Our inspection took place on 20 and 28 September 2017 and was unannounced.

Arbour Lodge is a care home which provides accommodation and personal care for up to 29 older people. At the time of our inspection, there were 27 people living at the home.

During this inspection, we met with the acting manager who had applied to CQC to become registered manager of the service. 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.

At our last inspection on 23 June 2016, we gave the service an overall rating of requires improvement. At this inspection, we found significant improvements had been made to the service, although some areas for improvement remained.

It was not always clear whether, in meeting people’s nutritional needs, the provider had sought appropriate specialist nutritional advice. The provider’s induction did not fully incorporate the requirements of the Care Certificate. The Care Certificate is a set of minimum standards that should be covered in the induction of new care staff.

People were supported by staff who had received training in, and understood, how to recognise, respond to and report abuse. The risks to individuals had been assessed and plans put in place to keep people as safe as possible. Staffing levels were maintained to ensure people’s needs could be met safely. People received their medication safely and as prescribed from trained staff.

Staff received training and ongoing support to help them succeed in their job roles. People’s rights under to the Mental Capacity Act 2005 were understood and promoted. People had enough to eat and drink and their food-related preferences were taken into account. Staff monitored people’s general health and helped them seek professional medical advice or treatment when required.

Staff promoted positive, caring relationships with the people living at Arbour Lodge. People’s contribution towards care planning was encouraged by the management team. Staff understood how to treat people in a respectful and dignified manner.

People received care and support shaped around their individual needs and requirements. People had support to participate in social and one-to-one activities. People’s care plans covered a range of needs and these were followed by staff. People and their relatives knew how to raise concerns and complaints, and the provider responded appropriately to these.

The management team promoted open communication with people, their relatives and community professionals. Staff felt well supported by a fair and approachable management team. The provider completed audits and checks to assess, monitor and improve the safety and quality of the service.

Our inspection took place on 23 June 2016 and was unannounced. Arbour Lodge is a care home which provides personal care and accommodation for up to 29 older people. The location provides long term care, short stay and respite care. At the time of our inspection the registered manager told us there were 29 people living at the location.

We last inspected the service on 6 August 2014; we rated the service as requires improvement overall and there was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, management of medicine. Although requirements of the regulation had now been met, further improvements were still required.

At our inspection carried out on the 6 August 2014 we found the registered manager had moved to work at another location and was no longer employed at the home. We had not been informed of this as is required under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. During this inspection we found that the provider had appointed 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.

People’s medicines were not always stored safely. Medicines were not being stored at the correct temperatures and therefore were at risk of being ineffective. We also saw staff being disturbed during the administration of medicines which increased the risk of people’s medicines not being administered safely. People told us they received their medicines as prescribed.

People were not always supported by sufficient numbers of staff to respond to their needs in a timely and caring way. Staff, relatives and visiting professionals told us that there was not always enough staff deployed appropriately across the location to ensure that people were responded to promptly. People and their relatives told us that they sometimes had to wait for their requests for support to be responded to. We observed some people having to wait long periods of time for staff to respond to them.

People were not always cared for in a kind and compassionate way and were not supported to regularly engage in activities they enjoyed. Interactions between people and staff were often task orientated, although we did observe some examples of positive interactions during our inspection.

Mealtimes may not always have been a pleasant experience for everyone. People were offered a choice of food and drink, however there were inconsistencies in how people were afforded choice about what they ate and drank. We saw some people being offered choices whilst others were not. People were not always provided with drinks when they requested them.

People’s personal and sensitive information was not always kept safe. We saw that people’s daily notes were left unattended in communal areas. We also found notes relating to other people in people’s care records.

People were supported by a staff team who had been subject to appropriate pre-employment checks to ensure that they were of a suitable character to provide care and support to people. Staff understood how to recognise and report harm or abuse and how to keep people safe.

People were asked for their consent by staff before they provided care and support. The principles of the Mental capacity Act were being followed and people were offered choices.

People had good access to healthcare when required and staff were able to recognise any changes in a person’s health or wellbeing and act on this promptly.

People’s privacy and dignity was promoted and they were encouraged to maintain their independence and supported to maintain relationships that were important to them

People and their relatives were involved in the assessment, planning and revi

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The visit was unannounced, which meant the provider and staff did not know we were coming.

