This inspection took place on 1 November 2017 and was unannounced.

At our last inspection on 29 March 2017 we rated the service as ‘Requires Improvement’ and identified three breaches which related to safe care and treatment, person-centred care and good governance. The service remained in 'special measures' as the well-led domain was rated 'Inadequate' which it had been at our previous inspection in October 2016. If any key question is rated ‘Inadequate’ over two consecutive comprehensive inspections the service is placed in special measures. We have now rated these key questions and the service overall as ‘Good’.

Pennine Lodge 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. Pennine Lodge provides personal care for up to 40 older people living with dementia. The home is split into three separate units each with their own communal areas. Harrison unit has 14 places, Ryland and Williams units each have 13 places. There were 39 people using the service when we visited.

The home has a registered manager. 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 found the provider, registered manager and staff had worked hard to sustain and build on the improvements we had found at the last inspection. The increase in staffing levels had been maintained and was kept under review. The registered manager recognised additional staff were required at mealtimes and recruitment was on-going. We saw staff team worked well together as a team in meeting people’s needs.

Staff understood safeguarding procedures and knew how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the CQC. Risks to people were assessed and managed to ensure people’s safety and well-being.

Medicines were managed safely. Robust recruitment procedures were in place which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

The home was clean, bright and well maintained. Many areas had been redecorated and refurbished and this was on-going. People had been involved in these discussions for example choosing their own bed linen and murals to go round their bedroom doors.

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’s care plans were more personalised and the home was implementing an electronic care record system. People had access to healthcare services such as GPs, district nurse, dentist and chiropodist.

The mealtime experience for people had improved. Lunchtime was a pleasant, sociable occasion and we saw people were offered choices and given the support they required from staff. People's weights were monitored to ensure they received enough to eat and drink.

People told us they liked the staff and described them as kind and caring. People told us they were treated with respect and this was confirmed in our observations. People looked clean, comfortable and well groomed. We saw people enjoyed a wide range of activities both in the home and out in the wider community.

People and relatives knew how to make a complaint. Records showed complaints received had been dealt with appropriately and the outcome communicated to the complainant.

People, relatives and staff praised the improvements that had been made since the last inspec

This inspection took place on 29 March 2017 and was unannounced.

At the last inspection on 5 and 12 October 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We found seven regulatory breaches which related to medicines, staffing, nutrition, safeguarding, dignity and respect, premises and quality assurance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Pennine Lodge is a care home which provides personal care for up to 40 older people living with dementia. Accommodation is provided over two floors with passenger lift access. There are 36 single bedrooms and two shared bedrooms. The home is split into three separate units each with their own communal areas. Harrison unit has 14 places, Ryland and Williams units each have 13 places. There are secure garden areas at the front and rear of the home. There were 40 people using the service when we visited.

The home had appointed a new manager who had been in post five weeks when we carried out this inspection. The manager is in the process of registering 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.

Overall we found some improvements had been made in the home since our last inspection, although there were still areas where further improvement was required.

Staffing levels had increased and staff were now allocated to work on specific units which helped ensure people had regular staff who they could relate to and who knew them well. Staff worked well together as a team to ensure people’s needs were met in a timely manner.

Staff understood how to identify abuse and were aware of the action to take if abuse was suspected or reported. We saw safeguarding procedures had been followed when incidents had occurred and most had been notified to the Care Quality Commission.

We found improvements in the way people’s medicines were managed which meant people received their medicines when they needed them. However, record keeping needed to improve in relation to prescribed creams and other medicines.

Risks to people were not always assessed and managed to ensure people’s safety and well-being. For example, fire safety and the recording and monitoring of people’s nutritional needs. We also found recruitment checks were not always thorough as references had not been sought from the applicant’s last employer. We made a recommendation about recruitment procedures.

The home was clean, comfortable, bright and well maintained. Many areas of the home had been refurbished and redecorated and this was ongoing. People had been involved in choosing colour schemes and a start had been made on making the environment more dementia friendly with the use of pictures, tactile objects and memory aids.

