About the service: Devonshire House and Lodge is a residential care home that was providing personal and nursing care to 71 people aged 65 and over at the time of the inspection. A service is mainly provided to older people who may be living with dementia and /or have a physical or sensory impairment.

People’s experience of using this service:

• People were valued as individuals and treated with care and compassion. Staff emphasised how important it was to know each person well in order to provide person centred care. This deep knowledge of people also helped staff understand when people needed reassurance and how best to provide it. People, family members and professionals gave consistently positive feedback about the caring culture of the home. Comments included, “I am so blown away by the staff” and “The staff are more like friends and family.”

• Staff engaged positively with people throughout the day. This helped build strong bonds that increased people’s confidence in sharing their views about their care and the service. Staff knew how to communicate with people so people understood the options available to them. Staff were skilled in understanding people’s responses.

• The registered manager and staff extended their care and compassion to people’s family members and saw them as part of the home’s community. Comments included, “[…] is getting the most gentle, loving care and so are we!”

• People, relatives, staff and professionals gave exceptional feedback about the impact the registered manager had had on the home and on the lives of the people living in it. Staff told us they saw the registered manager as a role model. It was clear staff had adopted the registered manager’s approach to the care of the people living in the service. People were encouraged to share things staff had done that mattered to them and staff were rewarded for their contribution.

• The registered manager had a clear vision for the service and took regular action to help ensure this vision was realised. This included engaging the local community in the life of the home and supporting people to be a part of their local community. They told us, “This is a home and people in it should be a part of their community. It’s about people being included and valued.”

• People lived in a service that kept them safe. Staff had been recruited safely and had received training on how to recognise and report abuse. People were supported to take their medicines safely and to reduce any risks relating to their individual health and care needs.

• People’s care was provided in line with best practice. People were cared for by staff who received regular training that was tailored to meet the needs of the people living in the service.

• People’s needs and preferences regarding food and drink were known and respected. People told us they liked the food and staff gave examples of things they did to help ensure people got the food they liked, whilst maintain their health.

• People’s ideas and preferences were sought and listened to in relation to the internal and external environment. People were offered a variety of different ways to spend their time. Staff understood what people enjoyed doing and constantly worked to offer a variety of activities based on people’s preferred pastimes and hobbies.

• We have made a recommendation about the management of some medicines.

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

Rating at last inspection: Requires Improvement (report published 12 April 2018). We did not request an action plan as there were no regulatory breaches.

Why we inspected: This was a planned inspection based on previous rating.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Devonshire House and Lodge 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.

Devonshire House and Lodge accommodates up to 77 people across four separate units, each of which has separate facilities. The units include nursing care, residential care and dementia care. At the time of the inspection 46 people were living in the service.

This inspection took place on 8, 9 and 11 January 2018 and was unannounced.

We had carried out an unannounced comprehensive inspection on 20 and 21 April 2017. The overall rating was inadequate, therefore the service entered 'special measures'. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

We told the provider to make improvements to how people's medicines were managed, how people were protected from risks including the spread of infections and in the event of an emergency evacuation, how staff were deployed and how incidents were recorded and managed. We also told them to ensure people were treated with dignity, to improve records of people's individual needs, to ensure confidential information was protected, to ensure there was enough for people to do and that the Mental Capacity Act 2005 (MCA) was followed. We also told them to improve their systems to monitor the quality of care people received, to inform the commission of significant events and to ensure advice from external agencies was acted upon.

The Commission considered its enforcement policy, and took enforcement action which was to impose a condition on the provider's registration. This meant the provider was required to carry out audits of the service, describe what action was being taken to improve the service and to meet the regulations; and submit a report of their findings on a monthly basis to the commission. The Commission then reviewed the provider's monthly returns to ensure improvements were being made. We also used the information in these reports to inform this inspection.

During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures and no longer has to submit monthly reports; but some further improvements are still required.

People had risk assessments in place but these did not always reflect the full range of risks people might experience due to their individual health or social care needs. Staff had a good understanding of the Mental Capacity Act, however people’s records did not always clearly reflect whether someone had capacity or not, or show how their legal rights were then protected.

Staff had an in depth knowledge of people’s needs however, people’s care plans did not always contain this level of detail about their routines and preferences. Monitoring of the quality of the service had improved. The provider, manager and staff regularly undertook a range of audits and spoke with people to ensure they were happy with the service they received. However these had not identified the areas for improvement highlighted during this inspection.

