This inspection took place on 28 April 2017 and was unannounced. This meant that the provider and staff did not know we would be visiting. Willow Lodge Care Home is a nursing home which provides accommodation and care for up to 48 older people including those living with dementia. There were 44 people living at the home at the time of the inspection.

The last comprehensive inspection of this service was carried out in November 2015. At that time the service was in breach of three regulations. We followed up on these breaches at a focussed inspection in March 2016 and found the breaches had been met. At this inspection we found that the improvements made had been maintained.

The service had 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.

Medicines records were not always accurate, and we have made a recommendation about this. Other processes in place for the safe administration of medicines had been followed.

People, relatives and staff told us they thought the home was a safe place to be cared for. Staff were aware of their responsibilities in keeping people safe, and a safeguarding policy was in place. Maintenance staff had carried out essential safety checks of the home regularly. The home was clean and tidy. We found some items which could be harmful, such as cleaning products, were not adequately stored. The registered manager arranged for the cleaning cupboard lock to be replaced immediately.

There were enough staff to meet people's needs, and safe recruitment processes continued to be followed.

Staff had undertaken training in a range of subjects related to care and safety, including training in supporting people who have dementia. Training was up to date and well monitored. Staff were supported to further their personal development through regular supervisions and an annual appraisal.

Care Quality Commission (CQC) is required by law to monitor the application of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their 'best interests'. We found the provider was complying with their legal requirements. Where restrictions on people's liberty were in place to keep them safe, applications had been made to the local authority to grant Deprivation of Liberty Safeguards in line with legal requirements.

People were provided with a choice at every mealtime and drinks and snacks were offered throughout the day and night. People's nutritional needs were well documented and staff were aware of how to support them.

People were supported with their healthcare needs, and we saw referrals had been made to a range of healthcare professionals.

People we spoke with told us staff were kind and caring. Relatives told us they were kept up to date with their relative's care, and that they felt welcome when they visited the home.

People's needs had been assessed and specific and detailed care plans had been created to ensure all staff had access to information about how best to provide the care people needed.

People were encouraged to share their feedback by using a tablet based in the reception to record their views as they arrived or left the home, and through a yearly survey. Complaints records were well maintained and evidenced that the provider's policy had been followed.

Activities were held on a daily basis, and trips out to local towns and beaches were also planned regularly.

People and staff told us the service was managed very well. The quality assurance system included a range of audits and actions identified to drive improvements were monitored by b

Willow Lodge Care Home provides accommodation and personal care for up to 48 older people, some of whom are living with dementia. At the time of our inspection there were 39 people receiving a service.

We carried out an unannounced focused inspection of Willow Lodge on 17 March 2016. This inspection took place because we had received information of concern regarding the care and safety of people living at the home. We previously carried out an inspection on 26 and 27 November 2015 and at that time, we found the provider was not meeting four regulations which related to person centred care, safe care and treatment, staffing and good governance. This report covers our findings into those concerns and the previous breaches of regulation.

The manager of the service was not yet registered with the Care Quality Commission, but she had an application in progress. A registered manager is a person who has registered with 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.

People told us they felt safe and relatives agreed with this. Safeguarding procedures continued to be in place and the manager ensured staff were aware of their responsibilities. Accidents and incidents were recorded, monitored and reported as necessary to the local authority and CQC.

Improvements had been made in relation to the management of medicines. Safer management processes were in place. Staff administered and recorded medicines appropriately and accurately.

Improvements had been made in infection control. Deep cleaning had taken place, additional domestic staff had been appointed and the domestic staff were undertaking qualifications to improve their skills and knowledge.

Staffing levels had increased. Care staff told us they had additional staff on duty throughout the day to ensure people’s care needs are met. Senior carers had more time to concentrate on their own duties rather than assisting with care tasks when they were short staffed.

People’s opinion of the food still varied, we saw an appetising well balanced meal being served during the inspection. People were given choices and other options were available. Some staff were still talking over people’s heads as they supported them. We have made a recommendation about staff training on the subject of person-centred care.

There were a significant range of repairs and redecorating being completed. We saw that there was some general untidiness associated with the redecoration. The plans in place to modernise and re-design the home included a larger dining area, a better clinical room and fresh decoration.