At our previous inspection of 12 July 2013 the provider was not meeting the requirements of the law in relation to care and welfare of people who use services and safeguarding people who use services from abuse. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made.

Arbour Lodge is registered to provide accommodation and support for 29 older people. At the time of our visit there were 28 people living at the home.

On arrival at the home, we found that the registered manager had moved to work at another location and was no longer employed at the home. We had not been informed of this as is required under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. We met and were assisted by a recently recruited care manager.

We found that people’s safety was sometimes compromised. This was due to a lack of appropriate side tables for people to use and equipment for assisting people to move not being consistently maintained. We found that medications were not consistently secured. We also found that people’s cash amounts were not always accurately recorded.

Staff were aware of how to support the rights of people who lacked the capacity to make their own decisions or whose activities had been restricted in some way in order to keep them safe. However, some people’s care records lacked robust documentation to show their rights were being protected in line with legislation. The management team were unaware of the latest developments surrounding Deprivation of Liberty Safeguards.

Staff demonstrated an awareness of what could constitute abuse and that matters of abuse should be reported in order to keep people safe. Staff were aware of how to report issues to the provider and to outside agencies.

Staff sought the views of people and their representatives to understand people’s needs. Although no recent surveys had been carried out to gain people’s views on the service, people attended residents’ meetings to share their opinions and suggest changes. People’s health and well-being was supported by staff arranging appointments with external healthcare professionals when required, such as a GPs and district nurses.

We found that the provider carried out a number of audits to identify areas for improvement in respect of general maintenance of the home. Regular audits were carried out by the provider and the new care manager was undertaking a full audit of records in order to identify any issues. However, we found that not all accidents and incidents were analysed so that the provider could identify and prevent any recurring issues.

We foundone breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This means that the law about how people should be cared for was not met. You can see what action we told the provider to take at the back of the full version of this report.

People and their representatives were complimentary about the service and its staff, describing them as caring. Our own observations of how staff delivered care supported this positive view. Staff were patient and unhurried when assisting people. We saw staff delivering skilled care and observing best practice, supported by accurate care records. Staff maintained people’s dignity and privacy.

During our inspection we spoke with five people, three members of staff and the acting care manager. We looked at five people’s care records.

We found that people were supported in making day to day decisions about the care they received. One person told us, “There’s a choice of food”. People’s values and diversity were respected and promoted.

Staff were not always clear about the care needs of people. We saw that some people were not supported with eating in an appropriate way.

People told us that they felt safe living at the service. Some people’s financial transactions were not appropriately recorded.

We found that staff were recruited in a safe way and correct checks were carried out to ensure their suitability to care for people. One person told us, “The girls are lovely”.

The service maintained a number of audits to ensure the quality and safety of care. People’s views about their care were obtained by the provider.

During our inspection we spoke with three people, three members of staff, the deputy manager and the manager.

We found that people were offered involvement and choice. One person told us, “I’m always asked what I want to eat”. We saw that people received care which supported their needs.

People’s safety was protected by the home and one person told us “I feel safe here”.

Medications were given to people as prescribed and one person told us that medication was given “on time”.

Staff were recruited in a safe way to ensure people were cared for by staff who were suitable to work with vulnerable people.

We saw that the provider had systems in place to monitor the quality of the service provided to ensure that people’s needs were met in a safe way. We saw that the home had checks in place which ensured people’s safety. The management sought feedback on people’s views and one person told us they “couldn’t complain about the home”.

The care records we looked at told staff about the importance of promoting people’s privacy and dignity.

One person who uses the service said, “The staff always knock on my bedroom door before entering.”

Care plans and risk assessments were in place and provided information about people’s needs and how best to meet them.

One person said, “This is a nice place to live.”

Another person told us, “It’s OK living here but I’d rather go home.”

Although the home had the relevant safeguarding policies in place and training records showed that staff had received safeguarding training, not all staff had a good understanding about abuse or how to protect people from this.

Practices ensure people receive their medicines appropriately but the storage and security of controlled drugs were unsafe.

The home operates an effective staff recruitment procedure to ensure staff are suitable to work with vulnerable people.

One person who lives there said, “The staff are nice but not all of them, some are good and some are bad.”

Another person said, “The staff are alright, they are very good.”

One person told us, “The staff are lovely, very helpful and patient.”

The home operates a number of quality assurance audits to ensure the effectiveness of the service provided to people.