Some staff training had taken place since the last inspection and dates for further training had been booked.

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

People had access to healthcare services such as GPs, district nurse, dentist and chiropodist. Healthcare professionals we met during the inspection said the home were receptive to advice they gave and were working with them to make improvements.

The mealtime experience for people had improved. Lunchtime was a pleasant, sociable occasion and we saw people were offered choices and given the support they required from staff.

People and relatives praised the staff who they described as 'good’ and 'caring'. We saw st

This inspection took place on 5 and 12 October 2016 and was unannounced.

At the last inspection on 18 and 21 August 2014 we found three regulatory breaches which related to medicines, person-centred care and quality assurance.

Pennine Lodge provides personal care for up to 40 older people living with dementia. Accommodation is provided over two floors with passenger lift access. There are 36 single bedrooms and two shared bedrooms. The home is split into three separate units each with their own communal areas. Harrison unit has 14 places, Ryland and Williams units each have 13 places. There are secure garden areas at the front and rear of the home. There were 40 people using the service when we visited.

The home has a registered manager who has been in post for four years. 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 found marked differences in the three units we visited which impacted on the outcomes people experienced. For example, Harrison unit has a spacious layout and large communal areas, the other two units are more confined and have small communal areas at opposite ends of a corridor. The registered manager told us people could be admitted to any of the units as there was no specific admission criteria for each unit.

Although the registered manager had looked at people’s dependencies and used a staffing tool which showed the home was over-staffed, we found there were insufficient staff deployed to meet people’s needs. For example, we observed two people did not get up until late morning, not through choice but because there were not enough staff to assist them. We saw delays in people receiving help they needed from staff at mealtimes and occasions when there was only one care staff member available to support 13 people.

We found inconsistencies in how individual and environmental risks were managed. We saw some areas of good practice, yet others where risks had not been assessed or mitigated. For example, two people had detailed risk assessments and care plans in place to manage challenging behaviour and we saw staff put this into practice. However, there was a lack of assessment and guidance for staff in relation to another person who displayed similar behaviours. Similarly, most upstairs windows had openings restricted in line with Health and Safety Executive (HSE) guidance to keep people safe, yet we found two windows opened to three times the limit recommended by the HSE.

Medicines management was not safe and we found some issues we identified at our last inspection in August 2014 had not been addressed.

Staff were aware of the different types of abuse and knew the reporting systems. Records showed that incidents reported to the registered manager were dealt with appropriately and referred to the local safeguarding team. However, we found the reporting systems were not always effective as we found two safeguarding incidents had occurred which the registered manager was unaware of as these had not been reported to them and they had not been dealt with.

We found overall standards of cleanliness were maintained, however there were isolated areas which were not clean, we also found continence pads had not been bagged before being placed in the clinical waste bins and there were odours. Although the Statement of Purpose stated the home provides specialist dementia care we found a lack of aids, adaptations and use of colour in the environment meant it was not easy for people living with dementia to find their way around the home.

Robust recruitment procedures were in place which ensured staff were suitable to work in the care service. Staff received the induction, training and support they required to fulfil their ro

We carried out the inspection with an 'expert by experience' who spoke to people who lived at the home. An 'expert by experience' is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgment about the quality of care.

During our visit we spoke to two people who lived at the home and relatives who were visiting another person who was not able to give us feedback. One of the relatives we spoke with told us they felt the staff were very good. They also told us they felt very well informed about their relative's progress and there was only one occasion in the 18 months since their relative had lived at the home when they had not been updated about a change in their health. Another relative told us there had been an improvement since October 2012 in how her mother was dressed. This related to difficulties in the laundering of clothes and her mother not wearing her own clothes.

Many of the people living at the home were unable, due to complex care needs, to comment on the service they received. Two people told us that they like living at the home and that the staff are very good and kind.

We spoke with one visitor who told us that they are very satisfied and had been involved in their relatives care plan and that staff always let them know what was going on.

However other evidence did not support this. We saw that people did not look well cared for and were not treated with dignity and respect. There were areas of the home that were not clean and not well maintained. We also didn’t think there were enough staff on duty to meet people’s needs.

