We inspected Lorraines Residential Home on 27 June 2018 and the inspection was unannounced. At the last inspection we found breaches of legal requirements. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well led to at least good. At this inspection we found that the provider had made the improvements and was no longer in breach of regulations.

Lorraines Residential Home 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 care and support for up to 15 older people and on the day of our inspection there were 12 people living there. Accommodation is on one floor with a communal lounge, a dining room and accessible gardens.

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 provider had renovated the home; replacing flooring, furniture and bathrooms. This had reduced the risk of falls and improved the infection control measures which could be implemented. People were included in choosing the colours of the re-decoration and were happy with the new environment. Consideration had been given to ensuring that the environment met people’s needs; corridors were painted different colours to assist people to orientate and information was shared in different formats to address sensory disabilities.

Recruitment procedures were established to ensure that new staff were safe to work with people. Staff received training and support to enable them to fulfil their role effectively and were encouraged to develop their skills. They received regular supervision and attended team meetings where they discussed improvements to the home.

People were kept safe by staff who understood their responsibilities to detect and report abuse. They had developed caring, respectful relationships with people and ensured that their dignity and privacy were upheld. There were enough staff to meet people’s needs promptly. 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.

People were supported to maintain good health and had regular access to healthcare professionals. Mealtimes were not rushed and people were given a choice of meal. We saw that food and drink was regularly provided and records were maintained for people who were nutritionally at risk. Care plans were regularly reviewed to correspond with changing support needs and they were personalised and accessible.

People were encouraged to pursue interests and hobbies and some activities were planned. Visitors were welcomed at any time. People knew the registered manager and felt confident that any concerns they raised would be resolved promptly. There were regular meetings with people and their relatives and their feedback was used to improve the home.

Risks were assessed and actions were put in place to reduce them, and their effectiveness was monitored and regularly reviewed. Lessons were learnt when things went wrong to reduce the likelihood of it happening again. Medicines were managed to reduce the risks associated with them and people received them when they needed them.

There were systems in place to drive quality improvements which included regular audits and feedback from people who use the service and staff. There were good relationships with other organisations and professionals to assess and improve the quality of the home.

We inspected Lorraines on 23 May 2017 and it was an unannounced inspection. The home provides accommodation and support for up to 15 older people, some of whom are living with dementia. At the time of our inspection 14 people were living at the home. The home had a registered manager in place. 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 completed a comprehensive inspection on 19 July 2016 and a focused inspection on 25 August 2016. At the focused inspection only reviewed staffing levels in line with a warning notice that we issued and we found that improvements had been made in the number of staff available to meet people’s needs. After the comprehensive inspection the provider sent us an action plan within the timescales we requested to demonstrate how they would make improvements and meet the regulatory breaches. At this inspection we found that some of these actions had been put in place; for example, to manage medicines and improve understanding of safeguarding. Actions around supporting people with making decisions were partially completed but still needed to be fully embedded. Some of the actions around the management and governance of the home had been implemented but were not effective. The provider told us ‘The manager needs to ensure that the audit process is completed fully. Findings of the audit are reported to the owners and documentation of when this was completed so that the time scale of improvements to the home can be quicker and dealt with within a more suitable time scale’. We saw that these audits had been completed and reported to the provider but that action had not always been taken as a consequence of this. For example, the home had not been maintained to a sufficient standard to ensure that people could be supported safely. Areas of the home were difficult to clean because of the disrepair. These concerns had been highlighted through the internal quality improvement systems but the provider had not taken action to remedy the situation.

Safe recruitment procedures were not always followed to ensure that staff were suitable to work with people. It was not always clear when people were not able to make some decisions for themselves. When they were deprived of their liberty to keep them safe the legal applications had not always been made.

People were kept safe by staff who understood their responsibilities to protect them. Posters helped to explain to people how to raise a concern or make a complaint. They were also assisted to make choices about their care and how they wanted to be supported. They had care plans in place to support this and these were regularly reviewed.

There were enough staff available to be able to support people. The staff were knowledgeable about people’s needs and understood the risks to people’s health and wellbeing. They supported them to see healthcare professionals regularly to maintain good health and to have good nutritional intake. Medicines were managed to protect people from the risks associated with them and to ensure that people received them as prescribed.

Staff had positive relationships with people and respected their privacy and dignity. People were encouraged to participate in activities and important relationships with friends and relatives were encouraged. People and their relatives were communicated with so that their feedback could contribute to the development of the service.

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.

We carried out an unannounced comprehensive inspection of this service on 19 July 2016. A breach of legal requirements was found in staffing. On 29 July 2016 we issued a warning notice to the provider. We told the provider to take action to meet the regulations before 23 August 2016.

We undertook this focused inspection visit on 25 August 2016 to check that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lorraines Residential Care Home on our website at www.cqc.org.uk

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 was registered to provide accommodation for up to 17 older people. At the time of our inspection 13 people were using the service.

