The Lodge

The Lodge is a residential care home that is registered to provide support to 30 people aged 65 and over and people living with dementia. At the time of the inspection, 16 people were using the service.

People’s experience of using this service and what we found

The provider, new management team and staff had worked hard to make improvements to the service in a short space of time. We received positive feedback regarding the management team and their leadership of the service. There was a kind and caring culture at the service which was supported by staff who were passionate about caring for people. Governance systems had been implemented which had helped identify shortfalls which were addressed in a timely manner.

Fire safety issues had been addressed. People were supported by knowledgeable and skilled staff who understood and effectively managed risks to people’s safety and well-being. People were kept safe from abuse and concerns were appropriately reported.

People’s medicines had been administered safely. However, some records and medicine protocols needed improving and action was taken during the inspection. Accidents and incidents were monitored, reviewed and used positively to support learning. The service was clean and tidy and current government guidance was being followed.

Positive working relationships had been established with other professionals which had helped ensure people received the referrals and professional support they needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 August 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement. This service has been rated requires improvement for the last 8 consecutive inspections.

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the last inspection. This report only covers our findings in relation to the key questions of safe and well led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement. However, we found improvements had been made to the safety, governance systems and oversight of the service. Please see the safe and well led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about quality assurance systems.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Lodge is a residential care home that is registered to provide support to 30 people aged 65 and over and people living with dementia. At the time of the inspection, 23 people were using the service.

People’s experience of using this service and what we found

The service was not well-led. Robust quality assurance systems continued to be ineffective. Shortfalls had not been identified or promptly addressed which placed people at risk of harm and of receiving a poor-quality service. There had been regular changes in the management team and there was a continued lack of oversight from the provider. This was the eighth consecutive inspection where the provider had failed to reach a rating of good.

People were not always safe. The provider had failed to ensure fire safety risks were addressed in a timely manner. Records to manage risks to people’s safety and wellbeing were not always up to date. Some areas of the service were not clean, and staff did not continually follow infection control guidance to manage the risk of spread of infection. People’s medicines were not always administered safely or as prescribed.

Recruitment processes and staffing levels were safe. Staff supported people in a timely manner. Staff understood signs of abuse and processes to follow to raise concerns. Concerns had been appropriately raised with the local authority safeguarding team. However, required notifications had not always been sent to the Care Quality Commission (CQC).

Staff were kind and attentive to people. Most feedback from people and their relatives about the care provided was positive. Staff felt supported in their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 August 2021). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last seven consecutive inspections.

The provider was required to complete an action plan after the last inspection to show what they would do and by when to improve. However, we did not receive this. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider reviewed their medication processes to ensure they were followed correctly, and accurate records were kept. At this inspection, we found improvements had not been made and the provider was in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 27 May 2021. A breach of legal requirements was found. The provider did not complete the required action plan after the last inspection to show what they would do and by when to improve governance of the service.

We undertook this focused inspection to check they had made improvements and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, medicines, infection control, records and governance of the service at this inspection.

Follow up

We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Lodge is a residential care home providing accommodation and personal care to people aged 65 and over and people living with dementia. At the time of the inspection, 19 people were using the service.

People’s experience of using this service and what we found

Quality assurance systems were in place but had not identified or addressed all the shortfalls found during the inspection which placed people at risk of receiving a poor-quality service. Accidents and incidents were appropriately responded to and were monitored by the management team.

People’s medicines were appropriately administered, although consistent guidance was not always available, and some records were not properly completed. We have made a recommendation about medicines.

People did not always receive appropriate support with their oral care and referrals were not always made when concerns were identified. People were provided with appropriate support at mealtimes and had different options to choose from. However, records did not always accurately show how much people had eaten or drunk.

Staff completed a range of training and understood how to keep people safe, though records did not always show all staff had participated in regular fire drills.

Staff ensured people lived in a clean and tidy environment. Infection prevention and control (IPC) practices had been updated to follow government guidance.

Staffing levels were appropriate to meet people’s needs and maintain people’s safety. Staff were trained in safeguarding and appropriate referrals had been made to the local authority. Safe recruitment practices were followed and induction processes were in place to ensure staff had the skills and knowledge required for their role.

