The inspection took place on 01 September 2016 and was unannounced. When we last inspected the service on 09 July 2015 we found it was not meeting the required standards. We found breaches of the Regulations in relation to staffing and good governance. At this inspection we found that necessary improvements had been made and the service was no longer in breach of the Regulations.

Milford Lodge is a residential care home that provides accommodation and personal care for up to 60 older people, some of whom live with dementia. The accommodation was arranged over three floors and at the time of our inspection there were 50 people living at the home.

There is a manager in post who has registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

At the previous inspection we found that the quality of care provided to people often lacked consistency across different units and floors at the home mainly because of lack of staff. At this inspection we found that there were sufficient numbers of suitably trained and skilled staff employed at the service to meet people`s needs at all times.

Staff had received training in how to safeguard people against the risks of abuse and they were able to tell us how they would report any concerns internally and externally to local safeguarding authorities.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role they performed and able to meet people’s needs.

People received their medicines from staff who were trained and had their competency to administer people`s medicines safely regularly assessed.

Staff obtained people’s consent before providing the day to day care they required. Best interest processes were followed in cases where people had lacked capacity to take certain decisions in line with the principles of the Mental Capacity Act 2005.

People were complimentary about the skills, experience and abilities of the staff who supported them. We found that staff had received training relevant to their roles and had regular supervisions to discuss and review their performance and professional development.

People told us that the quality of the meals and meal service had improved. People were asked about their menu choices a day before, however if they changed their minds on the day this was easily accommodated. People who lived with dementia had their food served on coloured plates and were presented with verbal and visual prompts to enable them to make informed choices about which meal they preferred.

People told us they were looked after in a kind and compassionate way by staff who knew them well. Staff were knowledgeable about people`s likes and dislikes regarding their care and promoted people`s dignity and privacy when delivering care and support.

Information contained in records about people’s medical histories was held securely and confidentiality was sufficiently maintained. People and their relatives told us they were involved in the planning, delivery and reviews of the care provided.

People had opportunities available to pursue their social interests or take part in meaningful activities relevant to their individual needs. We saw that where complaints had been made they had been recorded and investigated. Where appropriate these were shared with staff to help ensure improvements were made to the quality of the service provided.

People knew about the management and leadership arrangements at the home. People, staff and relatives were complimentary about the registered manager, they told us the registered manager was approachable and had and `open door` policy.

There were regu

The inspection took place on 09 July 2015 and was unannounced. The service is newly registered and had not been inspected before. Milford Lodge is a residential care home that provides accommodation and personal care for up to 60 older people, some of whom live with dementia. The accommodation was arranged over three floors and at the time of our inspection there were 38 people living at the home.

There is a manager in post who has registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. However, the registered manager was absent from the home on an extended period of extended leave. The management of the home was being covered by members of the provider’s senior management team. An experienced acting manager was at the home Tuesday to Thursday inclusive and the regional manager covered Monday and Friday.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection a number of appropriate applications had been made to the local authority in relation to people who lived at the home.

We found that the effectiveness of staff deployment lacked consistency across the home and there were insufficient staff to cope with the demands placed upon them. The quality of care provided often lacked consistency across different units and floors at the home mainly because of lack of staff. People told us that they felt their needs were not met safely at all times due to lack of staffing.

Staff had received training in how to safeguard people against the risks of abuse. They were able to describe with confidence what constitutes abuse and the reporting procedure they would follow to raise their concerns.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs.

We found that medication had been administered following best practice guidelines, however not always at the times prescribed. People had access to health care professionals when necessary and their health needs were met. The environment and equipment used, including mobility aids and safety equipment were well maintained and kept people safe.

Staff obtained people’s consent before providing the day to day care they required. We found that processes to establish if people had lacked capacity for certain decisions were not always followed in line with the MCA 2005. Staff had no clear guidance in how to ensure the care delivered was in the person’s best interest.

People expressed mixed views about the skills, experience and abilities of the staff who supported them. We found that staff had received training relevant to their roles. Staff had regular supervisions to discuss and review their performance and professional development.

People expressed mixed views about the standard of food provided at the home. We saw that the meals served were hot and that people were regularly offered a choice of drinks. We also found that the menu request for people was done the day before and no visual choice was given for people with dementia to enable them to make informed choices.

Most people told us they were looked after in a kind and compassionate way by staff who knew them well.

Information contained in records about people’s medical histories was held securely and confidentiality sufficiently maintained. People and their relatives told us they were involved in the planning, delivery and reviews of the care provided.

People told us the care they received was not always personalised or delivered in a preferred way. We found that most staff had taken time to get to know the people they supported and were knowledgeable about their likes, dislikes and personal circumstances.

People expressed mixed views about the opportunities available to pursue their social interests or take part in meaningful activities relevant to their individual needs. We saw that where complaints had been made they were recorded and investigated. However, there were no records to show that positive lessons had been learnt or that service delivery was improved from the complaints raised.

People knew about the management and leadership arrangements at the home. However, they told us that communication was not effective between management staff and people.

At this inspection we found the service to be in breach 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.