We carried out an unannounced comprehensive inspection of this service on 11 and 13 April 2017 and rated it ‘Good’. After that inspection we received some concerns in relation to the safety and governance of the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Lodge Care Home on our website at www.cqc.org.uk.

The Lodge is a residential care home situated in South Shields. It provides accommodation and personal care for up to 53 people with physical and mental health related conditions. The service does not provide nursing care. At the time of our inspection 44 people used at the service.

There was an established registered manager in post who was employed to manage the service and had been registered with the Care Quality Commission (CQC) to provide regulated activities since October 2010. 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 2008 and associated Regulations about how the service is run.

In May 2017, CQC received some information of concern from a relative of a person who used the service. The concerns related to general care issues which we shared with the local authority safeguarding team and contracts monitoring team. Subsequently the local authority conducted an unannounced visit to the service and fed back some further concerns to us at a multidisciplinary information sharing meeting. These concerns related to several aspects of the service including updating care plans and assessments, daily recording, communication and governance.

Following the local authority’s visit to the service, a multi-agency decision was made to place the service under South Tyneside Council’s ‘Provider Concerns’ process. This meant the provider had to produce an action plan to address the issues which would be closely monitored by the local authority contracts monitoring and safeguarding teams. The provider also agreed not to admit any new residents for a period of time.

Additionally, in June 2017 we received an adult protection alert from the Fire Service, following an incident they had attended when one person was accidentally locked in a bedroom.

A follow up visit was conducted by the local authority on 26 July 2017 where improvements were noted but some actions were yet to be completed or sustained. It was acknowledged that new processes had been implemented to improve the service and reduce the identified risks. However, the local authority raised further concerns about safety. This related to medicine management, people using a wheelchair without the lap strap fastened and people not wearing appropriate footwear.

The CCG reported no additional concerns had been raised by their staff and the link GP for the home had provided positive feedback about better communication. The local district nursing team had also shared positive feedback and had noted a more proactive approach being taken by the staff to monitor and manage health conditions.

The improvements and the additional matters were discussed at a further multi-disciplinary meeting and a decision was made to remove the service from the ‘Provider Concerns’ process as the level of risk was considered to be minor. It was agreed by the multi-disciplinary team that the home’s ongoing improvements should be closely monitored in line with the local authority’s quality assurance programme.

CQC used all of this information to inform their decision to conduct an urgent focussed inspection to check the safety and governance of the service.

At our inspection, we found that the service had made further progress with the newly implemented processes and procedures. We discu

This inspection took place on 11 April 2017 and was unannounced. A second day of inspection took place on 13 April 2017 and was announced.

We previously inspected the service in April 2016 and found the service was in breach of regulations around the safe care and treatment of people because records and systems did not support the safe management of medicines. During this inspection we found the service had made improvements, details of which can be found within the report.

The Lodge Care Home provides personal care and support for up to 53 people, some of whom are living with dementia. At the time of our inspection there were 46 people using the service. The service does not provide nursing care.

The home 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.

The arrangements for managing people's medicines were safe. Staff supported people with their medicines in a patient and caring manner. Medicines were stored appropriately. All medicine records were completed accurately and regular medicine audits were carried out.

Staff had a good understanding of how to safeguard people and were able to give examples of different types of abuse and potential signs to look out for. Staff were confident how to report any safeguarding concerns they may have and were aware of the provider's safeguarding and whistle blowing policy.

Risks to people's health, safety and welfare were assessed. All measures to reduce risks were identified and put in place. Risk assessments were reviewed regularly and updated in line with people's changing needs. The provider also had up to date risks assessments in place regarding the premises and environment.

We received mixed comments regarding the adequacy of staffing levels. During the inspection we found there were enough staff to meet people's needs and cover was sought in times of staff absence. New staff were recruited in a safe way and all appropriate pre-employment checks were carried out in line with the provider's policy and procedure.

Accidents and incidents were recorded and all identified action was taken. The provider monitored accidents and incidents to identify any possible trends and measures that could be put in place to reduce the likelihood of a recurrence.