A new registered manager had been employed to manage 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. The registered manager had been employed following the last inspection and had been in post for seven months at the time of this inspection.

Since the last inspection, the governance systems in the service

The overall rating for this service is ‘Inadequate’ and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection took place on 20 and 21 April 2017 and was unannounced.

Devonshire House and Lodge is a purpose built nursing home providing residential and nursing care for up to 77 people. Devonshire House and Lodge is part of the corporate group Harbour Healthcare. The home is divided into five units, two nursing units and three residential units. On the days of the inspection 52 people were living at the home. Devonshire House and Lodge provides care for older people who may also have mental health needs which includes people living with dementia.

A manager was employed to manage the service who was in the process of registering with Care Quality Commission. 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 manager had only been employed for three weeks and was in the process of getting to know the service.

Prior to our inspection we received information of concern that there were insufficient staff and equipment to meet people’s needs safely. Concerns were also raised that people’s dignity was not always respected by staff, there were no emergency evacuation plans for people, medicines management and administration was unsafe and people’s records were often unclear and completed inconsistently.

Following the inspection, we received further concerns from health and social care professionals about the safety of people living at Devonshire House and Lodge.

At our last inspection on 2 and 3 November 2016, we found breaches of regulation. People’s care plans were not always easy to understand and were not reviewed regularly. Risks to people’s health and safety were not always assessed and actions identified to mitigate risks were not always followed. Records to monitor people’s health needs or concerns were not always completed correctly and people’s care plans did not contain clear information for staff about how to protect people’s rights, if they were assessed as lacking capacity. Staff were not always deployed effectively and did not always have competence, skills and experience to provide safe care and treatment. Equipm

The inspection took place on 2 and 3 November 2016 and was unannounced. Devonshire House (previously known as Bickleigh Down), provides care across five units. It incorporates three residential units and two nursing units, for people who may require nursing care and for people who are living with dementia. Devonshire House provides care and accommodation for up to 77 people. On the day of the inspection 49 people lived in the home. Devonshire House is owned by Harbour Healthcare Ltd. At the time of the inspection, Harbour healthcare Ltd, had owned Devonshire House for five months.

A manager was employed to manage the service. They were in the process of registering with Care Quality Commission. 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 the start of the inspection, the manager had been in post for two days. They were supported by a deputy manager who was also new to post, as well as nurses and/or senior carers who were responsible for the day to day running of each unit.

The inspection was prompted in part by notification of an incident following which a service user sustained an injury. The information shared with the CQC about the incident indicated potential concerns about the management of risk of falls relating to new flooring that had been fitted. Incident records showed that only one person had slipped on the new flooring and that the fall had been due to a spilt drink. We identified during the inspection that spillages were not always cleared away as soon as possible. The provider told us they would work with the staff team to improve their practice in this area.

Risk assessments to guide staff how to help mitigate risks relating to people’s care were not always up to date, reflective of people’s needs or followed by staff. Records to guide staff how to keep people safe if there was an emergency such as a fire were not always clear and during a fire alarm, some staff were not clear what actions to take. The manager and provider were in the process of reviewing everyone’s risk assessments and monitoring whether staff followed them. They also told us they would also ensure they clarified the guidance for staff regarding how to keep people safe in an emergency.

People who needed hoists to help them move did not have slings (which are used on the hoist) which had been assessed for their individual needs. This put people at a risk of injury or cross contamination from other people. The provider told us they would immediately order individual slings for people, according to their assessed needs.

People and staff told us there were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. However, these were not always deployed in the most effective way to meet people’s needs. On the second day of inspection, this had resulted in two people still being in bed at midday. Staff told us this would not be the normal choice of the individuals. The manager and provider told us they had already made some changes to how staff were deployed and would have a closer overview of this in the future.

The manager and some staff had attended training on the Mental Capacity Act 2005 (MCA).

Staff had a basic knowledge of the MCA but when people lacked the capacity to make decisions for themselves, care plans did not always provide clear information for staff about how to ensure their rights were protected. The manager told us they would ensure staff received training and support to understand the MCA and review people’s care plans to include clear details for staff. Where people’s liberty was restricted in their best interests, the correct legal procedures had been followed. We have made a recommendation abo