Everyone we spoke with spoke highly of the manager. We saw she had made significant improvements throughout the service. New and more detailed audits had been introduced and staff told us they were much more involved with the running of the service through various staff meetings and supervision sessions.

Some essential checks on the safety of the premises had been carried out by external contractors. Other checks, including fire safety had been carried out by the manager following the installation of a new fire detection system. The manager had arranged for a maintenance man from another home to visit and carry out other routine checks.

Care records were in the process of being reviewed by the manager and nursing staff. Some of the care records we reviewed contained blank care plans. The manager had an action plan in place which she used to ensure the identified gaps were completed and improvements were carried out.

We have not changed the rating of the home at this inspection. This was because work required to meet previously identified breaches of regulations was still being completed. We also wanted to be reassured that improvements made would be sustained over a longer period.

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of our inspection. Their name appears because they were still a registered manager on our register at the time and had not deregistered. The name of the registered manager at the service does not appear in this report, as the manager in post was awaiting her CQC registration.

We were unable to speak to some of the people using the service because of the nature of their condition.

We spoke with four people out of 29 who were living at the service, six relatives and six care assistants about the care and support provided by the service. One person told us, “I’m very well looked after; I tell all my family the care staff are wonderful people… I’m a very lucky fellow being here.” Another person told us, “The home is nice, the staff are very good and I’m very happy here.” One relative told us, “She is well looked after and I’m happy with the place; I sleep a lot easier knowing she’s so well looked after.” Another relative said, “I’ve got no complaints whatsoever with her care, support or treatment. I can walk away from here knowing for a fact she’s safe and well looked after; the care’s smashing.”

We found that there were suitable numbers of skilled, trained and experienced staff. One person commented, “The staff are fine, they know what they are doing.” One relative commented, “The people here are looked after very well. The staff definitely know exactly how to care for people and know what they are doing.” Another relative told us, “The staff are here for the residents; they genuinely care for the residents.”

We found that staff received appropriate training, professional development, appraisal and supervision. One relative told us, “The care staff seem very competent; I’ve never had any concerns since he’s been here.” Another relative said, “The staff are definitely well trained and they know what X needs and what’s best for her.”

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of our inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke with three people and seven relatives to find out their opinions of the care and treatment at the service. One relative told us, “It’s good here, the staff are wonderful. The bedroom is clean and they keep me informed about any problem X has.”

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Relatives we spoke to were positive about the care and support people received. One relative told us, “The care staff are very good. My mum gets a lot of attention, there’s always someone there for her.”

Relatives and staff told us that suitable numbers of skilled, qualified and experienced care staff were not always on duty and that more staff on duty would be appreciated.

Staff informed us and records confirmed that they were appropriately trained; however we found that suitable appraisal and supervision arrangements were not fully in place.

We found that effective systems were in place to regularly assess and monitor the quality of service provided.

We saw that people’s personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

Thirty eight people were using this service at the time of our inspection. We spoke with five of them about their experiences of the care and support they received. We also spoke with relatives of another five people, and we spoke with the manager and seven staff.

Relationships between staff and people were clearly good. People told us staff spoke to them respectfully and we found this to be the case.

People we spoke with were positive about the care and support they received. Comments included, “There’s not really anything I’m not happy with, good people work here” and “It’s very good living here.” One relative told us, “It’s one of the best homes, that’s why I picked it. They treat X well.” However, people also told us there was not much for them to do and we found there was a lack of daytime activities on offer.

People told us they felt safe living at the service, and with staff who worked there. One person said, “I feel safe and secure, the staff are wonderful people.” Safeguarding arrangements were in place at the service and we found the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found there were suitable numbers of skilled, qualified and experienced staff on duty.

There was a complaints system in place and we found that most complaints were fully investigated and resolved to the satisfaction of the complainant.

We spoke with people to gain their views about living in the home. People said they liked

living at the home. They said staff were helpful and kind. They said they were given

choices about things that were important to them, such as food and daily routines. People

we spoke with said they knew to contact the manager if they had any concerns about the

care provided at the home.

