About the service: Loganberry Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Loganberry Lodge is registered to provide care and support for up to 138 people, some of whom live with a diagnosis of dementia. Care is provided across four units in the main building and a separate unit called Huckleberry located adjacent to the main building. There were 127 people in residence when we inspected.

Rating at last inspection: Requires Improvement (Published 20 February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

People’s experience of using this service:

Since the last inspection the service had improved in several key areas and met the characteristics of ‘Good’.

People received personalised care from staff who knew them well. People told us they were happy living in the service and staff were kind and caring.

There were clear systems in place to recruit staff and ensure their suitability before they started work at the service. Staff were observed to be busy at key points in the day, but people told us staff were mostly available when they needed them. Staff received training to develop their skills and enable them to meet people’s needs.

Risks to people’s safety had been considered and steps taken to reduce the likelihood of harm. The environment was well maintained. People benefited from clear signage which helped them to orientate themselves around the building and stay independent.

Meals were nicely presented and looked appetising and people told us they enjoyed the food.

Medicines were managed safely, and practice followed professional guidance.

People had access to a range of health care professionals and support. Where risks were identified to an individual’s health or welfare, referrals were made to the relevant healthcare professionals for support and guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care plans were detailed and informative and underpinned the delivery of care. There were a range of activities provided to enhance people’s wellbeing.

People’s views were sought, and the information used to make changes to areas such as activities and catering.

Staff were supported in their role and received regular supervision. Staff were motivated and told us the service and the care provided had improved. They expressed confidence in the management of the service.

The registered manager had worked in partnership with local services including the local safeguarding authority and quality improvement teams to improve quality and safety monitoring systems.

The provider had a framework to monitor performance and drive improvement. This included the collection and analysis of data as well as regular audits.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 12 and 13 December 2017 and was unannounced.

Loganberry Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Loganberry Lodge is registered to provide care and support for up to 138 people, some of whom live with a diagnosis of dementia. Care is provided across four units in the main building and a separate unit called Huckleberry located adjacent to the main building. There were 133 people in residence when we inspected.

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.

At our last inspection of the service on 1 June 2017, we rated the service as "Requires Improvement" overall but as inadequate in the key question of Safe. This was because we found deficiencies in the way medicines and staffing were managed. We found that the provider was in breach of a number of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was placed in special measures as the service had been rated ‘Inadequate’ in Safe over two consecutive comprehensive inspections. We took enforcement action and issued warning notices setting out our concerns and the actions the provider needed to take to improve. Following the inspection the registered provider sent us an action plan setting out the steps they would take to address the concerns. At this inspection we found that improvements had been made and as a result were no longer in special measures, although the overall rating remains ‘Requires improvement.’

Medicines were managed in a safer way. Medicines were stored securely in clean and tidy treatment rooms, and the temperatures of the storage areas were recorded regularly. Our observations and a review of the records showed that medicines were administered as prescribed. We have however recommended that the provider review medicine procedures and protocols to further protect people. This should include the management of diabetes and distressed behaviours, as well as the guidance available to staff on supporting people at the end of their life.

At this inspection we found that there had been improvements to staffing. The service was fully staffed and was no longer dependent on agency staff which meant that people were supported by a consistent team of people who knew them. However the feedback from people was not consistently positive and some people continued to express concerns about the availability of staff. The registered manager provided assurances that they closely monitored staffing levels and told us that they intended to make further changes to deployment to take account of the comments made at the inspection. We have recommended that the provider keep staffing levels under close review to take account of peoples changing needs.

Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. The registered manager had made appropriate referrals to the local authority when they had concerns about people’s wellbeing. They were aware of their responsibilities under their duty of candour.

Risks were identified and management plans were in place to guide staff on how to reduce the likelihood of harm. The management plans were informative but staff did not always recognise potential risks or consistently follow the plan. The environment was regularly monitored and checks were undertaken on equipment to reduce the likelihood of equipment failure. Staff un

The inspection took place on the 01 June 2017 and was unannounced.

