Woodbridge Lodge is a residential care home for older people. It can accommodate up to 32 people. Some of whom live with dementia. The accommodation is a converted and extended large older house. At the time of our visit 24 people were resident.

At the last inspection on 13 October 2017, the service was rated Requires Improvement. We had not found any breaches in regulation, but had concerns about care planning and risk assessments for matters such as falls prevention and the environment and the use of the stairs. We had also concerns about management oversight as this was inconsistent and there was a lack of registered manager. The new electronic care planning system had not been effectively introduced. At this inspection we found there had been developments with improvements made in some areas, but other matters had not consistently been maintained and therefore we have continued to rate the service as Requires Improvement.

There was a lack of safe systems and management oversight. There were concerns in relation to several safety issues. Windows above ground floor not having restricted opening, there was not an effective system in place to ensure when a person required a sling that an assessment was carried out by a competent person, oversight of controlled medicines and infection control systems being monitored and suitable equipment in the form of a sluice and systems understood by all. This lack of systematic oversight of these safety issues placed people and staff at potential risk that was avoidable. We have made a breach in relation to Regulation 12.

There had been improvements made with the embedding of the electronic care system. We found staff to be more competent and confident with the system. A registered manager was in place and feedback about them was positive. However, when they were absent feedback was that communication was not consistently effective within the service.

People spoke highly of the service offered and felt appropriately cared for. People experienced good care with on-going monitoring of health needs and access to health services. Visiting health professionals told us that the service was caring and met the needs of people who lived there. There was varied, needs led social stimulation that people were happy with. People were supported to have maximum choice and control of their lives. People liked the variety and quality of food on offer.

Staff told us that they had the training and support to carry out their roles effectively and confidently. Staff spoke highly of the management who they said were approachable and made positive changes when needed. Staff were happy and positive. People looked happy. On the second day of our visit there was a degree of calm and several visitors were seen on both days.

There were sufficient numbers of staff to meet people needs. People were able to develop caring and meaningful relationships with staff. People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required.

Medicines were generally safely managed using an electronic system. The registered manager had quality assurance processes in place that were fed up to and monitored by the provider. There was a culture of learning from listening to people and positively learning from events so similar incidents were not repeated. The registered manager was supported appropriately by the providers management system and resources being available to them.

At the last inspection we reported that an incident was subject to a criminal investigation. The previous criminal investigation has been concluded and no action has been taken.

Further information is in the detailed findings below.

This inspection took place on 16 and 18 August 2017 and was carried out by one inspector. The first day of the inspection was unannounced.

Our previous inspection in December 2016 had identified a breach of Regulations 9 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans contained generic statements which were not always correct and quality monitoring and auditing processes required improvement. At this inspection we found that the provider was in the process of implementing a new care planning system. Care plans were now more person centred but still lacked some detail about people’s care requirements. Quality monitoring had improved with regular audits. However, the implementation of the new care planning system meant that some action had not taken place. Sufficient action had taken place to improve the care plans and quality monitoring at the service, which meant they were no longer in breach of the regulation. However, they still needed to make improvements.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk from the environment. This inspection examined those risks.

The service provides care and support for up to 32 people. At the time of our inspection there were 21 people living in the service some of whom were living with dementia.

The service is required as a condition of registration to have a registered manager. On the day of our inspection there was not 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. The service had a manager in place who was undertaking the registration process.

Since our previous inspection the service had introduced a new computer based care planning system. Care staff used hand held smart phones to access care plans and input information about the care provided. At this inspection the new system was being used by staff but full details had not been transferred to the new care plans. This meant that care plans did not always contain the detail required. However, staff knew people well and were able to provide the care and support needed. The manager was working to get all the care plans up to date.

Staff knew how to respond to any suspected abuse. People’s care plans contained risk assessments but these did not always contain sufficient detail about the action to be taken to mitigate the risk to ensure staff knew how to support people safely.

There were sufficient staff to meet people’s needs. They were appropriately trained to support people with their care needs.

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 be as independent as they were able.

There were effective policies and procedures for managing people’s medicines. People received their medicine as prescribed. The provider was introducing a computer tablet based system for the management of medicines.

People were supported to have sufficient to eat and drink. A choice of food and was offered and specific diets, such as gluten free, were catered for. People’s fluid intake was monitored when required.

Staff were caring and kind and treated people and each other with respect. People's right to privacy was maintained by the actions and care given by staff members. T

This inspection took place on 12 December 2016 and was unannounced. Our last inspection of 10 and 11 May 2016 had identified shortfalls in a number of areas in the service. These included not involving people in their care planning, not obtaining appropriate consent from people, not effectively mitigating risk, not meeting people’s nutritional needs and insufficient staff. At this inspection we found that improvements had been made in most areas but that care planning, the monitoring of people’s fluid intake and governance needed to be improved.

The service provides care and support for up to 32 people and is located close to Woodbridge town centre. On the day of our inspection there were 20 people living in the service. Some people were living with dementia.

The service did not have a manager registered with the Care Quality Commission but the person managing the service had applied to register. 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 living in the service. They however had mixed views as to whether there were sufficient staff. Staff told us that staffing levels had improved since our last inspection. Staff were allocated particular tasks throughout the day which could lead to a task based approach to care as opposed to a person centred approach.

Care plans were not always person centred. They contained generic statements which did not always relate to the individual. They also contained inaccuracies which could put people at risk of receiving inappropriate care and support.

People received support with their meals. The lunch time meal in the dining room was a pleasant experience with people supported to enjoy their meal. However, this experience was not replicated for those who chose to eat in their bedroom. Fluids were not appropriately monitored to ensure people did not become dehydrated.

