The Lodge Care Home is registered to provide accommodation and personal care for up to 45 older people, some who may be living with dementia. At the time of our inspection there were 42 people using the service.

The home is built over four floors, with a number of lounges and dining areas.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff with the correct skill mix on duty to support people with their required needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people. 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.

Staff received an induction process and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions and observed practice.

People were able to make choices about the food and drink they had, and staff gave support if and when required to enable people to access a balanced diet.

People were supported to access a variety of health professionals when required, including opticians and doctors to make sure that people received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Further information is in the detailed findings below

The inspection took place on 21 April 2016 and was unannounced. At our last inspection on 20 March 2015, the service was found to be meeting the required standards in the areas we looked at. The Lodge Care Home is registered to provide accommodation and personal care for up to 46 older people who may also may be living with dementia. At the time of the inspection there were 29 people who used the service.

There was a manager in post who had 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 and associated Regulations about how the service is run.

People told us that they felt safe, happy and well looked after at the home. Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally. Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to help keep people safe. Trained staff helped people to take their medicines safely and at the right time. Identified and potential risks to people’s health and well-being were reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. Information about local advocacy services was available to help people and their families’ access independent advice or guidance.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

People were supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community. They felt that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders were complimentary about the registered manager, deputy manager and how the home was run and operated. Appropriate steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement.

This unannounced inspection was carried out on the 20 March 2015.

The Lodge provides accommodation and personal care for up to 45 older people. At the time of the inspection there were 24 people living in the home.

The service does not have 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 the time of the inspection the manager had applied to be registered.

During the last inspection carried out on the 26 August 2014 we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These had now been met.

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The provider had effective recruitment processes in place, and there were sufficient numbers of staff employed and they were deployed effectively on a day to day basis.

People were protected from avoidable risks and staff were aware of their duty of care to the people. Staff were trained to recognise and respond to signs of abuse. Risk assessments were carried out and reviewed regularly.

There were sufficient staff on duty to ensure the safety and welfare of people. Staff were appropriately allocated to ensure a good skills mix.

Medication was administered, recorded and managed appropriately.

The staff had appropriate training, supervision and support, and they understood their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

There was a variety of choices available on the menus, snacks were freely available throughout the home and people were supported to have sufficient food and drinks to meet their dietary needs.

People were supported to access other health and social care professionals when required, and encouraged to continue their relationships with their family members and friends.

Staff were caring, kind and compassionate and cared for people in a manner that promoted their privacy and dignity. People felt listened to and had their views and choices respected.

People were involved in the decisions about their care and their care plans provided information on how to assist and support them in meeting their needs. The care plans were reviewed and updated regularly.

The home was managed in an inclusive manner that invited from people, their relatives and staff.to have an input to how the home was run and managed.

The home had systems in place to assess, review and evaluate the quality of service provision.

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We carried out this inspection to check if the home had met the conditions of the Warning Notice issued on the 11 September 2014.

We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

We found that the home was meeting the standards we had inspected.

If you wish to see the evidence supporting our summary please read the full report.

You can see our judgements on the front page of this report.

Is the service caring?

We did not review this aspect of care at this inspection. Pease see inspection report dated 28 August 2014.

Is the service responsive?

We did not review this aspect of care at this inspection. Please see inspection report dated 28 August 2014.

Is the service safe?

We found that the home had systems in place to ensure the safe ordering, storage, administration and recording of medication. We found that medication was administered by staff who were trained to do so.

Is the service effective?

We did not review this aspect of the service at this inspection. Please see inspection report dated 28 August 2014.

Is the service well led?

We did not review this aspect of the service at this inspection. Please see inspection report dated 28 August 2014.

This inspection was carried out by one inspector from the Care Quality Commission (CQC) as a follow up to the inspections carried out on the 11 June and the 09 July 2014. It was carried out over two days. We looked at six care records, spoke with eight people who lived at The Lodge Care Home, eight the staff, the manager, the regional manager, people’s relatives and visitors to the home. We visited all areas of the home and had sight of all the people who lived there. We observed lunch on the second day of our inspection.

Below is a summary of our findings.

Is the service safe?

At the last inspection carried out on the 11 July 2014 we were told by some of the people who lived at the Lodge Care Home that they did not always feel safe. By safe, we mean that people were protected from abuse and avoidable harm. At this inspection we spoke to some of the same people and we were told that they now felt safe and protected. We found that the manager had acted on the feedback we had given them and had investigated and taken appropriate action to ensure that the people felt safe.

