We carried out an unannounced inspection of this service on 10 and 13 February 2017. We also carried out a focused inspection on 17 August and 11 September 2016 in response to previous concerns that we had received. From the focused inspection we did not find any breaches of regulation but we did note that improvements were required to aspects of risk assessment updating, care plans and consistency of management. Improvements had been made and recently the service had identified further improvements required to care recording as people’s needs changed and to ensure these changes were consistently recorded from the care plan to the care folders that were kept in each person’s bedroom.

Cheverton Lodge is a 52 bed nursing home which provides nursing and personal care for up to 46 older people and 6 young people with physical disabilities. Each person had their own bedroom and there were communal lounges and dining areas on each floor of the home.

The home did not have a registered manager. However, a manager had been appointed in September 2016 and they had submitted an application to register with the Care Quality Commission (CQC). 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.

Care plans described people’s support needs but the care and support provided was not clear in some cases. Updating care records to reflect the level of personal care required, for example how frequently they wished to have a bath or shower, for some people needed to be more accurate and also reflect positive changes in care as people’s conditions improved. However, we noted that this issue had recently been recognised by the provider who told us of the steps they were taking to address it.

The turnover of managers within the home had previously led to an unstable management structure. Information we had previously received from a healthcare professional and relatives indicated that the lack of consistent management had impacted on communication with them. The situation had improved. More effective communication had been established with health and social care professionals, which we had been told by professionals, for example commissioning and nursing and assessment team members in the local authority. Feedback at the most recent relative’s meeting was also positive and the issues around communication that had arisen last year were improving.

Medicines were managed well and safely. However, there had been an error on the typed medicines audit for January 2017, which was later clarified.

There had been several staff vacancies within the home from the middle of 2016. The recruitment programme which the provider had focused on had achieved success with almost all permanent staff posts now filled. There was much less reliance on temporary staff. Staff were recruited safely. There were enough staff on each floor during our visits and we saw that staff were able to spend time with people at other times when not supporting people with care tasks.

The staff team had access to the organisational policy and procedure for protection of vulnerable adults from abuse. They also had the contact details of the local authorities who largely placed people at the service. Staff said that they had training about protecting people from abuse and we were able to verify that this training did occur. Staff we spoke with had a good knowledge and understanding of their responsibilities to keep people safe from harm.

Risk assessments had improved and these were being recorded and updated in a timely way, which is an improvement to what we had found at our previous focused inspection. Information provided at handovers between staff was also clear.

People were provided with a wide cho

We carried out an unannounced focused inspection of this service on 17 August 2016 as a result of concerns that we received. We received further concerns and returned to the home on 11 September 2016. The concerns related to a high turnover of staff and unstable management, communication between healthcare professionals, relatives and staff at the service, quality of food and issues around the external environment. This report only covers our findings in relation to the concerns recently raised. At our last comprehensive inspection in December 2015, we found that the service was meeting all of the standards that we inspected.

Cheverton Lodge is a 52 bed nursing home which provides nursing and/or personal care for up to 46 older people and 6 young people with physical disabilities. Each person has their own bedroom and there are communal lounges and dining areas on each floor of the home.

The home did not have a registered manager. However, there was an interim manager in post 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.

The previous registered manager had left the service in May 2016. Since this time there had been three interim managers at the home. The current interim manager was leaving in September 2016 and a further interim manager was due to take over. We were advised that the new interim manager would be applying to be the registered manager.

The turnover of managers within the home has led to an unstable management structure. Information received from a healthcare professional and relatives that we spoke with indicated that the lack of consistent management had impacted on communication with them.

There were several staff vacancies within the home, specifically around nursing staff. However, the home had recently recruited to these posts and were waiting for staff to start. Seconded nurses from other Barchester homes, regular agency staff and bank staff were being used to ensure consistency of care.

One person that had been diagnosed with a terminal illness three weeks prior to our visit did not have a risk assessment of care plan in place about this.

Most risk assessments were appropriate and information about risks had been carried over into people’s care plans. However, for two people with known risks, there were no risk assessments in place.

Information provided at handovers was not always clear and some people’s monitoring charts were not always completed. People had files in their bedroom with information on care tasks that had been or needed to be completed by staff. Information from these files was not always carried over onto handover sheets kept in the offices on each floor of the home. Staff did not always have up to date information when handing over between shifts to ensure continuity of care.

People were provided with enough food and drink. Food looked and smelled appetising, was of good quality and offered choice. People that were on special diets such or had swallowing difficulties were given appropriate food, although on occasions, one person who had a specific diet did not receive food that met their dietary needs.

The home was currently undergoing refurbishment. This was due to be completed by the end of September 2016. The home was clean and tidy on the days that we inspected.

We carried out an unannounced focused inspection of this service on 5 October 2015 as a result of anonymous concerns that we received. The concerns related to a lack of staffing, care and welfare of people with emerging healthcare needs and the times at which medicines were being administered to people.

After the previous comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to two breaches of regulations that we identified at that time. This report only covers our findings in relation to the concerns recently raised and does not include the previous two regulation breaches, which we will review at our next comprehensive inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Cheverton Lodge Nursing Home’ on our website at www.cqc.org.uk’.

Cheverton Lodge is a 52 bed nursing home which provides nursing and/or personal care for up to 46 older people and 6 young people with physical disabilities. Each person has their own bedroom and there are communal lounge and dining areas on each floor of the home.

The home’s registered manager has worked in this role since February 2015. 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 found there were the designated numbers of staff on each floor during our visit, with staff on duty for the night and morning shifts as outlined in the duty roster and bed status plan.

