Werneth Lodge is a residential care home that provides accommodation and personal care for up to 42 older people, including some people who live with dementia. At the time of our inspection the home accommodated 37 people.

Werneth Lodge is a former red brick mill owner’s house close to the main Manchester to Oldham Road. The main building runs at a tangent to the road, accessed via a side street, and an extension built on the western side of the main building enclosed a car park and garden area. On the opposite side of the building stands part of the original building – the coach house which has been converted to provide a further number of bedrooms and a lounge area. This part of the building is connected to the main building through a short hallway which passes the main entrance. Some of the rooms in this part of the building looked out over Manchester Road.

This inspection took place on the 20 April 2018 and was unannounced. This was a focused inspection carried out by two adult social care inspectors. The inspection had been brought forward prompted by concerns relating to a specific incident. This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident.

When we last inspected Werneth Lodge in December 2017 we rated the service as ‘good’ and did not find any breaches of the Health and Social Care Act 2008. We did however make recommendations about the security of the building, the management of risk, and care planning. At this inspection the service remained ‘good’.

This focused inspection was carried out to assess any current risks to people using the service. We therefore only looked at two domains where the key lines of enquiry are about risk and leadership of the service. No other concerns had been identified through our ongoing monitoring. Therefore the other three domains, namely, effective, caring or responsive were not assess as part of this targeted inspection process. A full comprehensive inspection will be carried out at a later date.

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 2008 and associated Regulations about how the service is run.

People told us they felt safe at the service. The registered manager knew how to protect people from harm and told us what they would do if they had any safeguarding concerns. Risks to people had been assessed and plans put in place to keep risks to a minimum. Lessons were also learnt from complaints, safeguarding and incidents to help prevent reoccurrence in the future.

We toured the building and found the service had improved security by fitting new key pads and updating the codes that allowed people to enter and leave the building. The service had also ordered a closed-circuit television (CCTV) system to capture the entry and exit of people, staff and visitors to the home. The CCTV has been fitted since the inspection.

We saw the home had detailed and up to date risk assessments to promote the safety and well-being of people who used the service

Detailed assessments of people's needs were completed before they moved into the service. This was done to ensure the service could meet the person's needs and that they would be happy living at Werneth Lodge. The assessment process included visits to the person's home or hospital.

People's initial care plans were based on information gathered during the assessment process and background information from commissioners and relatives.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were reviewed monthly.

We inspected Werneth Lodge on 19 and 21 December 2017. Our visit on 19 December was unannounced.

The service was last inspected in October 2016, and rated Requires Improvement. There were two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to the way the service was governed. Following the inspection the provider sent us an action plan which stated the breaches would be addressed. At this inspection we found significant improvements in all areas.

Werneth Lodge is a residential care home that provides accommodation and personal care for up to 42 older people, including some people who live with dementia. At the time of our inspection the home accommodated 38 people. Lounges, the dining area and bedrooms were well laid out with consideration of easy and unobstructed access for people who used the service. The bedrooms were bright with large windows letting in natural light. All were en-suite with additional bathrooms on the corridors.

When we looked around the home, we found it looked clean, although the area around the lift entrance at the main door was sticky from spilt drinks.

People told us that they felt safe in Werneth Lodge, and when we spoke with staff they demonstrated a good understanding of how to prevent abuse. We saw that the service had safeguarding procedures in line with legislation and local authority policies so when incidents of potential abuse occurred these were reported and appropriate action taken to protect people from harm.

Care records showed that risks to people's health and well-being had been identified, and where risk had been identified corresponding detailed care plans were put into place, and reviewed on a regular basis. Risks were assessed in relation to each individual, taking into consideration their choices, abilities and mental capacity. Environmental risks were considered; when we looked around the home we saw that steps had been taken to prevent injury or harm, and records showed that equipment and services within the home were serviced and maintained in accordance with the manufacturers' instructions.

We saw that when recruiting new staff, appropriate processes were in place to ensure that they had the right quality and character to work with vulnerable people, and once in post all staff received regular supervision and appraisal and were provided with training opportunities to develop their skills. There were sufficient staff on duty, and we saw that they had time to spend talking and interacting positively with the people who used the service.

Systems were in place to ensure that all medicines were stored correctly and dispensed by staff trained to provide medicines safely, and where health needs were identified we saw staff followed advice given by professionals to make sure people received the care they needed.

People who used the service were offered choices, and capacity and consent issues were considered. Where people lacked capacity, best interest decisions were taken and documented to show that decisions made were in their best interests. Where people were subject to a deprivation of liberty the service sought the appropriate authorisation to provide care and support.

The service recognised and responded well to people’s needs and wishes, and respected cultural and social norms and values. Attention was paid to people’s nutrition and hydration needs. People told us they were generally satisfied with the food offered, but some told us ways they felt meals could be improved. The service employed an activity coordinator, and regular activities were arranged. On the second day of our inspection the service held a Christmas party, and we saw people who used the service enjoyed this day. Relatives and friends told us they were welcomed at Werneth Lodge, and we saw that they had been invited to the Christmas party.

We saw that people were treated with respect and dignity by kind and patient staff. We observed and overheard kindly i

This was an unannounced inspection which we carried out on 3 October 2016.

We last inspected Werneth Lodge in May 2014. At that inspection we found the service was meeting all of the legal requirements in force at the time.

Werneth Lodge is a care home that provides accommodation and personal care for up to 42 older people, including some people who live with dementia.

A manager was in place and they had applied to become registered with Care Quality Commission. 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.