Staff were kind and caring and people’s relatives provided positive feedback. Staff were positive about the impact the management team had on the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 23 November 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to people losing weight, personal care, staff training and cleanliness of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed and remains requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Lodge is a residential care home providing personal care to 19 older people and people with a dementia related condition at the time of our inspection. The service can support up to 30 people.

People's experience of using this service and what we found:

Improvements had been made and people received an effective service, from staff who were responsive to their needs. Staff assessed risks to people’s safety and well-being and acted to mitigate these. However, there were still aspects of environmental safety that needed further improvement. These had not been identified in the regular checks and audits that were conducted. The provider took prompt action to address the issues we found at this inspection.

Care plans and risk assessments had improved and contained information that enabled staff to provide care in line with people’s preferences and needs. Staff were more knowledgeable about people’s needs and ensured people were able to access the support of health care professionals and specialists when needed.

People received appropriate support with their nutrition and hydration. Mealtimes were calm and organised. Continued attention was needed to ensure monitoring records were always completed in a timely and consistent way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There was a new registered manager in post and staff felt positive that management was now more consistent. This helped them feel clearer about their role and expectations.

The provider was no longer in breach of legal requirements and improvements had been made to the care provided, but further work was required to ensure quality assurance processes effectively identified and addressed concerns about all aspects of the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 17 April 2020) and there were multiple breaches of regulation. Because the provider was rated inadequate in at least one domain for two consecutive inspections, they were placed in ‘special measures’. This means we keep the service under review and, if we do not propose to cancel the provider's registration, we re-inspect within six months to check for significant improvements.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service between 4 December 2019 and 7 January 2020. Multiple breaches of legal requirements were found.

We undertook this focused inspection to check the provider now met legal requirements. We looked at the Key Questions Safe, Effective and Well-led, as these were the areas of most concern at the last inspection. Therefore this report only covers our findings in relation to the Key Questions Safe, Effective and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion (Caring and Responsive) were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

The Lodge is a care home for up to 30 older people and people with a dementia related condition. At the start of the inspection there were 23 people using the service.

People’s experience of using this service and what we found

People living at The Lodge did not always receive a service that provided safe, effective, person centred care to meet their holistic needs. People’s basic care needs were not always met. On day one of the inspection people were not offered the opportunity to use toileting facilities and were sat in the same position for long periods of time. This put people at risk of developing a pressure sore. People did not always receive their medicines as prescribed and risks to people were not always recorded, monitored or reviewed.

Care plans and risk assessments did not contain information to provide the safe care and support for specific health requirements. They were not person-centred and lacked information on how to support people in line with their needs and preferences.

Staff lacked the support from the management team and lacked understanding of their roles and the principles of providing high-quality care. Their training did not cover how to meet people’s specific health needs and they did not have the necessary knowledge and skills to do so.

A lack of effective communication between staff showed a disorganised service at mealtimes. Some people did not receive a healthy balanced diet in line with their dietary requirements. They received food that posed a risk to their health because staff were not aware of people’s dietary needs.

The service was not well led. The service had failed to retain a competent manager. The provider had a lack of oversight of people’s basic care needs and the governance of the service. Ineffective quality assurance systems failed to identify the improvements required. This was the third consecutive inspection where we have identified breaches of relevant regulations.

Improvements had been made to areas of the environment and the provider had an ongoing action plan to address the remaining areas that required attention. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Interactions between staff and people were natural and positive feedback was received from people and relatives. The provider had recruited two activities coordinators to provide stimulation for people and prevent them from becoming socially isolated. Improvements had been made to engagement with the local community.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 7 June 2019) and there were multiple breaches of regulation. The provider was requested to provide information and documentation. The provider completed an action plan following this to show what they would do and by when to improve. At this inspection, enough improvement had not been made, and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified four breaches in relation to managing risks, staff training and support, meeting people’s care needs and improving the quality of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

People’s experience of using this service: People were not receiving a service that provided them with safe, effective, compassionate and high-quality care.