We found that referrals were being made to other healthcare professionals by the service when the need arose although speedier action had been found to be needed when the local authority had responded to a concern raised in July 2015. Morning medicines had been administered to everyone that required them at a reasonable time.

People told us that they were happy with the care and support they received. One person said "I love it here." Another person said that "people are very caring" and "we are very well looked after." We spoke with a visitor to the home who was a very good friend of a person who used the service. They said that "the home is very clean" and "It's lovely here."

We talked to a local General Practitioner who visited the home weekly. They told us that they would be "more than happy to have a relative living at this home." They told us that it was "A genuinely good service", that relatives seemed happy with the quality of care received and that people who moved into the home appeared to settle quickly.” They said "people are respected."

We spoke with a local Occupational Therapist (OT) who supported people who used the service. They told us that communication between staff in terms of information being handed over could improve but said that the quality of the service was "generally quite good." They said that when a person had fallen at the home the local community team which the OT works in had been informed very quickly.

We found that people experienced a high quality of care and treatment when they used this service and that people were treated with dignity and respect. We also found that people were kept safe from the risk of abuse and abuse occurring, however the deprivation of liberty which arose as a result of the use of bed rails and a lap strap was not properly explored or documented as evidence that the person's deprivation of liberty and best interests had been fully considered.

We found that the equipment people used was safe and effective and that people had enough qualified, experienced and skilled staff to support them at all times.

We found that the home carried out various internal quality checks which helped to keep people safe and that these were well documented across a wide range of checking and auditing tools.

We spoke to seven of the fifty people who live at the home. We also spoke to two care workers, two relatives of people living at the home and a general practitioner. We observed how people were supported by staff. All the people we spoke with were positive about the service and staff. They told us staff were nice and respected their privacy. People told us staff assisted them with their needs and they had access to healthcare service.

They told us they were able to see the doctor when they needed to, and that they were asked if they needed pain relief, so were not left in pain. They told us that their medicines were always available for them.

People using the service felt there were enough staff at the home. They told us staff were available when they needed support. They said staff always responded to call bells. We saw staff were present to assist people when they needed support with their meals, personal care or other needs.

People told us they had no concerns about the service. They indicated they knew how to make a compliant and who to contact if they were not happy with their care.

People and visitors said they felt able to raise any concerns or requests. They said the staff listened to them and treated them with respect. People's relatives also praised the way that staff communicated with them. All the people we spoke with said they felt safe living in the home.

The home ran organised activities for people during the week, for example, gentle exercise, discussion around current affairs, games and puzzles, music events and a weekly religious service. Outings were arranged from time to time usually for small groups. Places recently visited included Arsenal football club, Kenwood House and local shops. One person spoke with us about how much they had enjoyed the visit to Arsenal.

The home sought feedback from people using the service, relatives and visitors. For example, there was a visitor's book in reception which was checked daily by staff. We saw that suggestions had been acted on. Most comments praised the home, for example, one entry read: "This is a wonderful place. My partner is treated with kindness and respect."

Cheverton Lodge is a 52 bed nursing home which provides nursing and/or personal care for up to 46 older people and 6 young people with physical disabilities. Each person has their own bedroom and there are communal lounge and dining areas on each floor of the home.

This inspection took place on 10 and 18 December 2015 and was unannounced.

We also carried out a focused unannounced out of hours inspection on 5 October 2015 in response to whistleblowing concerns raised. At that visit we did not find that the concerns were substantiated.

At the time of our inspection a registered manager was employed at 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 comprehensive inspection on 14 and 16 April 2015 the service was not meeting all of the regulations we looked at in respect of Regulation 18 (1) (Staffing) and Regulation 10 (2) (a) (Dignity and respect). At this inspection we found that the service had addressed the previous breaches of regulation.

The staff of the service had access to the organisational policy and procedure for protection of vulnerable adults from abuse. They also had the contact details of the London Borough of Islington which is the authority in which the service is located and other authorities who also placed people at the service. Staff said that they had training about protecting people from abuse and this training had recently been updated, which we verified on training records. Staff were able to describe the action they would take if a concern arose.

We found there were the designated numbers of staff on each floor during our visits, and we saw that staff were able to spend time with people other than when only engaging in care tasks. Staff were regularly present in communal areas to identify and respond to immediate assistance that people required.

Risk assessments concerning falls and those associated with people’s day to day included instructions for staff about how to minimise risks and were clear. Staff showed a detailed knowledge of the people they supported and their unique preferences about how care was provided.

There were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately and making the necessary applications for assessments when these were required.

People were supported to maintain good health. Nurses were on duty at the service 24 hours and a local GP visited the home each week, but would also attend if needed outside of these times. People told us they felt that healthcare needs were dealt with well and we saw that staff supported people to make and attend medical appointments.

Everyone we spoke with who either used the service, relatives or other visitors, praised staff for their positive and caring attitudes. The care plans we looked at were based on people’s personal needs and wishes and some miner matters needed attending to but overall care plans reflected the care and support that people required.

People’s views were respected as was evident from conversations that we had with people using the service, relatives and staff. We saw that improved systems had been established to assist clear communication between staff at the home. They were updated of changes in the service and were able to feedback their views and opinions through staff handover and other meetings.

The service complied with the provider’s requirement to carry out regular audits of all aspects of the service. The provider carried out regular reviews of the service and sought people’s feedback on how well the service performed and outlined any the areas of improvement that were necessary to maintain the quality of the service.