager took prompt action to address the anomaly. Notwithstanding the issue above, people received their medicines as prescribed.

The provider gathered information prior to people being admitted into the home to help ensure they were able to meet people’s needs. Care plans were developed which were specific to each person and described how the person wished to be cared for.

People were encouraged to make choices for themselves whenever possible this included, being able to choose if they wanted to participate in activities. Where people did not want to take part in group activities, there were opportunities for staff to engage on a one to one level with for people.

There were measures in place to help ensure only suitable people were employed by the service. Staff received training which was refreshed regularly so they were up-to-date with the relevant training. Enough staff were deployed to effectively meet people’s needs.

People had support to access appropriate healthcare and their nutritional needs were met according to their needs and preferences. The provider was able to offer appropriate end of life care to people.

The provider worked within the remit of the Mental Capacity Act 2005 (MCA). Staff were aware and knowledgeable about the MCA and how it impacted on people who used the service. Staff sought consent from people prior to providing care. Staff generally treated people with dignity and respect.

There were assessments in place which identified possible risks to people and others and action that needed to be taken to minimise the risks. These included measures to prevent the risk of infection and to help ensure people were protected from possible harm and the measures they needed to take if they were concerned about someone’s welfare.

There were a number of ways people could comment on the quality of the service. There were annual postal surveys and resident and relatives meetings. People knew how to make a complaint if they were unhappy with the service and told us they felt able to approach the manager or operations director with their concerns.

The inspection took place on 28 January 2015 and was unannounced. The last inspection of the service was on 21 February 2014 and there were no breaches of legal requirements at the last inspection.

Lodore Nursing home is a care home providing personal and nursing care to up to 36 older people, it specialises in care for people at the end of their lives. 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 and associated Regulations about how the service is run.

The service had policies and procedures in place to make sure people were kept safe. Staff were knowledgeable about the actions they should take if they suspected abuse. Staff had been appropriately recruited and all employment checks had been completed prior to them starting work. People received their medicines as prescribed.

There were systems in place to make sure the service complied with the Mental Capacity Act 2005 and to ensure the service did not deprive anyone of their liberty without proper safeguards being in place.

There were enough staff employed to keep people safe and to meet their needs. The provider had ensured that staff had sufficient skills to do their jobs. The new manager had identified the need for formal meetings and appraisals with staff to consider professional development.

People were supported to maintain good health and access healthcare professionals as needed. They were provided with a varied and balanced diet and their nutritional needs were assessed and monitored. People received their medicines when they required them. People at the end of their life received compassionate and appropriate care.

People were asked for their consent to care and treatment. Where people did not have the capacity to consent, the provider had acted in accordance with legislation and guidance.

The staff were kind and caring, they had positive relationships with the people they cared for based on respect.

People received care which was individualised and met their assessed needs. They were given opportunities to voice their opinions on the service so the provider would get information on the quality of service people received.

People were encouraged to be as independent as possible and there were systems in place for them to participate in tasks of daily living even though they may have been risky to them. There was a range of activities for people to participate in, if they wanted to.

The provider monitored their service to make sure people received high quality care at all times.

People and their relatives told us "the staff are very nice and helpful," "the food is brilliant" and "they have everything I need here."

People told us they received "lots of information about everything" and we found evidence that people were involved in planning their care. Staff told us ways in which they ensured people's privacy and dignity were respected.

We found that people had comprehensive assessments of their needs and that care was planned to reflect both these and any assessed risks. People told us “they see to us if anything is wrong with our health” and “they are very good to me and always have been.”

Staff told us how they would respond to any allegations or suspicions of abuse. There was a safeguarding procedure in place and we found evidence of staff training in safeguarding people from abuse. People told us they felt safe at the home.

Appropriate checks were undertaken before staff began work. We found evidence that staff went through an appropriate recruitment procedure before working at the home.

We found evidence that the home used surveys and meetings to capture the views of people and their relatives and these were acted on. One person told us, “they listen to what we want: we don’t have to report to the matron.”