People were supported to maintain their independence and do as much as possible for themselves. However, they were not supported with hobbies, interests and activities. People living with dementia were not always supported to lead meaningful lives.

Staff received training and support and were aware of their responsibilities with regard to reporting safeguarding incidents and the application of the Mental Capacity Act 2005. However, the reporting of safeguarding incidents was not always effective. We were also concerned that staff did not always demonstrate effective support for people living with dementia.

There were procedures in place to ensure people’s medicines were managed safely. However, we found improvements were required in the monitoring of medicines prescribed to be taken as required.

The management team had made improvements since our last inspection in developing a more open and honest culture. Regular meetings were held with people and staff to encourage participation in the development of the service. However, there were continued shortfalls in the quality assurance processes.

This inspection took place on 10 and 11 May 2016 and was unannounced.

Our previous inspection of 23 June 2015 had rated the service as Requires Improvement in the areas of Effective and Responsive. This inspection found that improvement had not taken place and a number of requirements of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were being breached.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service provides care and support for up to 32 people and is located central to Woodbridge town. On the day of our inspection there were 30 people living in the service. Some people living in the service were living with dementia.

The registered manager of the service had left the service the week prior to our 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 provider had put arrangements in place to cover the management of the service while a new manager was recruited. This included cover by three different people all of whom had responsibilities elsewhere within the organisation that would continue.

Risks to people living in the service were not appropriately managed. Appropriate risk assessments were not always completed. Where they were, staff were not aware of the actions put in place to minimise the risk therefore these were not always followed. Appropriate manual handling practices were not always followed.

There were not sufficient staff to support people with their assessed care and support needs. This resulted in people waiting long periods for their care and support or not receiving the care and support they required. Staff regularly stayed over their contracted hours to provide care and support.

Effective infection control processes were not in place. Poor infection control procedures were observed during the inspection. Infection control audits were not used to improve processes.

The service did not demonstrate an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) appropriately. Where people who required a referral to the appropriate authority this had not always been carr

This inspection was carried out on the 23 June 2015 and was unannounced.

The service provides care and support for up to 32 people. On the day of our inspection it was fully occupied. The service was taken over by a new owner six weeks before our inspection and some of the systems and processes were changing to those of the new owner.

There was a registered manager in place. 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.’

Staff had received training in the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). However, assessments relating to DoLS did not follow up to date practices.

Assessments were carried out of people’s needs prior to them moving into the service to ensure their needs could be met. However, people were not regularly involved with their care planning following this initial assessment.

People told us they felt safe living in the service. We saw staff interacting with people and they did so in a kind, caring and sensitive manner. Staff showed good knowledge of safeguarding procedures and were clear about the actions they would take to protect people.

Recruitment checks had been carried out before staff started work. There were sufficient staff on duty to provide people with their assessed care needs. However, the new owner told us they were increasing the staffing levels.

People were supported to continue with hobbies and interests they had enjoyed prior to moving into the service.

People told us that they knew how to complain. The service had a clear complaints procedure in place. The new owner had ensured people were aware of new contact details if they wished to make a complaint.

People’s healthcare needs were met. People told us that they had access to their GP, dentist chiropodist and optician should they need it. The service kept clear records about all healthcare visits and appointments.

The service had an effective quality assurance system. This was being further developed by the new owner.

During our inspection we spoke with four people who used the service, one person’s relative and five staff members, including the provider, care manager, two care staff and the chef.

We observed that the staff were attentive to people’s needs, that they respected people’s privacy and dignity and sought their agreement before providing any support or assistance. The people we saw were relaxed, engaged with their surroundings and interacted with each other.

People told us that they were well cared for and liked living there. One person told us, “They (staff) are all very good.” Another person told us, “I always find staff are great.” A person’s relative told us, "This is a home. They are just so kind. (Relative) is really happy here."

We looked at the care records of four people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights. We found that the provider had effective recruitment processes in place.

We found that the provider had taken reasonable steps to ensure that the premises were safe and suitable for people to live in.

We found that the provider had good quality assurance processes in place to continually monitor the service delivery and ensure that the service was well managed. We found that the service was well led.

This was a follow up inspection to check that actions had been taken to improve this service. We found that the provider had implemented the following improvements. People were receiving safe and appropriate care that met their needs.

We found continued shortfalls in the provider's record keeping in terms of people's plans of care.

People who used the service understood the care and treatment choices available to them. We saw that people were treated with consideration and respect, and were supported to maintain their own independence.

People’s needs were assessed, care and treatment was not always planned and delivered in line with their individual care plan. Individual needs relating to visual impairment, symptoms of dementia, pain management and sleep patterns were not always well established in people’s care plans. There was an activity programme for both internal and external functions. The programme generally met individual people's needs . All attendees names were documented in an activity diary and activities were planned on a rotational basis to suit individual needs.

People we spoke with during the visit told us that the staff were kind and helped them with their daily activities of living. One person stated, "The staff are wonderful." Safeguarding policies and practices were well established and staff received appropriate training to ensure that they are up to date with their safeguarding practices. Staffing levels were appropriate to meet the needs of the people who used the service.

The provider used a system of audits to ensure that standards were maintained. Regular surveys of people who used the service helped to identify areas for improvement, survey respondents were positive about the service.

People who use the service stated that they are satisfied with the care that they receive. They are treated with dignity and respect and that they are involved with decision making in their individual care. They told us that the staff are nice and helpful and that their care meets their needs.