St Mary’s Lodge Residential Care Home for the Elderly 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. St Mary’s Lodge Residential Care Home for the Elderly does not provide nursing care. St Mary’s Lodge Residential Care Home for the Elderly accommodates up to 40 older people in one adapted building. At the time of our inspection 19 people were using the service. However, three of these were currently in hospital following a period of ill-health.

At our previous inspection on 5 and 14 December 2017 we found eight breaches of legal requirements. We rated the service ‘inadequate’ overall. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. At this inspection we rated the service ‘requires improvement’ overall and for each question.

A registered manager remained 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 sufficient action had not been taken to address all of the previous breaches of regulations and the provider remained in breach of three regulations.

Improvements had been made to the safety of the service since our last inspection. However, further improvements were required in regards to fire safety, supporting people with their mobility and planned work to replace the boiler. We also saw sufficient action had not been taken to ensure recruitment procedures were robust and ensure suitable staff were employed.

Improvements had been made to the service and the provider had completed the majority of actions following our last inspection. However, there were still areas requiring improvement and a robust governance framework was not in place. The provider had started to analyse information relating to incidents but this information was not yet being used to improve service delivery.

Despite the continued beaches of regulation we did find improvements had been made and the provider had taken sufficient action to address the other five breaches of regulations.

Safeguarding procedures were now adhered to and any concerns about a person’s welfare were reported to the local safeguarding adults’ team. The maintenance of the service had improved and we saw equipment was being regularly serviced to ensure it was in good working order. Improvements had been made to the delivery of training to ensure staff had the knowledge and skills to undertake their duties. Supervision and appraisal processes had also been reviewed and improved. The registered manager submitted statutory notifications to the CQC about key events that occurred at the service and were displaying their CQC rating. People, relatives and staff found the registered manager to be open, honest, approachable and accessible.

The registered manager had taken on board advice from us, the local authority quality team and community professionals to improve practice. However, there was an acknowledgement that the recruitment of a new manager would further strengthen the management and leadership of the service. Nevertheless, we would recommend that registered manager continues to attend local authority and clinical commissioning group meetings to enable them to stay up to date wi

This inspection took place on the 5 and 14 December 2017 and was unannounced. This is the first inspection of the service under this provider. The provider was registered with the CQC on 9 November 2017. The service was previously registered under a different provider. You can read our inspection reports for the service under the previous provider by visiting our website www.cqc.org.uk. The same registered manager remained 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was also one of the provider’s directors.

St Mary’s Lodge Residential Care Home for the Elderly is a ‘care home’. People in care homes receive accommodation and nursing or 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.

St Mary’s Lodge Residential Care Home for the Elderly accommodates up to 40 people across two adapted buildings that are joined together. Accommodation is provided on two floors with lift access between them. The service provides care and support for older people who are living with dementia. There were 33 people using the service at the time of our inspection.

This inspection was prompted following receipt of information from the local authority which raised concerns for the safety and welfare of people living at the service. These concerns related to a lack of heating and access to hot water. We looked at these concerns as part of this comprehensive inspection.

The registered manager had not provided evidence that they were fit to undertake their duties and had not learnt from previous CQC inspections they had been involved with under a different provider. There lacked management oversight of the service and there were insufficient processes in place to review and monitor the quality of the service. The registered manager had not consistently adhered to the requirements of their CQC registration and had not submitted notifications about key events as required.

Staff were unclear about their roles and responsibilities and there was not a clear vision or values in place regarding service delivery. The registered manager did not use feedback from people and/or their relatives to improve the quality of the service.

People were not provided with a safe and well maintained environment. People had gone a number of weeks without access to appropriate heating and hot water due to a boiler breakdown. The registered manager had not appropriately identified and managed environmental risks. The premises were not sufficiently maintained and effective systems were not in place to monitor and reduce the risk of infection. The design and layout of the premises did not fully promote people’s independence and consider the needs of people living with dementia.

Whilst the majority of medicines were stored securely and appropriately administered, recorded and disposed of, we saw safe practices were not followed regarding the storage and application of topical creams. The provider did not appropriately follow safeguarding adults’ procedures to protect people from harm.

Staff recruitment checks were not fully completed and therefore there was a risk that people were supported by unsuitable staff. The provider’s training matrix showed significant gaps and inconsistencies in staff’s completion of these courses and did not correlate with staff training certificates that we were shown. We could therefore not be fully assured that people were supported by suitably trained staff who had the appropriate skills and knowledge to support their needs. We found staff were not always adequately supported. Our inspection of sup