The inspection took place on the 31 January 2017 and was unannounced. We last inspected this service on the 20 July 2016 and rated the service as Requires Improvement in every key line of enquiry with a number of breaches of regulation. Following the inspection we met with the manager, regional manager and provider. They provided us with a robust action plan and with clear timescales for implementation. We re-inspected the service on the 31 January.. At this inspection we found the service had made significant improvements and there were elements of outstanding practice. There were systems in place to ensure that the improvements would be sustained.

The service provides accommodation on three floors. Each floor accommodates people with a different level of need with the ground floor being predominantly residential, the first floor providing dementia care and the second floor nursing care. The service can accommodate up to 75 people and was full at the time of our inspection

There was a registered manager at the time of our inspection. 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.

During our inspection we found a well-run service which operated in the interest of people using it. People received safe care by well trained staff who were familiar with people’s needs. Documentation told us what people’s needs were and how care should be delivered and identified any risks to people’s safety. Staff worked in conjunction with other professionals to minimise risk and promote safe care.

Staffing levels had increased since our last inspection and reflected the needs of the people using the service. This helped to ensure that people got timely, appropriate care. The environment was spacious and free from immediate hazards.

Staff knew how to recognise and manage concerns people might have. Safeguarding concerns were effectively managed to ensure the person’s safety was paramount and to prevent any additional harm.

Medication was administered by qualified staff. People received their medicines as required. Medicines were regularly audited to identify any shortfalls and ensure that if any had occurred they would be dealt with the urgency that was required.

Staff were well supported in their role and were helped to develop in confidence and the skills they required for their role. There were opportunities for staff support and we saw effective teams at work. Staff were happy and motivated with good communication across shifts.

People were supported to eat and drink in sufficient quantities for their needs and staff knew what their dietary needs were. Staff monitored this to ensure people’s health was promoted. The service had good links with other health care professionals and staff had the skills to know when they needed to contact the GP. They monitored people’s health care needs well.

Staff had a good understanding of legislation relating to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards. (DoLS) The MCA ensures that where people have been assessed as lacking capacity to make decisions for themselves, decisions are made in their best interest according to a structured process. DoLs ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

We observed staff who were kind and caring and familiar with people’s needs. The environment and the staffing contributed to people having a good standard of care. We received many compliments and saw that the service involved and consulted with people and took into account people’s feedback in the way the service was managed.

People had an assessment

The inspection took place on the 20 July 2016 and was unannounced. The service was last inspected on the 8 December 2014 under section 60 of the Health ad Social Care Act 2008 and was rated as requires improvement overall with a number of breaches of regulation. These related to Care and welfare and insufficient staffing levels in the service. Since this inspection we have received regular action plans from the manager telling us what continued actions they have taken to comply with regulations.

There is a registered manager 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.’

Our inspection concluded that people’s experiences in the service were mostly positive with people reporting good experiences on the ground and first floor but we did have some concerns about the care and clinical oversight of the care provided to people who required nursing care and resided on the second floor. These concerns were discussed the manager following our inspection and they took some immediate actions to rectify what we had found. In addition we met with the provider and they gave us a very detailed action plan which gave us confidence in the provider that they would address and had already addressed a number of shortfalls. The service in the main provided good care to people and staff were friendly, helpful and shown to provide care that was responsive to people’s needs.

Insufficient staffing to keep people safe was identified as a breach at the last inspection. During this inspection we felt there were enough staff most of the time. However the deployment of staff was not always used effectively to ensure people’s wellbeing and safety and there were times when people felt there were not enough staff. This was also highlighted by staff working at the service. The manager had systems in place to monitor the staffing levels in line with people’s needs. The standards of care was good but people’s safety could be compromised if current staffing levels were not maintained or increased according to changes in people’s needs.

Risks to people’s safety could be increased due to poor practices around infection control and poor monitoring and maintenance of equipment. We also identified issues with the management and storage of medicines, and creams. The care planning process required general improvements in terms of record keeping and monitoring of people’s health.

People were supported by staff who had all the required training and support they needed to work effectively. However we did identify some concerns around staff practices in relation to medication management and infection control practices.

People were supported to eat and drink enough for their needs and there was close monitoring of this. However we identified a number of risks around people specific dietary needs and risks from aspiration.

Although overall care delivery was kind and caring, staff did not always treat people with dignity and respect. People’s needs were assessed but we could not always see from the records that care had been delivered. Staff were familiar with people’s needs. Not all the people in the service had an opportunity to interact with others in a meaningful way and live full lives including participating in activities that interested them. The complaints procedure was not always effective in addressing people’s concerns.

