We carried out an unannounced comprehensive inspection at Prideaux Lodge on the 14 and 15 October 2015 where two breaches of Regulation were found. We issued requirement notices for these breaches.

As a result we undertook an inspection on 8 and 9 December 2016 to follow up on whether the required actions had been taken. At this inspection we found significant improvements had taken place and no areas requiring improvement were identified.

Prideaux Lodge provides accommodation and support for up to 20 people. Care and support is provided for people living with dementia type illness and who are at risks of falls and long term healthcare needs such as Parkinson’s. On the day of our inspection there were 15 people living at the service. The provider also offers a respite day care service. There was one person who was using this service.

A registered manager was in post. 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 and associated Regulations about how the service is run.

People appeared happy and relaxed with staff. There were sufficient staff to support them. When staff were recruited, their employment history was checked, references obtained and comprehensive induction completed. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and knew what action they should take if they suspected abuse was taking place. Appropriate training was provided to ensure staff were confident to meet people’s needs.

It was clear staff and the registered manager had spent considerable time with people, getting to know them, gaining an understanding of their personal history and building rapport with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s needs had been assessed and detailed care plans developed. Care plans contained risk assessments for a wide range of daily living needs. For example, nutrition, falls, and skin pressure areas. People consistently received the care they required, and staff members were clear on people’s individual needs. Care was provided with kindness and compassion. Staff members were responsive to people’s changing needs. People’s health and wellbeing was continually monitored and the provider regularly liaised with healthcare professionals for advice and guidance.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make specific decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA).

People were provided with opportunities to take part in activities ‘in-house’ and to access the local and wider community. People were supported to take an active role in decision making regarding their own daily routines and the general flow of their home.

Staff had a clear understanding of the philosophy of the home and they spoke positively about their work and the management. The registered manager undertook regular quality assurance reviews to monitor the standard of the service and drive improvement.

We inspected Prideaux Lodge on the 14 and 15 October 2015 it was an unannounced inspection which meant the provider and staff did not know we were coming. Prideaux Lodge provides accommodation and care for up to 16 older people, respite care is also offered, although at the time of our inspection there was no one on residing at the home on respite. On the day of our inspection 12 older people were living at the home aged between 69 and 99. People had various long term health care needs; this included some people living with dementia. Other conditions impacted on people’s mobility which may mean people are at risk from falls.

Although a registered manager was not in post the service had an acting manager who was in the process of undertaking registration at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. 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 and associated Regulations about how the service is run.

At the time of our inspection the provider had been operating the service for 12 months and this was the provider’s first inspection. Throughout our inspection, people spoke positively about Prideaux Lodge. Comments included, “Really lovely place to live, like a hotel” and, “I’m happy living here.” However, we identified a number of areas that required improvement.

The provider had not ensured some environmental risks related to emergency evacuation had been fully considered. This included fire exit doors which had coded locked bolts on.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider had not ensured that proper authorisation procedures had been followed in regard to restricting some people’s liberty.

Although staff we observed and spoke to were knowledgeable about their roles most staff had not completed their mandatory training. This meant the provider could not be assured all staff was up-to-date with their knowledge.

Care staff led most activities within the service. The provider had employed a part time activities co-ordinator, we saw that during the times they worked the activity sessions attracted more people and care staff were better placed to support people who required support assistance.

Although it was evident the new acting manager had made improvements in systems and processes in many aspects of the service there remained areas where the service was not consistently well led. The audit process was established but not routinely being undertaken in most areas. DoLS applications had not been undertaken in a timely manner. Staff supervisions were behind the schedule the acting manager had planned.

There were enough staff to look after people. We saw people were responded to and supported effectively by staff. Recruitment procedures were in place to ensure staff employed were of good character.

Meal times were enjoyed by people. One person said, “Always plenty of good food on offer.”

People had access to appropriate healthcare professional and staff told us how they would contact the GP if they had concerns about people’s health

People were looked after by staff who knew them well. Staff were kind, caring and treated people with respect and protected their dignity and promoted their independence.

Care plans were reviewed and updated regularly and people told us they felt involved in their care.

Staff told us they felt well supported by the acting manager and provider.

People told us they would be confident to raise any concerns or complaints with the staff, management or provider. .

We found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of this report.