About the service: Alphington Lodge is a residential care home. The home is registered to provide accommodation and personal care for up to 28 older people. The home does not provide nursing care. At the time of this inspection there were 21 people living there.

Rating at last inspection: Requires Improvement. Report published 27 April 2018.

Why we inspected: All services rated "Requires Improvement" are re-inspected within one year of our prior inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

People’s experience of using this service:

The provider had made good improvements to the service since our last inspection on 26 January 2018.

The governance of the service had improved. There was a comprehensive programme of checks and audits to determine the quality of the care. The provider had acted decisively to make improvements where failings had been identified.

There were safe systems in place for the storage and administration of medicines.

The provider had taken steps to ensure confidentiality was maintained.

The area manager had encouraged a change in the culture of the service so it was now more person centred.

People were supported by staff who treated them with patience, kindness and understanding. One person said, “They love me, and they come in and say, ‘are you alright?’ and look after me.”

Support plans provided information for staff on all aspects of people’s health and personal care needs. Staff knew people well and understood how they needed to be supported.

Staff received better training and induction so they could effectively perform their roles. They were well supported and spoke positively about the improvements at the service.

The service met the characteristics for a rating of "good" in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was "good". More information is in the full report.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The inspection took place on 26 January 2018 and was unannounced. This was the first inspection of the service since it was re-registered in December 2017. We previously inspected the home in February 2017 when the home was registered under a different provider company. At that inspection we rated the home as ‘requires improvement’ because we found three breaches of regulation. These were; breaches of Regulation 11, Need for consent; Regulation 19, Fit and proper persons employed; and Regulation 17, Good governance. At this inspection we found some evidence of improvements by the new provider, but we also found two new breaches of regulations.

At the time of the registration of this new provider, an action plan was requested to demonstrate the new provider had taken account of the areas of improvement, including enforcement action that had been taken against the previous provider. This gave us information on what the new provider intended to do to make improvements.

Alphington 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 home is registered to provide accommodation and personal care for up to 28 older people. The home does not provide nursing care. At the time of this inspection there were 20 people living there, although two people were in hospital. The accommodation is situated over three floors. There is a shaft lift providing access to each floor.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Some aspects of medicine storage were not entirely safe. We found medicines received into the home had been placed in a vacant bedroom which was not locked. The medicines were left on the floor, bed and cupboard. We discussed this with the registered manager who took prompt action to ensure the medicines were safely stored. All other aspects of medicine administration and recording were found to be satisfactory. Staff who administered medicines were well trained and their competency was assessed and monitored.

Some records relating to people’s care needs, including medicines, were not always stored securely. This meant records relating to people’s personal and health needs were not maintained confidentially. We saw some care plans were left unattended on a desk in the lounge, and a cupboard holding care plans and personal records was not always kept locked. Medicine administration records were left unattended on top of medicine trolleys.

People’s needs were met by sufficient staff on duty, although staff told us they were sometimes rushed. People living in the home and their relatives gave a mixed response when we asked if they felt there were sufficient staff to meet their needs. Comments included, “Yes, as far as I am concerned”; “Sometimes, and sometimes not. Sometimes they are frazzled and pushed”; “If someone is ill, someone on leave” [staff are not as readily available]”. The provider told us they were aware of staff feeling rushed and had asked the staff to complete an anonymous survey to gather their views. They carried out a review of staff routines shortly before our inspection and took actions to support staff, improve staff morale, and improve the delivery of care and services to people living in the home. Safe recruitment procedures were followed before new staff were confirmed in post. Staff were well trained.

People and their relatives were involved and consulted in assessing the person’s needs and drawing up a plan to show how their needs should be met. Care plan documents were d