This comprehensive unannounced inspection was carried out on 7 September 2018 and was unannounced. At the last inspection on 9 March 2016, the service was rated as ‘Good'. At this inspection we found the service was in Breach of Regulations 9 and 17 and has been rated as ‘Requires improvement’.

Dorset Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Dorset Lodge provides accommodation and personal care for up to 9 people in a large house situated in a residential area close to local amenities. At the time of inspection 4 people were living at the service. Each person had their own room with en-suite facilities.

There was a registered manager in post who was also the registered provider. 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.

The systems and processes for auditing medicines required strengthening to ensure robust oversight of people's medicines.

We made a recommendation about medicine management.

Health and safety checks, maintenance and fire drills were regularly completed, however environmental audits had failed to identify potential safety issues we found within the home environment.

We made a recommendation about environmental safety.

There were sufficient staff employed who had been safely recruited. Disclosure and barring service (DBS) checks to ensure staff were suitable to work with vulnerable people were completed but were not routinely renewed. Risk assessments had not been completed to support decision making regarding whether to renew staffs DBS.

We made a recommendation about safe recruitment practices.

People felt safe living at the service. Staff and the management team understood their safeguarding responsibilities and knew how to protect people from the risk of abuse.

Risks to people had been assessed and guidance was in place for staff to follow to ensure people’s safety and well-being.

Staff received an induction, training and supervision to support them to be competent in their role. Staff felt well supported and were regularly observed to check their performance and identify any learning needs.

People were assisted to have enough to eat and drink and received support to access treatment from healthcare professionals to maintain their health and wellbeing.

Staff were kind and caring and listened to people. People's consent was sought before care and support was provided.

People were treated with courtesy and respect and independence was encouraged. The service supported people to maintain relationships that were important to them.

We made a recommendation about the physical environment to support dignified practice.

People’s needs had been assessed and care plans devised which provided guidance to staff on how to meet those needs. However, care plans did not always contain personalised information to support staff to deliver person-centred care.

We made a recommendation about person-centred care planning.

People had the freedom to come and go as they pleased during the day and enjoyed past-times of their own choosing. However, restrictions were in place with regard to meal timings and sleeping and waking routines.

This was a breach of Regulation 9, [person-centred care].

There were systems and processes in place to respond to complaints and people knew how to make a complaint if needed.

The registered manager was not a visible presence within the service resulting insufficient oversight of the service and staff. Consequently, the systems and processes in place to monitor the safety and quality

This inspection took place on 9 March 2016.

Dorset Lodge is registered to provide personal care and accommodation for up to 10 people who have mental health needs. There were six people receiving a service on the day of our inspection, including one person who was in hospital.

A registered manager was in post. 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.

Staff knew how to identify abuse and how to report it to safeguard people. Recruitment procedures were thorough. Risk management plans were in place to support people to have as much independence as possible while keeping them safe. There were also processes in place to manage risks in relation to the running of the service.

Medicines were safely stored, recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs. People had support to access healthcare professionals and services. People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences.

People were supported by skilled staff who knew them well and were available in sufficient numbers to meet people's needs effectively. Staff used their training effectively to support people and to respect them and their rights. People found the staff to be friendly and caring. People participated in activities and interests of their choice at home and in the community.

Care records were regularly reviewed and showed that the person had been involved in the planning of their care. They included people’s preferences and individual needs so that staff had clear information on how to give people the support that they needed. People told us that they received the care they required.

Improvements were needed to the consistent management of the service and its quality checking systems. Staff found the registered manager to be supportive although they were not regularly in the service. People living and working in the service had the opportunity to say how they felt about the home and have their views listened to.

Our inspection team was made up of one inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four people using the service, two staff supporting them, one healthcare professional that was visiting the service and reviewing the care records of four people who used the service.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew the people well. One person told us. "The staff were very good; they helped me settle in very well. They took the time to talk to me about the support I need and how and when I wanted it.” This was confirmed by a visiting health professional who said “The staff have built up a strong and trusting relationship with the person.”

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this.

Is the service responsive?

People's needs were assessed before they moved into the home. People told us that they were involved in preparing their care plans. We saw that people's preferences, interests and religious and cultural needs had been recorded in their care plans.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. People we spoke with told us that if they were unhappy then they would speak to the manager. This helped to ensure that people received a good quality service at all times.

Is the service well-led?

We noted that the manager carried out regular audits including areas such as staff training, care plans, risk assessments, medication, maintenance of the premises and equipment. Staff told us that the manager was very supportive and accessible and that they received regular supervision and support. The provider had an on-call system in place for the out of hour’s period.

We talked with four out of nine people using the service and five staff. People told us that they liked living at Dorset Lodge, that staff gave them support. Comments included, “It’s very good.”

We found that the provider had suitable arrangements in place for obtaining, the consent of people using the service.

We considered how well led the service was. We found that the manager was in the process of reviewing the assessment and care planning system. When we reviewed care planning records, we found that people's care needs were not always accurately identified. The provider told us they were taking steps to improve their system to make it more effective and ensure that it reflected the care that was being provided.

We saw that there were systems in place for people to make complaints or give feedback on the service and we saw that the provider responded to people’s requests and needs.

We looked at how staff were caring for people. We found that staff interacted positively with people using the service. People told us they felt able to approach staff with any issue they had. People and staff told us that they routinely talked about healthy eating, menu options and cooking opportunities.

We spoke with four of the seven people living at Dorset Lodge. Each person we spoke with said that they were happy and that their care needs were being met. They all said they were involved in the development of their care plans and that they attended their care programme approach meetings. They said they had access to their social worker and that staff were very helpful.

One of the service users said that they self medicated after being risk assessed by the hospital.