This unannounced inspection took place on 21 February 2017. We last inspected Alsley Lodge in November 2014. At the inspection in November 2014 we found the service was not meeting all the regulations that we assessed and we asked the provider to take action to make improvements. This was in relation to medicine management and not protecting people against the risks of inappropriate or unsafe care and treatment due to its quality monitoring systems not being adequate. The service as a consequence was awarded a rating of ‘Requires improvement’ for the domains of ‘safe’ and ‘well-led’. The overall rating also resulted in ‘Requires improvement’.

We issued two requirement notices and asked the registered provider to tell us how they were going to make the improvements required. At this inspection we found that the registered provider and registered manager had made the changes and improvements needed to meet the requirement notices from the previous inspection.

Alsley Lodge provides care and support for a maximum of 33 older people. At the time of our inspection there were 31 people in residence at the home, as the dedicated respite room was vacant and one of the rooms could be used for double occupancy.

Alsley Lodge is in the village of Rufford, near Ormskirk and Burscough. The home, formerly a public house, has been developed to provide accommodation for older people who need assistance with personal care. The property is on one level within its own grounds. Bedrooms are mainly single occupancy but shared accommodation can be offered if required. Many of the rooms have en-suite facilities. Prices vary dependent on the size of the room, facilities and where the room is situated within the home.

The service had a registered manager in post. 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 and associated Regulations about how the service was run.

People told us they felt safe living at the home and this sentiment was replicated by relatives and visiting professionals we spoke with.

Staff knew how to keep people safe and how to recognise safeguarding concerns and detailed accident and incident records were kept. We discussed with the registered manager the possibility of discussing some issues with the local authority safeguarding team and we received confirmation that this had been done following our inspection.

The home was clean, tidy and decorated appropriately. There were no issues with infection control procedures.

The management of people's medicines had improved since our previous inspection and the home was compliant within this area. Nobody we spoke with raised any issues with regards to how their medicines were managed.

There were sufficient numbers of staff employed to meet the needs of people. The home had recently introduced an additional member of staff to assist with the transition from day to night shift.

People told us their care was delivered by a competent and caring staff team. We found evidence via training records to confirm this information as being accurate

We found the home was working within the principles of the Mental Capacity Act, although we did find some issues with how consent was gained from people using the service.

We found that people were referred to external health care professionals in a timely manner.

People we spoke with told us that the food and drink in the home was of a good quality. We observed lunchtime to be a pleasant and relaxed experience for people and that staff were attentive to people's needs.

People who lived at the home were very complimentary about the approach of the staff team and the care they received.

It was evident that staff knew people well and were able to describe people’s preferred routines, likes and dislikes.

Peopl

People who lived at Alsley Lodge told us that they were happy with the care received. One person said, "It's brilliant here, it's a good place to live. There is lots of good food to eat and there is plenty to do. If I want to do things I do, If I don't I just have to say so". Another person told us, "I'm very happy here, the staff are very kind. I have to say that the atmosphere of the home is very good".

People who lived at the home told us they felt safe, One person said, "I feel safe here, I have my call buzzer to hand and when I use it staff come very quickly, they are very good".

People were supported by staff who were appropriately trained to deliver the assistance required by each individual.

Appropriate systems were in place to regularly assess and monitor the quality of services that people receive. Internal and external auditing systems were used.

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 16 November 2012, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members and talked with staff.

What people told us and what we found

People told us they were happy with the care and support they received. One person said, "I couldn't be treated better, staff couldn't be nicer”. Another person said “I am very happy, there's always something going on”. People told us they were treated with dignity and respect and they were asked for their consent before care was delivered. One relative said “Staff are patient with my Dad and chat to him, staff can't do enough for you".

During the visit, staff were seen to be interacting with people in a calm and considerate way. Activities were available for people and an activities co-ordinator is employed within the home.

During our visit we spoke with a good percentage of people living at the home and their relatives. In general, we received positive feedback from everyone. We were told that a good quality of service was provided at Alsley Lodge, with high standards being maintained. People spoken with were evidently happy to be there.

Comments received included:

"I get everything I need. I just ring my bell and the staff are there in no time at all";

"There can't be anywhere better than this place, I am lucky to have found it";

"The staff are very friendly".

Alsley Lodge provides care and support for a maximum of 33 older people. At the time of our visit there were 29 people who lived at the home. Alsley Lodge is in the village of Rufford, near Ormskirk and Burscough. The home, formerly a public house, has been developed to provide accommodation for older people who need assistance with personal care. The property is on one level within, its own grounds. Bedrooms are mainly single occupancy but shared accommodation can be offered if required. Many of the rooms have en-suite facilities.

We last inspected Alsley Lodge on 17 December 2013 and found the service to have met all five of the regulations inspected.

There was no registered manager in place at the time of 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. We had been informed prior to our inspection that the previous registered manager had resigned as they had found alternative employment. An interim manager from a neighbouring home within the ‘Raycare Ltd’ group was temporarily in charge, she visited the service on a daily basis. A new manager had been recruited and was due to take up their post in approximately four weeks following our inspection visit.

People told us they felt safe at the home and with the staff who supported them. One person told us, “I definitely feel safe, there is always someone around, we get checked on regularly during the night.” Another person told us, “I like living here, the staff are very good and very caring, all of them. I feel safe and feel that I have a voice.”

However, people were not protected against the risks associated with medicines. This was because we found errors in the recording of medicines administered to people who used the service. We observed errors whilst shadowing a medication round and found evidence that staff who are responsible for administering medication were not suitably trained.

We raised these issues with the interim manager who told us they shared our concerns regarding the inexperience of some staff who were administering medication. They had introduced medication audits, which had started the day previous to our inspection visit. This consisted of looking at one person’s medication records in detail. Issues had been found regarding this person’s medication. During our inspection a meeting was set up with the local pharmacy who would undertake an audit of the medication at the home. Training sessions had also been booked with a recognised training provider, so suitable training could be given to staff who had responsibility for administering medication.

People told us they were informed daily about their meals and choices were given to them. When speaking to people in their rooms, we saw that the cook came and asked people what they would like for lunch and dinner. We spoke with the cook on the first day of our inspection who told us that the home catered for any specialist diets, whether that is for health or religious needs.

Staff were very knowledgeable when speaking about the individuals they cared for and it was evident during our observations that people knew the staff caring for them well. Staff showed warmth and compassion when speaking to people and were very attentive when dealing with any requests.

People we spoke with and visiting relatives told us that they knew how to raise issues or make complaints. They also told us they felt confident that any issues raised would be listened to and addressed. One person said, “I know who to go to if I have any problems, in fact it could be any member of staff here as they are all so caring. This is a kind home and a good home and the staff reflect that.”

We found some evidence of audits taking place. Examples included a catering/cleaning schedule and audit in September 2014. There was evidence that this had been taking place on a monthly basis. We also found an administration audit and action plan which included checks on the accident book, complaints, petty cash and daily logs. However we could not find evidence of any other recent audits taking place. The last full audit for the home we could find evidence of was from 2010.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to arrangements for safe keeping and administration of medicines and not monitoring the quality of the service well enough. You can see what action we told the provider to take at the back of the full version of this report.