We found that the staff were kind and caring and were aware of their duty of care to the people using the service. Discussions with the staff and a review of records showed that they had training in how to recognise signs of abuse. All the staff we spoke with told us that they would report any incidents and would ensure they were dealt with.

The people told us that the manger was easy to talk to and therefore they could tell her anything. “The new manager is lovely and very easy to talk to and that nothing is too much bother for her.” We were told that call bells were answered in a timely manner.

However we noted that mental capacity assessments had not been carried out on those people who had memory loss and a Deprivation of Liberty order had not been applied for, for all the people who had their freedom of movement curtailed. We were told that this was underway but had not yet been completed.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes and promoted a good quality of life which was evidence-based where possible.

We reviewed the care and support plans for six people who lived at The Lodge Care Home and we found that the care plans had been reviewed and now contained appropriate person centred information to inform care staff how to support people in an individualised way. All of the care plans we looked at had ‘This is me’ the form provided by the Alzheimer’s Society to ensure personal knowledge of the person.

Is the service caring?

By caring, we mean that staff involved the person in how they wanted their care delivered and that they treated people with compassion, kindness.

We observed the staff on duty to be caring and compassionate throughout the two days of the inspection. Staff had quality time to spend with the people and we saw that people were not left unattended. We noted that some staff knew the person as an individual, their background and personal details including their identified needs. However, not all agency staff were aware of the personal needs of the people.

Is the service responsive?

By responsive, we mean that services were organised so that they recognised and met people's needs in a timely manner. We found that the staff were well managed and that staff had been given designated duties. This meant that staff knew who they were attending to and did so in a timely manner. The home was managed in the best interests of the people who lived there. Lunch was well managed and those people who needed the most assistance were attended to by an appropriate number of staff.

Care plans had been reviewed and were written in a person centred manner. The home was aware of when it was no longer able to meet the needs of the people and referrals were made to the appropriate health and social care professionals.

The serving of lunch was staggered and this meant that the kitchen staff served food to the people in a manner that ensured the food was hot and appetising. Snack and drinks were freely available to the people and those who were not able to help themselves were assisted by staff.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation assured the delivery of high-quality person-centred care. We found that the home had made significant improvements since the last inspection. The manager was supported in achieving this improvement by managers from other services.

We noted the home was running in a more organised manner with close attention given to those who were most at risk.

We saw that there were new systems in place to audit the quality of care. We saw the positive impact of these audits, however errors were still being made in medication and had not been picked up by the auditing system.

Staff and the people who used the service had a forum where they could easily give their opinions on the services offered by the home. Staff’s morale was better and we were told that this had a positive effect on the people who lived there.

There were systems in place to ensure there was sufficient numbers of staff on duty to meet the needs of people and respect their wishes.

At the time of our inspection there was no registered manager in post. The person who had been managing the service had recently resigned. The position had been filled by an acting manager. In this report the names of two registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register. This was because they had failed to inform us they were no longer managing the service.

We carried out this inspection following information we had received raising concerns on how people were not being safeguarded.

We had sight of all the people who lived in the home and we spoke to eight of the 38 people who lived there.

As the home is medium size, the inspection team was made up of one inspector. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

We found that the home was not meeting all the standards we had inspected.

If you wish to see the evidence supporting our summary please read the full report.

You can see our judgements on the front page of this report.

Is the service caring?

We observed staff and saw that some members of staff were caring and ensured the cared for the person in a manner that promoted their dignity and independence. We saw that other staff did not treat people with dignity and respect. We saw one member of staff put a bib on a person who clearly said that they did not want it.

We saw a person offered lunch, this was handed to them in a chair, no table or cutlery was offered to them. We saw that a visitors to the home cared for the person and endeavoured to meet their needs by getting them a small table and offering them a spoon.

Is the service responsive?

People told us that there was no point in ringing their call bells at night as no one answered them. There was no order in how lunch was served. People who had the highest needs were left to fend for themselves while all but one of the staff attended to those people who were able to ask for their needs to be met. We saw that people were left to wait for assistance with their lunch and that their food was served at least 15 minutes before assistance was offered. We saw that the temperature of the food had not been checked prior to serving to people.

Is the service safe?

Three of the people we spoke with told us that there were staff members who they were frightened of. They carried this fear and were not able to be open about who they were frightened of. The manager undertook to address this issue. We saw that the majority of people were left on their own during lunch which meant that people could have put people at risk. Currently, the home was under the Local Authorities serious concerns process.

Is the service effective?

