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Inspection carried out on 25 October 2017

During a routine inspection

At the last inspection on October 2016 we found breaches of legal requirements. We asked the provider to take action to make improvements on record keeping. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found improvements were made.

Cepen Lodge Care Home provides residential care for up to 63 older people. The first floor is designated for people with a diagnosis of dementia. At the time of the inspection there were 60 people living at the service.

This inspection was unannounced and took place on 25 and 26 October 2017.

A registered manager was 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.

We found that staff were not always signing medicine administration records (MAR) for medicines administered. MAR charts were audited daily but the audit record showed staff were not signing medicines records for medicines administered. Procedures were in place for staff that consistently failed to sign medicines records.

Procedures on the administration of when required medicine (PRN) was not in place for all PRN medicines. For example, a PRN protocol was not in place for the treatment of angina attack. We noted that for some people the instructions for the application of topical creams were not clear.

Care plans were mainly person centred and we found consistent use of terminology which showed a respectful manner. In places the information in the care plans was not cross references and not consistent with the area of need.

People said they felt safe. The staff we spoke with said they had attended safeguarding of abuse training. They knew how to identify abuse and were clear on the procedures for reporting their concerns.

Assessments tools were used to identify risk and action plans were developed on how to minimise the risk to people. The staff were clear on the actions in place to manage the identified risk. For example lowering beds for people at risk of falls. Falls audits included the preventative measures and lesson learnt from the event. We saw from the audit the number of falls had reduced from the preventative actions taken.

Intervention charts in place followed risk assessments and were well completed. 24 hour fluid charts detailed people’s individual fluid intake target and were totalled throughout the day. Where people did not have enough to drink the information was passed to staff during handovers. A member of staff said the introduction of the monitoring fluids had improved people’s health.

Incident and accidents reports were completed. An online incident reporting system was used by staff to record accidents and incidents. The reports were investigated at provider level for patterns and trends and the registered managers received feedback on the analysis of accidents.

The number of staff on duty reflected the duty rota. We saw staff available at all times. Staff took their time with people and care was not observed to be rushed. However, staff said there was staff sickness. Action was being taken by the registered manager to manage sickness and absences.

Staff told us the training was good. There was mandatory training set by the provider which staff said they had attended. There were opportunities for vocational qualifications. Staff said during their one to one supervisions they discussed concerns, the people at the service and performance.

Staff knew the day to day decisions people were able to make. People’s capacity to make decisions about their care and treatment was assessed with accompanying best interest decisions in plac

Inspection carried out on 5 October 2016

During a routine inspection

This inspection took place on 5 and 6 October 2016 and it was unannounced. At the previous inspection which took place in October 2014 we found the home was not maintaining accurate records. We made a requirement notice on Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010.We found improvements were made to meet the requirements we made at the previous inspection.

Cepen Lodge provides residential care for up to 63 older people. The first floor is designated for people living with a diagnosis of dementia.

A registered manager was 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.

Risks were assessed and action plans developed on minimising risks. A Malnutrition Universal Screening Tool (MUST) was used to assess people’s potential risk of developing malnutrition. However the action plans developed as a result of the MUST were not consistently followed by staff to support people with poor nutrition. Charts used to monitor fluid intake were not consistently completed. This meant fluid intake charts did not provide staff with an audit trail of people’s deterioration. The registered manager told us through the Provider Information Return (PIR) this was to be addressed.

Risks were assessed for people with poor mobility and at risk of falls. Moving and handling risk assessments were developed which gave staff guidance on the number of staff and the equipment needed for each manoeuvre. Waterlow assessments were undertaken to assess people’s risk of pressure ulcers and action plans included the equipment used to prevent skin damage. Repositioning charts were used to monitor that people were moved regularly and were not exposed to prolonged pressure on the same body area.

Although the premises were clean we noted strong odours at times and in different places within the home. The registered manager said there had been housekeeping staff vacancies which were now filled and staff were to start working at the home once their induction was complete. We were also told new equipment was to be purchased and some remedial action to the property was to take place.