Loganberry Lodge is registered to provide care and support for up to 138 people, some of whom live with a diagnosis of dementia. Care was provided across four units in the main building and a separate unit called Huckleberry located adjacent to the main building. There were 132 people in residence when we inspected.

The service had 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.

We previously inspected the service on 22 and 29 November 2016 and the service was found to be in breach of a number of the legal requirements and rated inadequate in safe. The provider put in additional management support and sent us an action plan which set out the improvements that they intended to make. This inspection was undertaken to follow up on the concerns and check that progress had been made. We found that this was an improving service but there were still areas which required further work. At this inspection we found that medication procedures were not in line with best practice ,they did not work effectively or offer adequate protection to people. The provider was due to change to a new provider and had started the process of training staff on this new system.

Staffing levels had been improved and staff were more visible however, we identified issues with the deployment of staff and staffing levels at specific times.

Safeguarding was understood by staff and we saw that the manager followed the procedure when concerns were raised. There were arrangements in place to check on staff suitability as part of the recruitment process but we have made a recommendation to further strengthen the system in place.

Risk management plans were in place to address risks to individuals such as those from skin damage and falls but further efforts were needed to ensure consistency. Checks of the building, equipment and maintenance systems were regularly undertaken to ensure people’s health and safety was protected.

Staff had access to a wider range of training which meant that they were better equipped to meet the needs of people using the service however further oversight was needed to ensure that staff were putting their training into practice.

Responsibilities with regards to the Mental Capacity Act 2005 were better understood by staff. The manager told us that they were working towards reducing the restrictions on people’s movement around the building.

People’s nutritional needs were assessed and improvements had been made to how people were supported to eat and drink. Concerns were raised about the quality and timings of meals, however the manager assured us that they had already identified this issue and had a plan to address it.

People were supported to access ongoing healthcare support.

Staff had good relationships with those they supported however interactions were largely based around the completion of a task.

Assessments were undertaken to identify people’s care and support needs. People’s care and support plans contained information about people’s needs and personal choices however they varied in quality. Key information had not been included for some individuals and staff were not always familiar with the contents. Monitoring systems for the delivery of personal support were not always working effectively.

There was a range of activities available for people to participate in.

The provider had a system in place for responding to people’s concerns and complaints. Any issues were investigated and dealt with appropriately by the manager.

There had been improvements in managerial oversight of the service. Senior staff were more available and accessible,

The inspection took place on the 22 and 29 November 2016 and was unannounced.

Loganberry Lodge is registered to provide care and support for up to 138 people, some of whom live with a diagnosis of dementia. Care was provided across four units in the main building and a separate unit called Huckleberry located adjacent to the main building. There were 132 people in residence when we inspected.

The service had 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.

People spoke positively about the staff but told us that they were not always available in sufficient numbers when they needed them. Our observations were that staffing levels were not sufficient and this meant that people did not always receive personalised care or that risks were well managed.

The systems in place to mitigate risks to individuals from choking, falls and moving and handling did not work effectively and needed strengthening. Medication was not consistently well managed so for example, people were not always receiving creams and lotions that they were prescribed.

Safeguarding was understood by staff and we saw that the manager followed the procedure when concerns were raised. There were clear arrangements in place to check on staff suitability as part of the recruitment process.

People’s nutritional needs were not always well managed. There was a lack of organisation and oversight which meant that people did not always receive the help and support they needed. Guidance regarding supporting people with their dietary needs were not always followed.

Training did not equip staff with the knowledge they needed to work safely and effectively. Key pieces of legislation such as the Mental Capacity Act was not always understood by staff and put into practice. Some of the restrictions which were in place around the environment were not always the least restrictive.

Staff had good relationships with those they supported and worked hard however they had limited time to spend with people. There were care plans in place but they were not always up to date and this meant that staff were not all working in a consistent way and people did not always receive the care they needed.