Care and support were not tailored to meet people’s specific needs. Care plans and risk assessments were not personalised. Information generated from an electronic system did not contain personal information about people.

Infection control measures were ineffective. Areas of the service were unclean and had unpleasant odours. Some equipment was either broken or not fit for purpose.

Staff morale was low; staff felt unsupported and frustrated with the running of the service. Staff did not always complete their training in line with policy and relatives told us they didn’t feel staff had the understanding to support the needs of people. Supervisions and induction were completed. However, staff felt unsupported.

Some staff were kind and caring. However, other staff prioritised their own needs over the needs of the people at the service.

People were not supported to take part in activities. They sat for extended periods in the communal area without any engagement from staff.

The service was not well led. Ineffective quality assurance systems failed to identify the improvements required within the service.

Rating at last inspection: The service was last rated Requires improvement. (published 4 April 2018). This service has been rated Requires Improvement for the last three consecutive inspections. Following the last inspection, the service received a warning notice in relation to good governance. We also met with the provider to discuss improvements needed within the service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: At this inspection improvements were still needed and the provider continues to be in breach of regulations. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

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.

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. We have received some initial assurances from the provider about action they plan to take and we will continue to seek updates about the progress being made.

The last inspection took place on the 9 and 22 December 2016 and The Lodge was rated as requires improvement in all domains except caring which was rated good. The home was in continued breach of Regulation 17 Good Governance. Concerns related to poor record keeping. In addition to this a recommendation was made about staffing levels and activities.

The Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 28 people in one building. There are 22 bedrooms downstairs with a further six upstairs.

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.

The cleanliness of the home and laundry systems were not meeting expected standards. People and their relatives expressed concerns about bedrooms not being kept clean and clothing had gone missing.

Risk assessments were in place. However, for some people with complex needs in respect of their dementia and behaviours which posed a risk of harm to themselves or others there was a need to provide more direction for staff about how to manage these risks.

This was a breach of Regulation 12 (2) (a) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

There had been a number of incidents after 8pm whereby people had become distressed and caused harm to themselves or others. Concerns were raised about the complexity of people's needs and the impact this had on other people as staff were providing one to one care.

In the main, safeguarding referrals had been appropriately made. Staff understood how to recognise and protect people from avoidable harm or abuse and they felt confident that any concerns they raised would be investigated thoroughly. Despite this we found one safeguarding issue which had not been appropriately reported by the registered manager. We have made a recommendation about this.

Systems had been set up to assess the quality of care people received and where improvements were required there was a robust action plan to work through these.

Whilst it was evident a significant number of improvements had taken place under the leadership of the new registered manager and operations manager, further work was required to ensure people received care which was consistently good. We were assured the management team and staff team were committed to driving the required improvement but required further time to do this.

Despite the improvement still required, everyone we spoke with described the service as homely. Due to the relatively small size of the home staff had the opportunity to get to know people well. Staff were kind, compassionate and respected people’s diversity.

Staff were provided with the support, training and supervision they needed to deliver effective care. More specialist training on how to support people with behaviours which posed a risk of harm to themselves or others was due to be provided to staff.

The service followed the principles of the Mental Capacity Act (2005). Detailed mental capacity assessments were completed and we saw evidence the service had taken all practical steps to support people to make their own decisions. Where people were unable to make an informed decision there were best interest decisions in place which took into account their previous known wishes.

People told us the food was excellent and everyone spoke positively about the chef. Snacks were accessible for people throughout the day and people helped themselves.

Care planning documentation had improved and we could see the focus was on what was important to the individual. There was a focus on people’s strengths as well as a record of the support they needed. People’s likes and dislikes were recorded and staff knew people well. There was room for further improvement in care planning to ensure people’s changing needs were documented.

People had access to a range of meaningful activities which they told us they enjoyed.

Complaints had been appropriately responded to. The home had also received some compliments about the care people received.

We inspected this service on 9 and 22 December 2016. This inspection was unannounced. This meant the registered provider and staff did not know we were visiting. One of our visits began at 5:30am so we could speak with night staff. At the time of our inspection, there were 27 people using this service.