Staff had completed relevant training and received updates when required. Staff received regular supervisions and annual appraisals to discuss their progress and any training requirements.

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 were supported to meet their nutritional and hydration needs. People told us they enjoyed the food in the home. Care plans contained information about people's likes and dislikes in relation to food and drinks as well as details of how to support people with specific dietary needs.

Staff supported people in a caring way and demonstrated compassion and familiarisation when doing so. People and relatives told us staff were caring and they were happy with the support they received.

The provider completed assessments of people's needs prior to them moving into The Lodge Care Home. Assessments were used to devise personalised care plans to guide staff how to support people in line with their needs, preferences and wishes. Care plans were reviewed regularly and updated when required.

People and relatives knew how to raise concerns about the service. Copies of the provider's complaints procedure were on display in the home. The registered manager kept a log of all complaints received and information about investigations and outcomes.

Reg

The inspection took place on 6 and 12 April 2016. The first visit on 6 April 2016 was unannounced. The second visit on 12 April 2016 was announced. The last inspection of this service was carried out in May 2014. The service met the regulations we inspected against at that time.

The Lodge is a care home which provides personal care for up to 53 people, some of whom may be living with dementia. There were 51 people living there at the time of our inspection. The service does not provide nursing care.

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.

We found the provider had breached Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the registered provider did not have accurate records and procedures to support and evidence the safe administration of medicines. Records relating to medicines liable to misuse, called controlled drugs, were inaccurate, stocks of medicines were not adequately accounted for, and appropriate codes for the non-administration of medicines were not always used.

You can see what action we told the provider to take at the back of the full version of the report.

People spoke positively about the staff and told us they felt safe and cared for. One person told us, “It’s good here. We get well looked after.” A relative said, “My [family member] is safe here. They’re not worried about anything. Staff keep a check on [family member] through the night and this makes them feel safe.”

Staff completed safeguarding training as part of their induction and then at regular intervals. Staff we spoke with said they would raise any concerns immediately.

The premises were clean and comfortable. Regular maintenance checks were carried out to ensure the premises were safe.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs and showed how risks could be minimised.

The service was working within the principles of the Mental Capacity Act 2005. Deprivation of Liberty Safeguards (DoLS) applications had been made appropriately and contained details of people’s individual needs.

People told us they liked the food that was provided. People had a variety of options to choose from and drinks and snacks were readily available.

The service had features which supported people who were living with dementia such as themed areas and reminiscence material.

New staff received a comprehensive induction, which included training in key areas. Staff undertook additional training regularly, and received regular supervisions and appraisals.

People spoke positively about the caring and compassionate nature of the staff who cared for them. One person told us, “The staff are really nice and kind, and we all get on so well. I love it here.” Another person said, “I’m waited on hand and foot here, I don’t need anything at all.”

Care plans were detailed and specific to people’s individual needs. They were reviewed and updated regularly. When people’s needs changed this was acted on promptly.

The provider had an effective quality assurance system and people’s views about the service were frequently sought to check where improvements could be made.

During this inspection we spoke with eight people who used the service, five relatives, and a visiting healthcare professional. Some people who were using the service had dementia care needs which meant they were unable to tell us their views. We used a number of different methods to help us understand their experiences.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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. If you want to see the evidence that supports our summary please read the full report.

Is the service caring?

People were supported by calm and attentive staff. We saw that care workers showed patience and gave encouragement when assisting people. We saw people were supported to enjoy their meals at their own pace. We saw staff spent time chatting with people about their interests in a warm and engaging manner.

People described the service as “caring” and “helpful”. One person who was new to the service told us, “The staff have been friendly, courteous and obliging.” A visitor commented, “The staff are very caring. My parent has been here three years and residents always seem well cared for and clean.”

In discussions staff were knowledgeable about people’s individual needs and preferences and were respectful of their diverse needs. Our observations of the care provided and discussions with people showed us that individual wishes for care and support were taken into account.

Is the service responsive?

There was a visible staff presence throughout the home so that staff could support and supervise people when needed. The call alarms were responded to promptly so people got support in a timely way.

People told us they could join in a range of activities if they wanted. The daily activities included group events and others that met people’s individual interests.

