Downshaw 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.

Downshaw Lodge provides accommodation, nursing and personal care support to male adults with a range of needs arising from their physical and mental health. People living at the home have a dementia diagnosis and, as a result of their illness, may present with behaviours that challenge. The accommodation is split into two units, named Mason and Sheldon, situated over 2 floors and provides 45 bedrooms and a range of communal and activity areas. The home has a large outdoor garden area at the rear for leisure and activities. The service is located in the Ashton-under-Lyne area of Tameside. Downshaw Lodge is part of a large organisation; Qualia Care Limited. This inspection was the first inspection since the change in ownership of the home.

At the time of our inspection there were 45 people living at Downshaw Lodge.

This inspection was carried out over two days between 12 and 13 November 2018. Our initial visit on 12 November was unannounced.

The service had a registered manager in place. 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.

We identified breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were around medication errors, infection control and management oversight. You can see what action we told the provider to take at the back of the full version of the report. We also made recommendations around making the home environment more dementia friendly.

We looked at the safe management and administration of medicines and found medication was not always managed safely. We found regular checks and balances were carried out by senior staff; however, we found medication errors during our audit of safe medication management. We were unable to ascertain if people had received the right medicines in the right amounts at the right time. As a result, we requested immediate action be taken to ensure the safety of the people involved. We checked with the registered manager, who had taken appropriate action, and found no-one had come to harm as a result of the errors.

We identified concerns regarding infection control practice within the home. A recent infection control audit carried out in July 2018 had identified the same concerns we found during the inspection. We found some areas of the home were not always clean.

There were systems and checks in place to monitor the quality of the service to ensure people received safe and effective care. However, these checks had not always addressed the concerns we found during our inspection.

Systems were in place to safeguard people from abuse. Staff were aware of their responsibilities in reporting any issues or concerns so that people were protected.

People were supported by sufficient numbers of staff. Relevant recruitment checks were carried out to make sure people applying to work at the service were suitable.

Care files we looked at showed plans and risk assessments documenting people’s specific care and support needs. These plans outlined how people needed to be cared for in an effective and safe way

Care records at the home showed us that people received input from health care professionals, such as psychiatry and social care workers. People were supported to visit the dentist and general practitioner.

The home has good links with partnership agencies and the community. Several people accessed the community on a daily basis and people were offered a r