Care plans were not consistently person centred. People’s likes and dislikes and preferred routines were not always included within the care plans. People’s life history was not always documented. Care plans were reviewed but they were not always updated where there were changes in people’s needs.

People told us they liked living at the home and they felt safe. The staff were knowledgeable about the safeguarding of vulnerable adults from abuse procedures. The staff were able to list the types of abuse and the expected action for alleged abuse.

Medicine systems had improved since the last inspection and were effective. Staff said medicine errors and where there were omission of signatures on medicine administration records (MAR), were rare. Staff signed MAR charts to indicate when medicines had been administered. Protocols were developed for the administration of “when required” (PRN) medicines.

People and relatives said overall there was enough staff on duty but at lunchtimes more staff was needed to support people with their meals. The registered manager said activities coordinators were available to assist people with their meals.

Staff attended training which increased their skills and insight into people’s needs. Mandatory training set by the provider was attended by the staff. Staff said there were opportunities for vocational qualifications. Appraisals were annual and as a result of the discussions on areas of special interest, lead roles were assigned. For example, staff were assigned to take the lead on nutrition. One to one meetings took place to discuss perfor

Inspection carried out on 10 October 2014

During an inspection looking at part of the service

This inspection took place on 10 October 2014. This was an unannounced inspection.The home was last inspected in November 2013 and at this time all standards were being met. Prior to this a warning notice in relation to medicines was issued in July 2013 and a further compliance action in relation to medicines was issued in September 2013.

Cepen Lodge is a care home without nursing. The home can provide accommodation and personal care for up to 63 people and at the time of our inspection there were 48 people living in the home. There was an area within the home that provides care for people living with dementia.

The home 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 and associated Regulations about how the service is run.

We spoke with eight people who used the service, six staff and two visitors. People we spoke with were positive and felt well cared for and that their needs were met. Staff showed a caring attitude to people they were supporting. People told us; "I feel very safe. I very much appreciate all the help I get. They make sure I’m comfortable in my room and I’ve got everything I want" and "they’re looking after me, the help I get is first class."

People were not fully protected from risks in relation to their care because accurate records were not always maintained. This included records relating to the administration of medicines and the risks of falls for one person. This is a breach of regulation 20 of the The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Staff had received appropriate training to support them in identifying and acting upon any potential abuse. Staffing levels were at a level which ensured people’s needs were met.

The procedures for managing people’s medicines were safe, including the process for storage and administration.

Staff received training and supervision to enable them to carry out their roles effectively and were positive about the support they received.

Staff had training and awareness of the Mental Capacity Act 2005, however we have recommended that the decision making process in the home is reviewed to ensure it fully complies with the requirements of this legislation.

People were happy with the food and drink they received in the home. We observed a lunch time where people’s needs were being met. Where there were concerns about a person’s nutritional intake, this was acted upon promptly to ensure the person received adequate support.

People’s individual needs were recognised by staff and their support was reviewed regularly. Staff understood people’s needs. This was also reflected in the feedback we received from people in the home who told us staff understood the support they required.

There were processes in place to manage and respond to complaints. Information about making a complaint was on display throughout the home and people told us they felt able to raise concerns if they had them. Staff also reported feeling confident about raising any issues or concerns.

The home was well led by a registered manager. There was a structure in place for a lead senior care worker to be present to support each area of the home and our observations during our inspection showed this worked well.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern and allow action to be taken. However, quality assurance systems were not fully effective in identifying breaches of regulations. We have recommended that quality assurance systems are reviewed.

Monthly reporting took place in the home which looked at key areas such as the number of people with pressure ulcers and any concerns about a person’s weight. The registered manager received support from a regional manager within the organisation.

During a check to make sure that the improvements required had been made

We reviewed information provided by the manager of the home and recalled our observations during recent visits to the home and concluded that the home had taken action to ensure that people were treated with dignity and respect

Inspection carried out on 20 November 2013

During an inspection looking at part of the service

We spoke with a number of people in the lounges and dining rooms during our visit. They were "generally happy" with the service provided. A relative we spoke with said they were �very happy� as they had seen improvements in the home. Other visitors to the home told us they felt that �people were well cared for� and they had seen improvements in the quality of food since the new chef was employed. Visiting health care workers said that staff were �cooperative� and there was �always someone around to help�.