The home had an enthusiastic activities co-ordinator who arranged trips out to places of interest which helped to keep people active and involved. For example on the day of this inspection four people and staff were on a trip to a museum in York.

People and visitors told us they could approach the manager at any time if they wanted to discuss anything and felt they were listened to. One visitor told us, “The manager is very approachable. He makes it clear that if we have any issues we should go to him.” Another visitor told us, “There are regular meetings with relatives and residents and they listen to what we say.”

Is the service safe?

People told us they felt “safe” at the home. One person said, “It’s my first time in a care home and I’ve felt very safe here.” A visiting healthcare professional told us, “I have no concerns about people’s safety here, they’re well looked after.”

The premises were safe, well maintained and clean. Equipment was regularly serviced and the health and safety records were up to date. These checks meant that people were not placed at unnecessary risk.

The home had procedures to report any safeguarding concerns. Staff had training in safeguarding vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager understood the home’s responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The home had made a recent deprivation of liberty application to the local authority regarding one person. The manager was aware of the recent court ruling regarding DoLS in care settings, and training from the local authority was planned for the near future.

Is the service effective?

People felt the service met their needs. People’s comments about the service included, “I’ve been satisfied with the service” and “staff are very helpful”. There were individual care plans for each person which set out their care needs.

A visiting healthcare professional told us, “The staff always let us know if there’s been any change in people’s needs. The care practices are good, and it’s always the same staff so they see even the slightest changes in people.”

The home’s dementia care unit was working towards an award in dementia care services. This meant the unit would be assessed for staff training in dementia care, the environment and activities.

Is the service well-led?

The home had a registered manager who had been managing the home for three years. People and their visitors told us they had confidence in the management of the home and felt the manager was “approachable” and listened to their views.

The provider had a system to assure the quality of the service they provided. The way the service was run had been regularly reviewed. A range of checks were carried out including care records, medication and the dining experience for people who lived there. A regional manager carried out at least monthly visits to audit the systems and procedures at the home.

We spoke with two relatives who visited the service everyday to see their relative. They told us they liked the home straight away when they visited over a year ago. They said; "The staff are so lovely and everyone is so friendly" and "I feel really happy with how my relative is looked after". They also told us "It's been excellent" and "John (the registered manager) is great".

We found people’s privacy, dignity and independence were respected and people experienced care, treatment and support that met their needs and protected their rights. We found medicines were safely handled and there were sufficient numbers of suitably qualified staff. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

Some of the people told us about the help they received from the home when they were looking to move into a care home. Two people told us they received “helpful” information when they visited to look round they home. People told us they were visited by the staff and also by a social worker to carry out an assessment of their needs to make sure that home can look after them. One relative told us, “We met with the social worker who explained everything to mom and the family. They gave us all the information we needed and then we came to see the place for ourselves before mom decided to move here”.

Comments from people who used the service included:

“The girls are really good. They do this job because they care.”

“They are not well paid but they love what they do.”

“We are kept informed about everything. They let you know when mom is not well or need to get the doctor out.”

“They treat us with respect. I can’t complain”.

People told us they were happy at The Lodge Care Home and that staff supported them well with their healthcare needs. People we spoke with told us they received regular medical care from their GP and from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required.

We spoke with the people about safeguarding matters. They all told us that they felt safe being at The Lodge Care Home and had no concerns or worries about their safety or treatment. People told us about the support they received and said that they felt the staff protected them and promoted their welfare.

We did not speak with the people who used the service about this outcome area. This visit was a follow-up visit to a previous inspection in July 2011 to see what improvements have been made by the provider to meet this outcome.

We spoke with a number of people who use the service and they were positive about the care they received from The Lodge Care Home.

The comments and views from users and visiting relatives included:

“I am very happy here”.

“I have no concerns here. The girls are wonderful to us”.

“I can’t fault the care here”.

“This is a good home”.

“I wish there could be more activities for the residents in here”.

We spoke with three users about the medication system and they told us that on the whole they received their medication regularly and on time. We spoke to users about the environment they told us that their rooms were clean and they felt the home was always clean and had no smell.