We carried out a comprehensive inspection of Chapel Lodge on 25 and 26 October 2016. The first day of the inspection was unannounced.

Chapel Lodge provides care and accommodation for up to 23 older people. It is a converted chapel located in the village of Worsthorne, about two miles from Burnley town centre in East Lancashire. Accommodation is provided over two floors and all bedrooms are single. Six bedrooms have ensuite facilities and there are suitable bathroom and toilet facilities on both floors. There are inter-connecting lounges and a dining area. At the time of this inspection there were 21 people living at the home.

At the time of our inspection the service had a registered manager who had been registered with the Care Quality Commission (CQC) since 2010. 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 service was last inspected on 30 July 2013 and was found compliant in all areas inspected.

Some people we spoke with were happy with staffing levels at the service. However, most people felt that more staff were needed to meet their needs. Staff also felt that more staff were needed to avoid delays in responding to people’s needs. The service provider took action to address this issue.

People living at the home told us they received safe care. Relatives also felt that people were kept safe at the home.

There were appropriate policies and procedures in place for managing medicines and we observed staff administering people’s medicines safely.

Records showed that staff had been recruited safely. The staff we spoke with understood the importance of safeguarding people from abusive practice and were aware of the service’s whistle blowing (reporting poor practice) policy.

People told us staff at the home had the skills to meet their needs. We found that staff received an appropriate induction and effective training.

Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The service had taken appropriate action where people needed to be deprived of their liberty to keep them safe. Where people lacked the capacity to make decisions about their care, their relatives had been consulted.

Most people living at the home and their relatives were happy with quality of the food provided. They told us they had lots of choice and could have something to eat or drink when they wanted to.

We received positive feedback about standards of care at the home from community healthcare professionals who were involved with the service.

People told us they could make day to day decisions, such as what they wore, what they had at mealtimes and what time they got up and went to bed.

We observed staff communicating with people in a kind and affectionate way. People told us staff respected their privacy and dignity and encouraged them to be independent.

People were supported by staff to access a variety of activities at the home and most people were happy with the activities available.

Regular residents meetings took place and people were asked for their feedback about the service they received. We saw evidence that the registered manager acted on the feedback received and any suggestions made for improvement.

The registered manager requested annual feedback about the home from people there and their relatives. A high level of satisfaction was expressed about standards of care at the home.

People told us they thought the home was well managed and the registered manager was approachable.

The registered manager carried out regular checks to ensure that appropriate standards of care and safety were maintained at the home.

We found that recent improvements had been made to the home environme

People using the service told us they were happy with the care and attention they received at Chapel Lodge. One person said, “It’s a good place to be in.” Another person said, “The care is excellent.”

All the people asked told us they enjoyed the meals. One person said, “They feed you well, it’s like being in a restaurant.” People's nutritional status was monitored and when necessary advice was sought from other healthcare professionals.

We found that procedures and training for all members of staff was in place for the prevention and control of infection.

We saw that recruitment procedures were thorough in order to protect people using the service from unsuitable staff.

We noted that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were consulted about the care and facilities provided at the home.

We carried out this inspection to follow up areas of non-compliance found during our inspection of 3 January 2013. During this inspection, we found the required improvements had been made.

We saw that suitable arrangements were in place for the safe keeping and handling of medicines.

We found that staffing levels have been increased during the day in order to ensure that people received the care and support they needed.

We noted that systems were in place to monitor the quality of the service provided.

We saw that appropriate records were kept for people using the service.

We carried out this inspection to follow up areas of non compliance found during our inspection on 14 May 2012.

We found that although some improvements had been made there were some issues with the management of medication which could put the health and wellbeing of people using the service at risk. The auditing tool used by the manager to check medication had not identified the issues we raised.

People using the service told us they got on well with the staff team. One person said, “The staff are very good, they’re genuine friends.”

We found that the manager had further developed the quality monitoring system. However, this did not cover all aspects of the care and facilities provided at the home.

We saw that people’s individual care plans lacked clear directions for staff to follow in order to ensure their health and social care needs were met.

People using the service told us they were treated with respect and were satisfied with the care provided. One person said, “The staff are kind and we get good food.”

People using the service told us they were satisfied with the care provided at Chapel Lodge.

We found that members of staff responsible for administering medication had received appropriate training. However, we found that clear directions for staff to follow were not in place for medicines prescribed to be taken ‘when required’ and for the use of creams and ointments. The auditing tool used by the manager to check medication had not identified the issues we raised.

We saw that improvements to the premises had been made and refurbishment was ongoing. However, we found that no action had been taken to the address the risks associated with the steep ramp in the men’s toilet.

We noted that all members of staff had received the training they needed in order to provide safe and effective care for people using the service.

We found that improvements to the monitoring of the quality of the service had been made however, the system did not cover all aspects of the care and facilities provided at the home.

We saw that people’s individual care plans lacked clear guidance for staff to follow in order to ensure that identified risks were effectively managed.

People spoken with during the inspection indicated they were satisfied with the care and services provided at Chapel Lodge. They said, “It’s very nice, very good”. “I can’t think of anything I dislike”. “Couldn’t get a better place”. “Its’ okay”. "I am very happy here”. However, we considered peoples’ best interests and overall experience of the service and found some standards of quality and safety that were not being met.

Although people spoken with did not express any concerns, we found some parts of the home and some practices were not promoting peoples’ rights to privacy, dignity and choice.

People said they were getting support with healthcare needs and that they had ongoing attention from health care professionals. They were being supported sensitively with personal care needs. However, we found improvements were needed with planning peoples’ care and promoting safe medication practices.

People spoken with had mixed views about the activities on offer. Some said there wasn’t much going on, others said they liked watching television and reading. We found proper attention was not being given to providing meaningful activities and encouraging people to lead interesting lifestyles.

Although people told us they were generally happy with the quality and quantity of the meals provided. We found improvements were needed with offering and promoting drink choices.

People described the staff as, “Nice”. “Very kind”. “Alright”. “Grand”. One person said, “The manager is lovely”.

We received positive comments about the accommodation and facilities provided at Chapel Lodge, people said that they liked their bedrooms. But we found progress was needed in making sure the home is kept safe, clean and in good order.

We found improvements were needed with consulting with people about the quality of care and services provided at Chapel Lodge. Progress was needed in checking and maintaining standards and developing the service.