Many of the people using the service at Pennine Lodge are living with dementia and were unable to tell us their views about the service provided. We were able to talk to some people after lunch in one of the dining areas and they made these comments “they’re champion here, can’t fault them”; “they are very kind, they always help us when we ask”; “you only have to mention something and they’ll sort it out for you”; “they are so good to everyone”.

Everyone looked well cared for; people were well dressed and the hairdresser was visiting while we were there. We saw people being escorted to and from the hairdressing salon throughout the day and it was clearly an enjoyable, social occasion for everyone involved. We talked to the hairdresser; she told us she had been visiting for some time, she said she knew people really well and felt that people were really relaxed in the salon.

On our visit, we asked to look at some of the surveys that relatives had been asked to complete giving their views about the service provided. We also talked to some people who were visiting while we were there.

They said :

“People are always treated with dignity”. “If we have any concerns we can talk to any of the staff and it will be sorted “.

“They give us information, they tell us what is happening and we appreciate that”.

“We are confident that they would phone us if they needed to, this gives us peace of mind”.

The inspection was unannounced and took place over two days on 18 and 21 August 2014. When we inspected the service in January 2014 we found the provider had breached regulation because they had not regularly sought the views of staff in order to come to an informed view as to the standard of care and treatment provided to service users. They sent us an action plan and told us how they were going to make improvements. We also said the provider may find it helpful to review people's sleeping and resting preferences and assess how these were recorded and monitored. During this inspection we looked to see if these improvements had been made.

Pennine Lodge is a care home providing personal care and accommodation for 40 older people living with dementia. Thirty-six of the bedrooms are single and two rooms are double. At the time of our inspection there were 38 people living in the home.

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.

At this inspection we found the provider had a system to monitor and assess the quality of service provision although this was not always effective. They had introduced more measures to seek the views of staff but they needed to make some further changes to the way they monitored the service to ensure people received safe quality care.

Although we did not find the provider was in breach of regulations at the last inspection we recommended they should look at people’s sleeping and resting preferences because we were concerned that the morning routine was not personalised. At this inspection we found staff were getting some people up very early on a morning and were task centred rather than taking account of people’s welfare and individual preferences.

People were involved in activities within the home and the local community. People received good support to make sure their health needs were met. Care plans gave staff information about the best way to support people and assessments had been completed where areas of risk were identified in the care plans. However, it was unclear how the level of risk was determined because the service was not using evidence-based risk assessment tools which help to identify the level of risk and appropriate preventative measures.

Comments from people who used the service included, “They are good they will do anything for you.” “They’re really lovely.” “Wonderful people these are.” A relative said, “As soon as I came in here I had the feeling that this was the right place. You know when something is just right and it felt good, home from home. I could move in here myself.” One relative said overall they were happy with the care but on occasions they had noticed their relative wearing clothes they didn’t recognise.

People were supported by sufficient numbers of staff to keep them safe. Checks were carried out prior to the staff starting work to make sure they were suitable and they completed an induction when they started work. The provider had a programme of training, supervision and appraisal, however, we were concerned that the training provided may not equip staff with the knowledge and skills because staff sometimes completed up to ten training sessions in one day.

People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff we spoke with said people received safe quality care. Staff knew how to report a concern about abuse and were confident the registered manager would treat any concerns seriously.

The staff we spoke with were aware of their responsibilities under the Mental Capacity Act 2005. We saw that people’s capacity to make decisions about different aspects of their care and treatment had been assessed and recorded in their individual care plan.

People lived in a clean, comfortable and well maintained environment and were protected against the risk of infection. People were able to move around most of the home freely although bedrooms were locked during the day which meant people were unable to return to their bedrooms unaided.

We noted that staff had used small bedside cabinets to prop doors open when we first arrived, which is not a safe mechanism for keeping doors open.

People received a choice of suitable healthy food and drink ensuring their nutritional needs were met. At meal times appropriate assistance was provided.

The provider worked effectively with health professionals and made sure people received good support when they moved between different services.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.