We saw that people were left unattended by staff for long periods of time. We saw that staff did not know how to engage with the people in a meaningful manner. The day of our visit was a hot day and there were signs displayed to remind people to have plenty of drinks. But we saw that there were no drinks available for them to help themselves to. We noted that most of the people we observed were not able to assist themselves to drinks.

Is the service well led?

The home has a new manager who was appointed three weeks prior to the inspection., Therefore, it was too soon to comment on their approach to management. During the inspection we found them to be open and helpful in what was a difficult day. We found that staff were not recognising and meeting people’s needs.

During this inspection we set out to answer our five key questions; Is the service caring,

responsive, safe, effective and well led?

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people are protected from abuse and avoidable harm. We found that overall staff were able to demonstrate they knew how to keep people safe, and minimise risk.

We found that actions from medication audits had not been followed up and this may have put people at risk of repeated errors. We found that in some cases records had not been kept up to date, and or followed up, such as following up on episodes of challenging behaviour, and this may have put people at risk. We saw from records that staff had been trained in the protection of vulnerable adults. Staff we spoke with demonstrated their awareness of types of abuse, and explained the process they followed to raise any concerns.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes,

and promoted a good quality of life which is evidence-based where possible. We reviewed

the care records for five people who lived at The Lodge care home and we found that

they contained person centred information, which enabled staff to care for people

effectively. However, staff were not always provided with information on how to deal with aggressive situations, which meant that people may not have always received the care they needed We noted that people’s cultural preferences were not always recorded.

Is the service caring?

By caring, we mean that staff involved and treated people with compassion, kindness,

dignity and respect. We observed that overall the staff were kind and caring. We saw that the staff were approachable and showed patience and understanding with people who used the service. People who used the service and their relatives told us the staff were very 'caring'.

Is the service responsive?

By responsive, we mean that services are organised so that they meet people's needs. We

observed the staff to be responsive when interacting with people. Staff were aware of

people's needs and responded appropriately when people requested help.

However the provider had not taken appropriate action when medication errors had been identified. An action plan was not in place, and similar errors had been repeated during recent checks.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation

assured the delivery of high-quality person-centred care, which supports learning and

innovation, and promoted an open and fair culture.

We found that improvements were required in the overall management and day to day running of the home. There was no registered manager at the location. We spoke with the area operations director about this and recruitment plans were in progress at the time of our inspection.

We also discussed some of the day to day shortcomings with the deputy manager. The deputy manager acknowledged the shortcomings and said the inspection had been useful in identifying some of the day to day difficulties, which would be addressed without delay.

You can see our judgements on the front page of this report.

The people we spoke with said that they were happy with the care and support they received. One person said “I like it here. Staff are good to me. The food is good.” Another person said “Everybody is kind to me. I have no complaints.”

We found that people and their relatives had been involved in the decisions about the care and support provided. People’s privacy and dignity had been respected and promoted. We noted that the care plans and the risk assessments had been reviewed regularly so that current and up to date information was available to staff. We also noted that each person had an assessment of their needs carried out before admission, so that the staff at the care home would be able to make a decision whether they would be able to meet their needs.

There were appropriate systems for the management and administration of medicines so that people received their medicines regularly and on time. Staff had received appropriate training and support for the work they did. There were effective systems in place to assess and monitor the quality of service.

People who use the service told us that staff respected their dignity and provided personal care and support in the privacy of their own rooms. During our visit on 30 September 2011, people said that they and their families were involved in their care and support they received. They also said that staff were helpful, caring and offered them with choices in food, drinks and activities.

People told us that health needs were assessed and reviewed on a regular basis and appropriate help was sought from other healthcare professionals when required. People who use the service said that their health and welfare needs were met.

People using the service felt that their views were listened to but not always acted upon in a timely manner. They also said that when they have raised concerns, management has not kept them informed of the actions being taken.

We visited the home and spoke with eight people living there, nine carers, and visitors in the home and we looked at the care plans and records for four of the people in the home.

One person told us that "The home is quite good" and "My room is very nice". Another person said "The staff usually come quickly when I ring the call bell". A third person said "Lunch was very nice. I thoroughly enjoyed it." and another person told us "I am very happy here".

A visitor told us "People are very well looked after. The staff are polite and friendly and I have no worries or concerns".

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We observed that generally staff interacted positively with people in the home but we saw occasions where people were not supported appropriately when standing and walking, placing people at risk. We also saw that people's care plans were not fully reflective of needs and were not reviewed regularly meaning staff did not have clear guidance to provide care for people.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were effective systems in place to reduce the risk and spread of infection.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.