We met with several staff during our inspection, including the chef, activity coordinators and care staff. One of them said that they felt morale in the home had improved and that staff �want to come to work�. They put this down to the temporary manager who they said had �made a real difference�.

People's needs were assessed and care was delivered in line with their agreed plan. People were offered a range of opportunities both inside the home and when going out. The meal provided had improved and was served in pleasant surroundings. There were opportunities for people to give feedback on the menu. Records relating to the care and welfare of people who lived in the home had improved and those we looked at reflected the support people required.

Since our last visit there had been improvements in the administration of medicines. A new pharmacist had introduced a new system for administering medicines and staff training had been provided.

Inspection carried out on 16 September 2013

During an inspection looking at part of the service

At our last inspection in July 2013 we found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We issued a warning notice. The provider sent us an action plan to show how they would address this. At this inspection we found that action had been taken to put right the issues identified in the warning notice. However we found that further improvements were needed in the handling of medicines, to ensure that people were better protected from the risks associated with medicines.

Inspection carried out on 8 July 2013

During an inspection in response to concerns

This inspection was completed as a result of information given to the CQC by a whistleblower. We did not speak with people living in the home on this occasion.

From speaking with deputy manager, examining records and speaking with care staff it was clear that there had been a medication error. On Tuesday 25 June 2013 at 9 PM all of the people on the second floor of the home had not received their prescribed medication. This error had not been identified by the management team as medication administration had not been audited.

Inspection carried out on 5 August 2013

During a routine inspection

We completed a tour of the premises when we arrived and found the home to be tidy with no offensive odours. Staff were busy supporting people with getting up and breakfast.

We spent all day at the home and were present on all three floors throughout this time speaking with people living in the home, relatives and staff.

Comments from people and relatives included; "My mother was involved in my Nan�s care plan at admission and is consulted with on an on-going basis�, �A very nice room, I have no complaints� and, �They are very good (the staff), they bring me my meals here�, "�They (the staff) wouldn�t enter (my relatives) room without knocking on the door, they are dedicated and wonderful�, �The carers do really care, they always tell me when there is a problem�, �I feel very comfortable here, the staff are polite and friendly�.

Observations throughout the day showed that people were treated with respect and dignity by the staff.

Observations, looking at care documents and talking with people raised concerns about staff meeting all the needs of people in the home.

Inspection carried out on 21 November 2012

During a routine inspection

We spoke with many people in each of the different areas of the home. People said they liked living in the home and thought the staff treated them very well. People told us they felt safe in the home and would report any issues to the manager or staff. We asked staff about the deprivation of liberty safeguarding (DoLs) in relation to the Mental Health Act 2005. Most staff were able to give examples of where this would apply but some staff were not confident in their knowledge. We talked to the manager about this who showed us a recent home audit which had identified the need for further deprivation of liberty safeguarding training. This was to take place in December 2012.

We spoke with five members of the care staff who were on duty. They told us they were well supported by the management team and received the necessary training and information they needed for their roles. Staff said they felt they knew people well, their likes and dislikes and were familiar with their care plans.

People told us they knew how to make a complaint and if they were unhappy about any aspect of the service they would speak with care staff or the manager.

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 the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Inspection carried out on 8, 13 December 2010

During a routine inspection

People told us that they enjoyed living at Cepen Lodge. They spoke well of the staff team saying that they are "helpful, very good and excellent".

Views varied about the food provided by the service.

People enjoyed the activities on offer at the home. Relatives to told us they were happy with the service provided to their family members.

We observed that not all staff were respectful and promoted peoples� dignity. We saw that some people�s individual needs were not being met. We observed that people were not always being offered choices. We noted that some staff did not have sufficient knowledge to deal with behaviours that challenged.