People who used the service told us they felt safe. There were sufficient staff employed to provide consistent and safe care to people. People received their medicines in a safe way. Risk assessments were in place and they accurately identified current risks to the person. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Staff knew the people they were supporting well. Care was provided with kindness and people's privacy and dignity were respected. Records were not always up-to-date or regularly reviewed to reflect peoples' care and support requirements.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. They also received other training to meet people’s care needs.

Menus were varied and a choice was offered at each mealtime. Staff supported people who required help to eat and drink and special diets were catered for. Activities and entertainment were available for people. A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

Staff and people who used the service said the manager was supportive and approachable. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people's care and support needs and the running of the service.

Staff knew the care needs of the people they supported.

People had the opportunity to give their views about the service. There was regular consultation with people or family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided, however the auditing of care records was not effective. The environment was maintained for the benefit of people who used the service.

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

The Registered Manager for this service was promoted to Area Manager for the organisation in May 2012. The Area Manager remained also the Registered Manager for the home because we did not receive an application to cancel their registration. This has now been received although at the time of our visit the Area Manager was still managing the service.

We inspected this home because we received some concerning information that stated care practices at the home put people at risk. The provider responded to us in writing regarding these concerns. We looked at the concerns and the provider’s response during our inspection.

The local authority had also told us of recent concerns regarding health and safety, infection control and the management of people’s monies in the home. Action had been taken to address these issues.

We saw that most of the people staying at the home had complex health care needs. Three people who lived at the home and who were able to speak with us told us that the staff were “helpful”, “nice” and “brilliant”. We heard that the food was “good” and “not bad on the whole”. One person said “I have no complaints”.

We saw that people lived in a clean and odour free environment. People received respectful and supportive care from staff and their health, medication and nutritional needs were monitored and supported. However, quality assurance systems, safeguarding and staff training and support systems needed improving.

This inspection was a follow up inspection to check whether the Registered Provider had taken action to ensure that people living at the home received care that was respectful and promoted their dignity.

We inspected Werneth Lodge Care Home on 25 June 2012, where we found that people were involved as far as possible in deciding when and how their care and support was provided. However, we observed on three occasions staff standing over people whilst providing support with diet and drinks. This practice did not promote people’s dignity.

At this inspection, we observed staff providing people with appropriate care and support. We saw that staff involved people in the decisions regarding what food and drink they wished to have for their lunch. When someone needed assistance with diet and drinks, we observed that this was provided in a way that promoted the person’s privacy and dignity.

At this inspection visit 37 people were accommodated. We were told that approximately 80% of people living in the home had complex health care needs such as dementia. This meant it was difficult for people to tell us what their experiences were of living in the home. However one person said “Staff speak to you properly. They are respectful” and “Staff are very good with everyone”. Another person said “It’s okay here”.

We spoke with a health care professional who visited the home on a regular basis. They told us that they “had no concerns at all” about the quality of care provided by the home.

We saw that 24 people had been asked for their feedback about the service being provided by the home. A report, dated May 2012 was compiled from the eight returned responses. The report highlighted that people had identified issues with the laundry service and it included the actions taken to address these issues.

Our inspection team was made up of an inspector who addressed our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

Some of the people living at Werneth Lodge were living with dementia and could not always give their verbal opinions of the service they received. However, when we observed the care provided to these people we saw that they were treated with kindness and respect. People who were able to express an opinion told us that they were happy with the care and treatment they received from the staff at Werneth Lodge.

When we looked at records we saw that people who lacked capacity were fully protected when decisions were necessary for their health and personal care needs.

We saw evidence to demonstrate that staff had received training relevant to their role, and this meant the needs of people using the service were met by a trained staff team.

Is the service effective?

When we spoke with relatives visiting the home they told us that they were fully informed regarding their relatives care and were kept up to date with any changes in care needs. They told us that if they had any concerns they felt confident in reporting these to a member of staff or the manager and that they believed they would be addressed in a timely manner.

When we looked at individual care plans we saw evidence to demonstrate that people were supported to access a wide range of medical services such as G.P.visits, dental visits and hospital appointments. We saw documentation on care plans to show that where a change of care need had been identified this had been reported to the appropriate healthcare professional. This demonstrated that staff were responsive to changes in individual care needs and that appropriate referrals were made where necessary.

Is the service caring?

During our observations we saw staff support and help people in a kind and sensitive manner and in a way that promoted the dignity of the individual. People we spoke with told us they were very happy living at Werneth Lodge and that the staff team were very caring. One person said, "The staff are so kind, a good day is when everyone is jolly and the staff are always trying to help people".

Care plans and medication records were checked regularly to make sure people's changing care needs were being fully met.

Is the service responsive?

We saw that people's needs were assessed before they were admitted to the home to help ensure that there were staff in sufficient numbers and with the right skills to meet individual's assessed needs. Records showed that when any new care need was identified a new care plan was put in place. Staff were aware of the need to keep up to date with people's changing care needs and respond to them in timely and appropriate way.

Is the service well led?

Since the appointment of a new manager several changes had been made in the home. Systems had been put into place to monitor and audit the day to day running of the home. Staff training had been prioritised so that they had the right skills to meet the needs of the individual people living in the home. Spot checks were carried out to monitor and assess the delivery of the care provided by the staff and one had been completed on the day of this visit by the manager and the area manager.

Systems were in place to obtain feedback from people living in the home and their friends and relatives. This would help the manager in developing the service and making changes when these were needed.