The service had quality assurance systems in place and is constantly trying to improve the service it provides. However we identified concerns which had not already been identified or addressed by the provider. Areas of the service lacked leadership and engagement from senior staff to ensure staff practices were of a good standard and im

The inspection took place on the 8 December 2014.

Stanley Wilson Lodge provides accommodation on three separate floors. The ground floor is residential, the middle floor is for people living with dementia and the top floor is for people with nursing needs. The home can accommodate up to 75 people. On the day of our inspection the home was fully occupied.

There was a registered manager 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 and associated regulations about how the service is run.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions for themselves and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others.

The staff were acting lawfully and had a good understanding of relevant legislation and how to support people who did not have capacity to make decisions about their own care and welfare.

Staff knew what actions to take if they suspected someone to be at risk from abuse or harm. This meant as far as possible people could be protected.

People were adequately supported and kept safe but there were not always enough staff to respond to people’s needs adequately.

People’s health care needs were met but we identified inconsistent practices around recording so could not be assured that people’s needs in relation to their health and welfare were met accurately.

The home provided sufficient emotional and social stimulation for people with a range of activities and links with the community to help people stay in touch with their pasts.

There was an effective complaints procedure and people and their families were encouraged to give feedback about the care provided. This enabled the manager to address any concerns when they arouse.

The service was well managed, and there was an open, positive culture. People’s rights were promoted and risks to people’s safety were monitored to ensure as far as possible these were reduced.

During our inspection we spoke with five people who lived at the home and two other people’s relatives. They all said that staff sought their consent before providing care and treatment and that they felt their, or their relative’s needs were met. People and their relatives told us the care was, “Very good,” and, “Terrific.”

People told us there was a range of activities available which they could join in if they chose to. One person told us, “There are plenty of opportunities to mix socially here.”

We found that people’s needs were assessed and care delivered in line with their individual care plans. This ensured people’s safety and welfare. We saw staff providing care and support to people living at the home. They spoke in a calm and respectful way, gave people time to communicate and did not rush them.

People were cared for in a clean, hygienic environment and staff were aware of procedures to prevent and control the spread of infection.

People were cared for by suitably qualified, skilled and experienced staff. People made positive comments about the staff who cared for them. One person told us, “The staff are marvellous, all of them.”

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.

We spoke with five people who were taking part in a group activity and three randomly chosen people who spend their time in the communal areas of the home.

All eight of them told us that the home was a good place to live in. One person commented: “It is a good place here, they are very kind and help us how we want.” All eight people told us that staff respected them, asked them if they were happy with their care and listened to what they said. Three people were asked whether they felt safe and responded that they did. One person explained that they would tell the manager (calling them by their name) if, “there was any problem, or we wanted something, or to say what we want.”

Two people commented that staff were knowledgeable and skilled in helping them with all the tasks and particularly singled out the manager as, “Very well trained and skilled.”

They both expressed their opinion that there were enough staff on duty to meet their needs. One of them explained: “We do not need to wait too long when we call them, they come as soon as they can.”

All three people spoken with in the communal area confirmed that they knew about their care plan and when the care plans were reviewed. They stated that they had choice regarding their care and support provided within the home. One person told us that staff used computers to record notes about people.

Five people who were taking part in an activity (a gardening and plants group) told us that the food was fine. One person commented that they had asked for a smaller portion and that this request was respected.

Two people told us that they felt fully confident that staff held their medication and were administering it to them. “Only senior staff give us our medication”, one person explained.

People with whom we spoke, told us, that they were happy living at Stanley Wilson Lodge and they found the staff to be nice and caring. Comments included “I couldn’t get better care, I am very well looked after and attended to” and “I am very happy with the care and support, the carers are very kind and caring. I have no complaints.” People also confirmed that they were treated with respect and dignity.

Three relatives also confirmed they were happy with the care and support provided to their member of family. Positive comments were also noted within the home’s compliments book and within their most recent customer satisfaction surveys. Comments included “Very pleased with mostly everything and couldn’t ask for better”, “Staff seem to be very competent and caring” and “Thank you for the great care our relative got from all the staff. They were so kind and gentle with them especially towards the end. For us the care they got we could not fault.”

Three people spoken with did not always feel there were sufficient staff available. Comments included “Some staff take a long time, where are the care staff and nurses?” and “You can be left for a long time before someone comes, but staff do their best, they are very busy.” One person who used the service told us that they had rung their call bell on three occasions and each time this had been switched off and they were still waiting to use the toilet (they waited 20-25 minutes). The results from the provider's most recent customer satisfaction survey for 2010-2011 also raised concerns about staffing levels. Comments included “Need more carers, staff don’t have time to talk and are rushed off their feet” and “Staffing levels are not always adequate.”

People told us that they felt safe and that, if they had any concerns or worries, they would discuss them with their relative or a member of staff.