At our last inspection of the service in January 2016, we found breaches of regulation in relation to staffing, safe care and treatment, person centred care and the governance of the service. During this inspection, we identified that the registered provider was now meeting the regulations relating to safe care and treatment and person-centre care. However, we identified continued concerns regarding the registered provider's governance of the service.

We identified concerns regarding how people’s weights and food and fluid intake were monitored. Care plans were not consistently updated, where people had lost weight, to provide additional guidance to staff on how to manage the risks. We received information raising concerns about the support staff provided with personal care. We found that care records did not evidence that staff had regularly supported people to have a bath or shower. These concerns showed us that the registered provider had not maintained complete, accurate and contemporaneous records. This was a continued breach of the regulation relating to the governance of the service. You can see what action we have told the registered provider to take in response to our concerns at the back of our report.

The registered provider is required to have a registered manager as a condition of their registration for this service. 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. On the first day of our inspection, we were told the registered manager was no longer managing the service. An application to deregister them had been received by the Care Quality Commission and the process was completed on 15 December 2016 after which time the service did not have a registered manager. The service was being managed by an acting manager who was supported by the area operations manager in the management of the service. We were told the acting manager was in the process of applying to become the service's registered manager.

At our last inspection, we identified a breach of regulation regarding staffing levels. At this inspection rotas showed examples where only two staff were on duty at night. We continued to receive mixed feedback regarding staffing levels. We have made a recommendation about staffing levels in the body of our report.

The registered provider completed recruitment checks and new staff received an induction and training to support them to provide effective care. However, we identified gaps in staff training which needed to be addressed. We have made a recommendation about this in the body of our report.

Staff we spoke with demonstrated that they understood their responsibilities to safeguard vulnerable adults from abuse. People’s needs were assessed and care plans put in place to guide staff on how best to meet their needs. However, some care plans had not been updated as people’s needs had changed. Accidents and incidents were analysed to identify any patterns or trends or where further action could be taken to reduce risks. Health and safety risks were managed through appropriate checks of the building and any equipment used.

Staff sought consent to provide care and support and this was recorded in people’s care files. Where there were concerns regarding people’s mental capacity, this had been assessed and decisions made in their best interests where necessary. People who used the service were supported to take prescribed medicines where necessary and we observed that this support was provided in line with guidance on best practice regarding medicine management.

We received positive feedback about the food provided at The Lodge and observed that people were supported and encouraged to eat and drink regularly. People who used the service told us staff were kind, caring and treated them with dignity and respect.

We received mixed feedback about the activities on offer to people who used the service. People who used the service told us there was limited support available to them to go out of the service for day trips or activities. We have made a recommendation about this in the body of the report.

The registered provider had a policy in place outlining how they managed and responded to complaints. Records were kept evidencing how complaints about the service were addressed.

We inspected this service on 26 January and 2 February 2016. This inspection was unannounced. One of our visits was carried out between 5:30am and 11:30am so we could speak with night staff. At the time of our inspection there were 28 people using this service.

The service was last inspected in June 2014 at which time it was compliant with all the regulations we assessed.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

During this inspection we found that the home was not safe. We identified concerns around the systems in place to ensure that shifts were covered in the event of sicknesses and absences and concerns around unsafe staffing levels at night.

This was a breach of Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Night staff did not receive training on medication management despite being responsible for administering medication when needed. We identified concerns that tablets were not always stored in their original packaging and this increased the risk of medication errors occurring.

This was a breach of Regulation 12 (2) (c) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People had care plans to guide staff on how best to meet their needs. However, we found these were often task orientated and contained limited person centred information. Staffing levels impacted on staff’s ability to provide person centred care.

This was a breach of Regulation 9 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We identified that records were not always well maintained and the systems in place to monitor the quality and safety of the home were not robust enough.

This was a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take in respect of these breaches at the back of the full version of this report.

Risks around fire safety were not effectively assessed and the registered provider did not have a business continuity plan to ensure people’s needs would continue to be met in the event of an emergency. There was not a robust system in place to identify and respond to risks following accidents and incidents and this placed people at increased risk of avoidable harm.