At our last inspection the provider had not ensured that there were adequate staff to meet people's needs. At this focused inspection staffing levels had been increased and we saw that people did not have to wait for staff to attend to them. People were supported to move safely in line with their assessed needs. The additional staffing meant that there was more opportunity for people to pursue their interests and join in group activities. Staff were able to spend additional time with people who chose not to spend time in communal areas to ensure that their needs were met.

We inspected this service on 19 July 2016 and it was an unannounced inspection. Our last inspection took place in April 2014 and we found no concerns with the areas we looked at. The service was registered to provide accommodation for up to 17 people. At the time of our inspection 13 people were using the service.

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.

People were not always protected from the risk of harm because there were not always enough staff in place to keep them safe. The systems to ensure that staff were safe to work with people were not fully effective. Some people were not protected from potential abuse because concerns were not reported to the local authority to ensure people who used the service were safe.

People's medicines were not managed, stored and administered in a safe way. There was no guidance in place to ensure staff understood when to give people 'as required’ medicines.

The provider had not notified us about significant events within the home. There were not always systems in place to review the quality of the home and protect people. The building was not always managed and maintained to ensure that the environment did not cause a risk of harm to people.

When people were unable to consent to their care mental capacity assessments were not completed. Some people were subjected to restrictions and the provider had not identified where their support needed to be reviewed. People told us that they did not have the support they needed to pursue hobbies and interests. Their dignity and privacy was not always upheld.

People told us they enjoyed the meals and specialised diets were provided where needed. People who used the service had their healthcare needs met and saw professionals when they needed to.

Staff received training and support to do their job effectively and developed caring relationships with people. They knew people well including their life histories and preferences. Care plans were maintained and regularly reviewed and updated.

People knew who the registered manager was and staff felt supported. Complaints were investigated and action taken to make improvements where needed.

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 this report.

Most of the people we spoke with said they liked living at the home and said they were well looked after. One person said “The staff are very good” and another said “It’s really marvellous”. They also told us they received assistance promptly at night time when required.

We found there were a sufficient number of staff on duty at night time to meet people’s needs.

All the people we spoke with said they liked living at the home and said they were well looked after. One person said “You can’t grumble” and another said “It’s lovely here”. A relative told us “Everything seems okay “and described the staff as good. One person using the service said “If you ring the call bell they’re soon here”.

We saw care practice had improved since our previous visit in May 2013. There were no people seated in wheelchairs for long periods and everyone who required them had pressure relieving cushions to sit on. We also saw new equipment had been purchased. However, aspects of care records had omissions regarding risk assessments and care plans that had the potential to adversely affect people’s care and welfare.

We received information from the Local Authority to confirm recruitment procedures had improved and from Derbyshire Fire and Rescue Service confirming that fire prevention policies and procedures had improved.

Medication administration practice had improved since our previous visit in May 2013 and, with one exception, medication had been administered as prescribed.

People told us they enjoyed living at the home and said they were well cared for. A relative told us “It’s a very homely place“ and described the staff as brilliant. One person using the service said “The carers are ever so good” and another said “We’re well looked after”. They had access to health professionals when required. They told us that appointments with General Practitioners (GPs), district nurses, chiropodists and opticians were arranged as necessary.

We saw two people sitting in a wheelchair for long periods, one without appropriate cushions, and we found there was no documentation to justify the use of belts in wheelchairs. We found that one incident had not been reported as required to the proper authorities.

We saw the premises were clean and tidy and staff were able to describe infection control procedures.

We found that medication procedures required improvement as one medicine had not been given as directed, staff did not always use appropriate handling techniques and medication was found on a person that had been signed as administered.

We found that quality assurance processes were in place, essential staff training was up to date and complaints were dealt with appropriately.

People told us they were treated respectfully; one person said “they talk to you as if you’re human” and another that staff were “always polite”. One person we spoke with described the service as “sociable”.

People we spoke with and their families were very positive about the care that they received and highly praised the staff. One person using the service told us that the service was “very, very nice”, another said they “look after us well” and another that “I can’t grumble about how I’m looked after”.

A relative we spoke with told us they had no worries about the care provided by the service and said they felt assured that the person they were involved with was receiving the right care. They described staff as “loving” towards their relative and said they were “quite happy” with the service.

People using the service stated the food was good and told us they enjoyed their meals. One person told us that the food was “alright”.

One person said they were “quite happy” and another said staff were “very helpful” and “nice and obliging”. One person told us they would go to the manager if they had any problems and another gave us an example of how an issue had been resolved by the manager. One person said the manager “tries her best”.

People said the service was “friendly” and the staff were “helpful” and “very nice”. They told us they were well looked after; one person said “I love it here” and another that they were “very pleased” with the service.

We were told that the service was ”very welcoming” and that staff were motivated and keen to learn and that “nothing was too much trouble”.

Staff told us they felt supported by the manager and that they received sufficient traning.

People described the care as ‘ very good’ and said the service was ‘friendly’ and the staff were 'helpful'. We were told that the service had been 'very welcoming' and that staff were motivated and keen to learn. Meals were described as 'good'.

People told us the premises were clean and tidy and that there was 'no smell'.