About the service:

Cheybassa Lodge Rest Home is a ‘care home’. Cheybassa Lodge Rest Home accommodates up to 18 people living with dementia and physical frailty in one building. At the time of our inspection 14 people were living at the home.

People’s experience of using this service:

•The provider lacked effective governance systems to identify concerns in the service and drive the necessary improvement. At times there was a lack of clear and accurate records regarding people’s medicines and support needs.

•Accidents and incidents were not analysed at a service level which meant overarching trends and patterns could not be identified. We have made a recommendation about this.

•The provider was not meeting the requirements of the Accessible Information Standard (AIS), we recommended that the provider seeks reputable guidance to ensure this was met.

•We found that activities were not always reflective of people’s preference and we made a recommendation that the provider seeks reputable guidance in order to provide personalised support for people

•Despite this, people were happy living at Cheybassa Lodge Rest Home and people told us they felt safe. People were supported by staff who were kind, caring and who understood their support needs, likes and dislikes. Where they needed external health input they were supported to receive this.

•Staff were not always supported with regular supervision or appraisal but staff told us they felt well supported by the registered manager and had enough training to undertake their roles effectively.

•People and their relatives knew the registered manager and felt able to speak to her if they had any concerns. Staff felt the registered manager had improved the culture of the service. The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.

Rating at last inspection: Requires Improvement (Report published 13 February 2018)

Why we inspected: This was a planned inspection based on our last rating. At the last inspection the provider was rated as Requires Improvement.

Follow up: The overall rating of the service remains Requires Improvement. At the last inspection, the provider was found to be in breach of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection, we found the provider had met the requirements of Regulation 12 but remained in breach of Regulation 17. This is the second consecutive time the service has been rated as Requires Improvement and we will request a clear action plan from the registered person on how they intend to achieve good by our next inspection. We may decide to meet with the provider following receipt of this plan. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Cheybassa Lodge Rest Home 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. Cheybassa Lodge Rest Home accommodates up to 18 people in one building. At the time of our inspection15 people were living at the home.

This inspection took place on 8 and 12 December 2017 and was unannounced.

There was a registered manager in post 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 and associated Regulations about how the service is run.

People who use the service and one person's relative were positive about the care they received and praised the approach of the staff and how the service was managed. Comments from people included, “Staff are good as gold, not a bad egg”, “Staff are kind” and “The staff are very nice, all of them”. One person’s relative told us, “Staff are brilliant". We observed staff interacting with people in a friendly and respectful way.

People told us they felt safe living at Cheybassa Lodge Rest Home. However risks to people were not consistently monitored and managed to ensure they received safe care. The provider did not have effective systems in place to learn from safety incidents and concerns. The provider told us they took action following our inspection to manage these risks.

Staff knew how to identify abuse and they told us they would raise any concerns with the registered manager. Not all concerns had been shared with the local authority. The provider took action to report these concerns during our inspection. We have made a recommendation about the reporting of safeguarding concerns in line with safeguarding protocols.

People did not receive all of their medicines when required and some improvements were required to the recording of prescribed creams. All staff received medicine administration training and had to be assessed as competent before they were allowed to administer people’s medicines.

The home was clean and staff understood their responsibilities for infection control.

Care plans lacked detailed information about people's needs and preferences. The registered manager had identified improvements required to ensure all care plans were detailed and relevant. We have made a recommendation about involving people and their representatives in care planning.

People’s preferences and choices for their end of life care were not discussed with them or recorded in their care plans.

People received support to ensure they had enough food and drink.

The provider had identified improvements to the systems to monitor the quality of the service provided however these improvements had not been implemented. Improvements were needed to make sure quality monitoring processes were effective in identifying and addressing shortfalls in the service and improving the service people received. The provider did not had systems in place to learn from safety incidents and concerns.

People told us they felt the service was well managed.

People were supported by staff who had been through checks on their suitability to work in the home but improvements were required to ensure staff's full employment history was checked.

Staff required additional training to ensure they had the necessary knowledge and skills to meet people's needs. We have made a recommendation about staff training on the subject of dementia.

People had access to health care professionals and were supported to maintain their health by staff.

The provider had arrangements in place to respond to complaints and a complaints procedure. Improvements were required to how complaints were responded to.

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