This was an unannounced inspection which we carried out on 2 May 2018. This meant the staff and provider did not know we would be visiting.

We last inspected Manor Lodge in February 2017. At that inspection we found the service was in breach of its legal requirements with regard to Regulations 12, 9 and 17 of the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014. These related to safe care and treatment, person-centred care and governance. This was because systems were not all in place to keep people safe. Records did not provide an accurate account of the care people received. Robust quality assurance systems were not in place.

We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

We found improvements had been made so the service was no longer in breach of its legal requirements from the findings at the last inspection. However, during this inspection we found breaches of Regulations 18 staffing and regulation15 premises and equipment 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.

Manor Lodge is a care home. People in care homes receive accommodation and 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.

Manor Lodge accommodates a maximum of 22 people. Nursing care is not provided. Care is provided to people who have mental health needs, learning disabilities and/or a physical disability. At the time of inspection 16 people were using the service.

A registered manager was 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.

People said they felt safe and they could speak to staff as they were approachable. We had concerns however, that there were not enough staff on duty to provide safe and effective care to people.

Although a programme of refurbishment was taking place around the home. We considered more timely action was required in some areas to ensure it was safe and fit for purpose.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had a good understanding of the Mental Capacity Act 2005 and best interests decision making, when people were unable to make decisions themselves. People were involved in decisions about their care. They 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.

Staff knew the people they were supporting well. Records reflected the care provided by staff. Staff had developed good relationships with people, were caring in their approach and treated people with respect. Care was provided with patience and kindness. People were positive about the care provided and a camaraderie was observed between people and staff.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage

This inspection took place on 23 and 27 February 2017. The visit on the 23 February was unannounced. This meant that the provider and staff did not know we would be visiting. Manor Lodge Care Home provides accommodation, care and support for up to 22 people with physical or mental health needs, or a learning disability. There were 14 people living at the home at the time of this inspection.

At our last comprehensive inspection of the service, in June 2015, we found four breaches of legal requirements which related to person centred care, safeguarding, safe care and treatment and good governance. We returned to the service in January 2016 and found the provider had made improvements to meet legal requirements.

A registered manager was 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 this inspection we found medicines were not managed safely. Two people had not received their medicines as prescribed as they were out of stock. In one case the medicine was a pain relief patch, which they had not received for three days. Whilst staff had contacted the pharmacy team to reorder the medicine, they had not sought medical advice about what steps they should take to ensure the person's pain needs were met whilst waiting for their regular medicine to be delivered.

Medicines were not always disposed of safely. Where people had not taken individual tablets these discarded medicines had been stored in a sharps box. There were no records as to what medicines were in the box, or when and how they would be disposed properly. Medicines records were not always accurate.

Staff had received training in safeguarding people from abuse, however, where one person made frequent allegations the process had not always been followed.

Accidents and incidents had been recorded, but were not monitored and analysed. Risks had been assessed and where possible, action had been taken to reduce the likelihood of the risks occurring again.

There were enough staff to meet people's needs. Staffing had recently been increased, whilst the home recruited additional staff they relied on agency staff. Robust recruitment procedures had been followed.

Staff training was up to date. The manager monitored essential training to ensure any refresher courses were booked before training expired. There were no formal assessments of staff competency. Whilst the training element of the care certificate had been taken into account for new staff inductions, the provider had not yet incorporated the assessment, feedback and reflective practice elements. Supervisions sessions were planned for staff to discuss their training needs and performance. We saw these were not always regular. One staff member had not received any supervision since September 2016.

The Care Quality Commission (CQC) is required by law to monitor the application of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

The registered manager and staff understood the principles of the MCA. The registered manager told us that everyone who used the service was able to make their own decisions. Whilst we saw people were offered choice, and their decisions were respected, we saw one entry within care records which did not promote their rights.

Where restrictions on people's liberty were in place to keep them safe, applications had been made to the local authority to grant Deprivation of Liberty Safeguards in line with legal requirements.

People were very positive about the food on offer within the home. Most foods were home-made by the c

We carried out an unannounced comprehensive inspection of this service on 23, 24 and 26 June 2015, at which four breaches of legal requirements were found. These related to person centred care, safeguarding, safe care and treatment and good governance.

After the comprehensive inspection, the provider wrote to us to say what action they would take to meet legal requirements in relation to the breaches. We undertook a focused inspection on 26 and 27 January 2016, which was unannounced, to check that they had followed their plan and to confirm that they now met legal requirements.

You can read the report from our previous comprehensive inspection, by selecting the 'all reports' link for ‘Gailey Lodge Care Home’ on our website at www.cqc.org.uk

Gailey Lodge is the only location owned by Renal Health Limited and is based in Whitley Bay. The provider owns a sister home nearby, operated through a separate registered company. Gailey Lodge provides accommodation for up to 22 people with physical disabilities and/or mental health issues, who require assistance with personal care and support. At the time of the inspection there were 19 people using the service.

At the time of the inspection the home did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 had written to the provider and requested they take action to ensure a manager was formally registered with the Commission as soon as possible and an application was in progress. The home’s acting manager and the provider’s operations manager were present during, and assisted us with, the inspection.

At the previous inspection we had noted a small number of windows at the home did not have appropriate window restrictors fitted. At this inspection we found there were still windows without restrictors. The operations manager told us this had been an oversight. He contacted us the day after the inspection to advise us that this work had now been completed. Wider safety checks on equipment and safety systems were in place. Broken bulbs in rooms and corridors had been replaced and small electrical items had been tested to ensure they were safe.