This inspection took place on 26 and 27 November 2015 with the first day of the inspection unannounced. A previous inspection undertaken in March 2014 found no breaches of legal requirements.

Willow Lodge is a purpose built care home in the North Shields area of North Tyneside. It is registered to provide accommodation for up to 48 people. At the time of the inspection there were 32 people living at the home, some of who were living with dementia. Accommodation is provided over two floors with more residential needs catered for on the lower level and nursing needs supported on the upper floor, although not exclusively so.

The home’s currently identified registered manager had recently left the home. A new manager had been appointed and she was in the process of registering with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission (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.

Staff were aware of the need to safeguard people from abuse and had a good understanding of potential abusive situations. They told us they had received training in relation to this area and were able to describe the action they would take if they had any concerns. Records showed that any safeguarding issues had been dealt with appropriately and relevant authorities notified. Staff were also aware of the registered provider’s whistleblowing policy and told us they would immediately raise any concerns they had about care.

On the first day of the inspection there were transient odours in some areas of the home. The treatment room areas (where medicines are stored and some dressings changed), some parts of the kitchen and food trolleys were in need of cleaning. On the second day of our inspection we saw action had been taken and both treatment rooms had been thoroughly cleaned and food trolleys were much improved.

Checks on fire and other safety systems had not taken place for a period of around three months. This was because the previous maintenance man had left the home and no interim system had been put in place to ensure that safety systems were checked. A new maintenance man had recently been appointed and was starting to address this issue.

People’s views of staffing were mixed, with some people telling us there were enough staff and others suggesting they had to wait for assistance. There was one nurse and six care workers on duty during the inspection. However, only two staff were rostered to support the ground floor, with at least three people in this floor requiring help from two staff at time throughout the day. We also observed period of 20 minutes or more when lounge areas were not observed or checked. Suitable recruitment procedures and checks were in place to ensure staff had the right skills to support people at the home.

We found some issues related to the safe management and administration of medicines. Some people’s medicines were signed for before they had been given and people were not always given sufficient time to understand what was being asked of them during medicine administration. Poor ordering systems meant there was both under and over stocking of medicines.

People and relatives told us they felt staff had the right skills to support them. Staff confirmed they had access to a range of training, although highlighted the reliance on ELearning to maintain training levels. Staff also told us regular supervision took place and they received annual appraisals. A small number of staff were still in the process of updating their training and were due to receive supervision and appraisals in the near future.

People had mixed views regarding the meals provided at the home. Some people told us they were very good, whilst others said the quality was variable. We spent time observing lunches at the home and noted the food to be bland and unappetising. People who required a special diet did not always get a choice of meal. People who required assistance were not always supported with their meals in a dignified and appropriate way. Staff often talked over people whilst they were helping them and did not engage in conversation with people during support, neglecting the social aspect of the meal experience. People’s weight and dietary intake were regularly monitored and reviewed.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff understood the concept of acting in people’s best interests and the need to ensure people made decisions about their care. The registered manager confirmed applications had been made to the local authority to ensure appropriate authorisation and safeguards were in place for those people who met the threshold for DoLS, in line with the MCA.

People we spoke with and their relatives told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists, opticians and other health professionals. Staff were able to explain how they maintained people’s dignity during the provision of personal care and demonstrated supporting people with dignity and respect throughout the inspection.

Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care. Care plans also reflected advice from visiting professionals such as occupational therapists or speech and language therapists. Some activities were offered for people to participate in but people also had the opportunity to spend time on their own or in their rooms pursuing their own interests.

People and relatives told us they would speak to the manager if they wished to raise a complaint. We saw from records complaints had been dealt with appropriately and a response offered to the person who made the original complaint.

Audits and checks on the home and the environment had ceased to be carried out after September 2015. Where audit processes were in place, they had failed to pick up on some of the issues we identified, such as the lack of safety checks and the cleanliness of aspects of the home.

Staff felt supported and were positive and enthusiastic about the recently appointed manager’s impact on care and the running of the home. Staff felt the new manager listened to their views or concerns. The new manager told us she was looking to ensure people were at the centre of the home and care was personalised.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to Person centred care, Safe care and treatment, Staffing and Good governance. You can see what action we told the provider to take at the back of this report.