Activity staff were enthusiastic and provided people with regular activities which promoted their wellbeing. This was one of the strengths of the service.

Overall we found a service of contradictions where there were examples of good practice alongside poor care. There was a lack of consistency throughout the service and audits were not effective as they were not identifying or addressing these issues. The management was stretched and the two deputy managers were not working on a supernumerary basis which meant they were not able to provide the leadership that was needed.

We identified a number of breaches of regulation and you can see what action we told the provider to take at the back of the full version of the report.

We carried out this unannounced inspection on 13 April 2015.

Loganberry Lodge is a service based on two floors which provides residential care for up to 133 people and some people who live at the service have a diagnosis of dementia.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

There were robust staff recruitment processes in place. Staff received training to support people to meet their assessed needs and to keep people safe. People’s care plans included an assessment of risk to people and where risks had been identified a plan had been put in place accordingly. The staff we spoke with were knowledgeable about people’s needs.

The manager explained to us how they organised the staff to support them to complete dependency needs assessments for the people at the service. This information was used to calculate the number of staff required to be on duty at one time. The rota showed us there were sufficient staff on duty to meet people’s needs

Staff that administered medicines to people had received training for this purpose and there were systems in place for the safe ordering, storing and returning of unrequired medicines to the pharmacy.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards with systems in place to protect people’s rights under the Mental Capacity Act 2005. The MCA and DoLS provide legal safeguards for people who may be unable to make decisions about their care.

We observed the lunch periods and saw good interactions between staff and people who used the service. We saw evidence that staff understood people’s food and fluid requirements and protected them from risks associated with poor hydration and under nourishment.

People received the information they needed to help them to make decisions and choices about their care. People’s views and wishes were incorporated into their plans of care. Care plans recorded discussions held with the person or their representatives.

People’s privacy and dignity was respected, we saw staff knocking on doors waiting to be asked before entering.

The service carried out an assessment of people prior to them joining the service to identify if it could meet the person’s needs.

There was a complaints process in place and the service carries out audits to identify any actions it needed to take to improve the service.

We spoke with twelve people who used the service, two relatives, three members of staff and the manager as part of this inspection. One person said, "The staff are kind and friendly." People who used the service told us they were happy with the care they received and that they felt safe and the meals were very good.

One person said that, "The care here could not be better." Another person said, "It is blooming marvellous the way they look after me." A relative informed us how helpful and supportive the manager was to them and their relative.

We found the service had a robust recruitment process in place and staff had been trained with regard to safeguarding. The service worked closely with the district nursing team and supported people to make choices with regards to the way they lived their lives.

The service had quality and monitoring processes in place particularly audits, but we found that the provider was not monitoring the conditions of some people who used the service with regard to their diabetic care and needs.

We spoke with 14 people who used the service who told us that they were provided with a service that met their needs. One person said, “I am so pleased with it (the care that they were provided with).” Another person said, “Everything is alright.” Another said, “I am very happy.” Another said, "The care is excellent."

People told us that they chose what they wanted to do in their lives and that the staff listened to them and acted on what they said. One person said, “I choose what I want to eat and when I get up in the mornings.” Another person said, “The staff listen to what I want to do.”

People told us that the staff treated them with respect and kindness. One person said, “We get along nicely.” Another person said, “The staff very kind.” Another said, "They (staff) are very nice people." Another person pointed to a staff member and said, "(Staff member) is a dream." This was confirmed in our observations during our inspection. We saw that staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of five people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service.

One person who uses the service said that the staff are "very helpful and very kind".

Another person said "I love it here. Everyone is so caring and helpful. I definitely feel looked after".

People with whom we spoke were happy living at Loganberry Lodge. One person said 'I couldn't wish for a better home.' People said that they had choice in their day to day lives but occasionally this was restricted by staff availability. People said that the staff were 'lovely' and 'like friends.' People were also very happy with the food, the choice available and they spoke highly of the chef.