At the last inspection we had raised issues about the cleanliness of the home and infection control. The home had worked extensively with the local infection control team to improve cleanliness and infection management. Toilets and bathrooms had been upgraded and refurbished. Carpets had been cleaned and in some places flooring had been replaced.

We had also raised concerns about the safe management of people’s finances at the previous inspection. Appropriate systems were now in place to ensure that people were protected against financial abuse and, where necessary, appropriate applications to the Court of Protection were being considered. People told us they felt safe living at the home and staff confirmed that they had received training in relation to safeguarding vulnerable adults.

People told us there were enough staff to support them with their care. Extra staff had been scheduled to work in the evenings. Additional domestic time, kitchen staff and handyman hours had also been sanctioned by the provider. Proper employment processes were in place to ensure the safe recruitment of staff and proper checks were in place. Medicines at the home were stored safely and staff administered them appropriately. Medicine records were up to date.

At the last inspection we found that appropriate systems regarding the application to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards were not in place. The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act

The inspection took place on 23, 24 and 26 June 2015 and was unannounced. This was the first inspection of this location under the current providers, Renal Health Limited who took over in September 2014.

Gailey Lodge is the only location owned by Renal Health Limited and is based in Whitley Bay. The provider owns a sister home nearby, operated through a separate registered company. Gailey Lodge provides accommodation for up to 22 people with physical disabilities and/or mental health issues, who require assistance with personal care and support. At the time of the inspection there were 17 people using the service.

At the time of the inspection the home did not have a registered manager in place. This was because the previous manager had sadly passed away a few months previously. The registered manager of Gailey Lodge’s sister home was in the process of applying to add the home to her registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 home’s acting manager and the provider’s operations manager and nominated individual were present during, and assisted us with, the inspection

People told us they felt safe living at the home and said staff treated them very well. Staff had a good understanding of safeguarding issues and said they would report any concerns to the acting manager or senior staff. However, appropriate systems were not in place to manage people’s finances safely and effectively. We found problems with the maintenance of the premises. A number of windows on upper floors did not have window restrictors that met current guidance, several areas of the home were dark because light bulbs had not been replaced, carpets were worn on stairs and corridors and recommendations made in a fire safety assessment had not been actioned or planned.

The acting manager told us staffing levels had been reviewed to support the individual needs of people living at the home. However, people living at the home and staff told us that at times there were not enough staff, especially between the hours of 5.00pm and 10.00pm. Proper recruitment procedures and checks were in place to ensure staff employed at the home had the correct skills and experience. People living at the home were able to input into the recruitment process for new staff.

Medicines were stored effectively and records were up to date. Medicines were administered safely. We found some issues with the cleanliness of the home. Not all areas were able to be cleaned effectively because of worn or broken working surfaces. We witnessed a boiler used by people to make drinks also being used to fill a mop bucket. There had been no legionella assessment carried out at the home.

Staff told us they were able to access a range of training and we saw that a number of training events had been provided recently. Staff told us they would benefit from additional training specific to the needs of the people they were caring for. They said that until recently they had access to regular supervision sessions and had an annual appraisal. The operations manager told us that supervision sessions would be recommenced in the near future and showed us pre-meeting forms people had been asked to complete.

People told us they enjoyed the food provided at the home and we saw that it was hot and looked appetising. People had access to a kitchen so they could prepare their own hot and cold drinks; although some people raised concerns about restrictions on the availability of milk.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The acting manager told us one person was subject to a DoLS. However, we found the order had lapsed and there was no system in place to review the need for a DoLS. There was no system in place to assess if other people living at the home fell within the boundaries of the DoLS legislation and required formal reviews.

Elements of the home had been adapted to promote people’s independence, with ground floor rooms and lifts to other floors. We noted the decoration of the home was in need of refreshing in some areas. The registered manager confirmed a programme of refurbishment was in progress and some painting of rooms was taking place during the inspection.

People told us they were happy with the care provided. We observed staff treated people with consideration and there were good relationships between staff and people living at the home. Staff had a good understanding of people’s individual needs, likes and dislikes. People had access to general practitioners, dentists and a range of other health professionals to help maintain their wellbeing. Specialist advice was sought, where necessary, and acted upon. People said they were treated with dignity and staff respected people’s individual preferences. However, it was not always clear if people had been actively involved in reviews of their care and updating their care plans.

People had individualised care plans that were detailed and identified needs. However, care plans were not always up to date and had not been regularly reviewed. This meant the most up to date information about people’s care was not immediately available. The acting manager told us she was replacing and reviewing all the care records documentation to ensure people’s care plans were appropriate and up to date. People told us they liked to manage their own time and could do what the wished. There had been some discussion at a residents’ meeting about organised activities taking place at the home. People and professionals said that recent changes at the home had restricted people’s ability to go out into the community, because staff were not always available to accompany them. The provider told us they were currently discussing this issue with the local authority.

People told us they would tell the staff or the acting manager if they had a complaint, but were happy with the care they received. We saw complaints were recorded and responded to. However, there was no system to deal with people’s concerns or low level complaints.

The operations manager confirmed regular checks and audits had not been carried out at the home in recent months. He told us this was something they were looking to reinstate. There was no detailed action plan of the range of work required to be undertaken at the home, although the provider forwarded us an outline plan following the inspection.

People and staff were positive about the leadership of the new management and staff felt supported in their roles. They told us there had been a lot of change in recent months and acknowledged that change was always difficult. Staff meetings took place to discuss the running of the service and the care needs of people. People told us they were also involved in meetings and could raise concerns or make suggestions and requests.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment, person centred care, safeguarding and good governance. You can see what action we told the provider to take at the back of this report.