This inspection took place on 27 November and 5 December 2017; the first day was unannounced.

At our previous inspection in October 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Regulations 11,12 and 17 relating to consent, medicines and governance. We asked the provider to complete an action plan to show what they would do and by when to improve the rating to at least ‘good’. At this inspection we found improvements had been made.

The Lodge is a ‘care home with nursing’. 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. The Lodge accommodates up to 36 people in one adapted building. At the time of our inspection 27 people lived at The Lodge.

The service is required to 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 our inspection there was a registered manager in post and the provider had notified us about a period of absence they were taking. In the registered manager’s absence, arrangements had been made for the deputy manager to provide management cover.

Arrangements to ensure sufficient staff were consistently available had not yet been fully embedded. This had resulted in occasions of insufficient staffing. Actions were being taken by the provider to help keep staffing levels sustainable.

People made their own decisions in relation to their care and support. Where they needed support to make decisions their rights were protected under the Mental Capacity Act 2005. People understood their care and support because they received information in a format that met their needs.

Medicines were managed safely and practices were in place to prevent and control any infections.

A registered manager was in place. The provider had notified us of a period of absence taken by the registered manager; they had arranged for the deputy manager to provide oversight of the service in their absence. The deputy manager understood their responsibilities for the management and governance of the service.

Systems were in place to monitor and improve the quality of the service provided. These informed the deputy manager who had identified where further improvements were required. The service was focussed on achieving good quality outcomes for people. The service was managed with an open and transparent culture where care was centred on the individual person and staff were valued.

People were kept safe and the risk of abuse was minimised because the provider had systems in place to recognise and respond to allegations or incidents. Other risks were assessed and actions taken to reduce known risks. Pre-employment checks were completed on staff to check their suitability for the role. Staff received support for any needs identified in relation to protected characteristics of the Equalities Act (2010).

Staff received training in areas relevant to people’s needs and in line with the aims of the service. Staff received support through supervision and staff meetings. People’s health and any associated risks were monitored and responded to; referrals to other healthcare services were made where this would be of benefit. Staff provided care to help people maintain a balanced diet.

The premises had been adapted so as to be accessible to people with mobility aids. Signage had been used to help orientate people around the premises.

People were cared for by care staff who were kind and caring. Staff respected people’s privacy and dignity. People were supported with their inde

This inspection took place on 18 October 2016 and was unannounced.

There is a requirement for The Lodge to have a registered manager and there was a registered manager in place at the time of this 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.

The service is registered to provide nursing and residential care for up to 36 people, including some people living with dementia. At the time of our inspection 33 people were using the service.

Systems and processes to check on the quality and safety of services provided to people were not always effective at identifying shortfalls.

Medicines were not managed and stored safely in line with good practice. The provider could not demonstrate that people, whose fluid intake was monitored, received sufficient fluids. In addition, some people required repositioning at regular intervals to prevent and reduce the risks associated with pressure areas. The provider could not demonstrate these people were always repositioned at the frequency identified as required by the provider.

Policies and procedures were in place for the Mental Capacity Act 2005 (MCA). Applications for assessments using the Deprivation of Liberty Safeguards (DoLS) had been made when required. However care plans for people who lacked the capacity to consent to their care, did not contain a mental capacity assessment and best interest’s decision to inform the provision of care and support.

People were supported to enjoy mealtimes and received sufficient food and drink. However, staff did not know one person had diabetic needs and not all lists in the kitchen included people’s diabetic needs.

People were supported by staff who were compassionate and caring. Staff listened to people and respected their choices and decisions. Care and support respected people’s privacy and dignity. People’s independence was supported.

People received responsive and personalised care from staff who understood them and their interests. People were supported to engage in enjoyable interests and activities. People were asked for their views and people knew how to raise concerns or make suggestions.

The registered manager had taken action to recruit new staff to ensure they could provide sufficient numbers of staff to meet people’s needs. Any risks to people were identified and assessed and monitored.

Staff were supported through supervision and training. Staff received training in areas that were relevant to the needs of people using the service. People were supported to access other health care services as required.

The registered manager was viewed as being open and approachable and involved in the day to day management of the service. The registered manager was supported in their leadership by motivated and supportive staff.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection visit. You can see what action we told the provider to take at the back of the full version of the report.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional.

People told us they were treated with respect and dignity. They told us staff knocked on doors before they entered their rooms and also closed the bedroom door and curtains when delivering personal care. We saw that staff’s approach towards people was person centred and caring, and they interacted with people in a positive way. We saw that each person was approached in an individual manner, which showed the staff on duty knew each person very well. Staff members spoke quietly with people until prompted to speak louder.

People told us the food provided was good and they enjoyed their meals. They told us they were always offered a choice of meal, they had enough to eat, and hot and cold drinks were provided. We observed staff were attentive when supporting people during meal times. We saw that plate guards and spouted cups were used, which assisted people to maintain their independence. Finger foods were provided for one person who chose not to use cutlery but wished to continue to eat independently.

People told us they were happy living at The Lodge. They told us they felt safe, and had no concerns about any member of staff, or the care and service they received. They told us if they did, they felt able to raise concerns with any member of staff. Staff had a good understanding of the forms of abuse people would need protecting from. They said they had no concerns to share with us about any risks to the safety of people who used the service.

No one raised any concerns that their needs were not responded to at any time. One person who stayed in their room thought there might not been enough staff on duty in the afternoon as they did not see anyone. Another person thought that maybe there weren’t enough staff on at night. One relative commented that there appeared to be less staff on at the weekend. We checked the rotas and asked staff and found that staffing levels were the same at the weekend as during the week.

People were asked if staff spoke with them about their care needs. One person told us they knew about their care plan, another person was not sure but they were not concerned, as they were happy with the care provided. Relatives told us they were kept fully informed about any changes to occurred, and did not express any concerns about the care provided.

There was no registered manager in post at The Lodge at the time of our inspection. The deputy manager told us a manager had been appointed and would be starting work at the home within the next few weeks.

People told us the care they received at The Lodge was good. One person said, "I feel quite at home here." Another person’s relative told us they were , “Very happy. The staff are very supportive and caring.”

We found the home was being refurbished and decorated. The premises were generally safe, comfortable and accessible, including for people with mobility difficulties. We saw that sufficient equipment was available to provide people's care. The provider had ensured equipment was safe for people to use.

We saw that people's consent was obtained for their care, and that the deputy manager was working to ensure proper procedures were used if they could not make their own decisions, for example due to dementia.

We saw that plans were in place describing how people should be cared for and any risks that could affect them were assessed. The deputy manager had made improvements to some aspects of people’s care, including when they were at the end of their lives. This meant that people received consistent, safe and appropriate care that met their needs and ensured their welfare.

We found that adequate systems were in place at The Lodge for dealing with complaints and comments about the service.