This was a breach of Regulation 12 (2) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We had other concerns about how risks were being managed at The Lodge and are carrying out further enquiries in relation to this. We will report on our findings at a later date.

Despite these concerns people we spoke with were generally positive about the home, staff and the management of the service.

Staff had training and supervision to support them in their role. Staff sought consent before providing care and support and there were systems in place to assess people’s capacity to make decisions.

People were supported to eat and drink enough and access healthcare services where necessary.

People were generally positive about the kind and caring nature of staff. We observed that staff supported people to make decisions and respected people’s privacy and dignity.

People were not supported to go on outings or trips outside the home and improvements were needed in the support provided throughout the day to ensure people were meaningfully occupied. We have made a recommendation about this in the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People felt safe because their rights and dignity were respected and they were able to make some decisions about how they spent their day to day lives.

People were safe because staff knew what to do when safeguarding concerns were raised.

When people displayed distressed behaviours and responses then staff dealt with these effectively and respected people's dignity.

The service kept the home clean and hygienic to minimise the risk of people getting a healthcare associated infection.

People and their belongings were safe because the service assessed and managed the risks to people and the environment.

Is the service effective?

People's needs, wishes and choices were known and respected.

People's health and well-being was monitored and healthcare advice was promptly sought when people's health changed.

Is the service caring?

People were treated with kindness and compassion and their dignity was respected. People told us 'I like it here. The staff are very good to everybody.' One relative wrote in the survey about the home 'my relative always speaks well of the staff.'

Staff responded in a caring way to people's needs when they need it. People's independence was promoted.

Is the service responsive?

People received care and support in accordance with their preferences and interests.

People had their individual needs regularly assessed and met.

Is the service well-led?

There was a clear management structure and staff understood their roles and responsibilities.

People said the manager was approachable and available. Visitors spoken with were confident that any concerns would be looked into properly.

New systems were in place to monitor how the service was operating. These needed to be sustained and built on, to demonstrate good leadership and an open culture that was always looking to improve.

We walked around the home, looking in many of the rooms, and found the service overall was much cleaner and new furniture and furnishings had been bought. This made it a more pleasant environment for the people living there.

The service had better hand-washing facilities, and other improvements had been made, to help minimise the risk of a spread of infection. However, more robust and regular monitoring arrangements needed to be introduced to ensure this improvement is sustained.

Whilst people overall were getting their medication safely and at the times they needed them, some records required closer monitoring to ensure they were an accurate record of medication administered.

The staffing arrangements in place ensured there were sufficient staff to meet people's needs, although the staff rota could more accurately reflect which staff are working each day.

There are not effective quality monitoring arrangements in place to ensure that improvements made in recent months can be built on and sustained.

Recently the Care Quality Commission (CQC) received concerning information about the cleanliness of the home, and the apparent lack of kitchen staff working there. So we decided to look at these two areas during this visit.

We were not able to speak to people using the service because of their complex care needs. However we noted that overall people looked clean and well cared for.

Whilst the domestic cleaning of the service was mostly satisfactory, other cleanliness and hygiene processes needed improving, so as to protect people from the risk of the spread of infection.

Whilst people mostly were getting their medication safely and appropriately some areas of medication management still needed improving, to minimise the risk of harm.

There were sufficient care staff working at the home, but a lack of kitchen staff meant care staff could not always promptly meet people's needs because they were working in the kitchen.

People's records were now better maintained and more accurately reflected the care they needed and wanted.

We found people were given, and signed contracts which explained which services would be provided at The Lodge and how much these would cost.

We found people overall received safe appropriate care that met their needs.

The majority of people were given their medicines at the time they needed them and in a safe way. Despite this, we found medication records and systems needed improving.

Staff were supported to attend training but the current staffing levels, or the way staff were deployed did not always support people to have interesting, meaningful lives.

There was a system in place to check the quality of the service provided, but this needed expanding to include other areas of service delivery.

Care records were not always accurate and well maintained. Written information did not always evidence that people were receiving safe and appropriate care.