This inspection took place on 31 July 2018 and 1 August 2018 and was unannounced.

Eaton 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 care provided, and both were looked at during the inspection. Eaton Lodge accommodates up to 24 people in one adapted building. At this inspection, 23 people were living at the service.

There was no registered manager in post. The previous registered manager had left the service in May 2018. There was a manager in post, who had started the registration process. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

We inspected Eaton Lodge in February 2018 when three continued breaches and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment, person centred care, safe recruitment of staff. We imposed a condition in relation to good governance, the provider was required to send CQC a monthly report with details of the audits completed on the service and the action taken. These had been submitted as required to meet the condition.

At our last inspection, the service was rated ‘Requires Improvement’ overall with well led being Inadequate. At this inspection, improvements had been made but there continued to be breaches of regulation. Therefore, this is the third consecutive time the service has been rated Requires Improvement.

At our last inspection, there continued to be shortfalls in the service that were identified in the previous two inspections. At this inspection, improvements had been made but there were three continued breaches of Regulation.

Potential risks to people’s health and welfare had not been consistently assessed and there was not always detailed guidance for staff. Improvements had been made in providing guidance for staff around diabetes and epilepsy but there continued to be shortfalls around how to move people safely. The manager had started to write new care plans for each person, however, these did not always contain detailed information about people’s choices and preferences. Care plans did not always reflect the care being given. Staff knew people well and could describe how they supported people and moved them safely. During the inspection we observed people being moved safely.

There were sufficient staff on duty to meet people’s needs; however, staff continued not to be recruited safely and the provider’s policy had not been followed. Staff told us they felt supported by the manager and had discussed any concerns they had. The manager had not recorded these conversations and did not have a structure in place to formalise staff supervision. This is an area for improvement.

The manager had completed audits on all areas of the service and these had been recorded on the reports sent to CQC. However, the manager did not have a system in place to ensure that they continued regular audits. The manager showed us the documentation they planned to use which included an action plan, who was responsible for the action and when it was completed. The provider now recorded their visits to the service, the areas they had looked at and who they had spoken to. However, they had not recorded if they found any shortfalls and what action they had taken.

Previously, medicines had not been managed safely. At this inspection, the manager had taken action when shortfalls were identified. Medicines were now managed safely, there had been no errors in administration and people received their medicines when they needed them. Staff competency had

This inspection took place on 15 and 16 February 2018 and was unannounced.

Eaton 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. Eaton Lodge accommodates 24 people in one adapted building. There were 24 people living at the service at the time of the inspection.

The service had a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations, about how the service is run.

We last inspected Eaton Lodge in December 2016 when three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment, person centred care and good governance.

At our last inspection, the service was rated ‘Requires Improvement’. We asked the provider to complete an action plan to show what they would do and by when to improve all five key questions to at least Good. The provider had not provided an action plan and there had been minimal improvement. At this inspection there were three continued breaches of regulation. This is therefore the second consecutive time the service has been rated Requires Improvement.

There continued to be shortfalls in the service that were identified at the previous two inspections. The oversight of the service by the provider had not improved. The provider’s representative told us that one of them visited the service regularly and this was confirmed by the registered manager and staff. However, these visits were not recorded and there was no information about what the provider checked at each visit. The provider had not identified that improvements had not been made and that regulations had not been met. The provider did not have oversight of the quality of the service being provided to people.

The registered manager told us that they completed audits on all areas of the service, including care plans, medicines and infection control. These audits were not recorded to show what had been reviewed and if any shortfalls had been found. The registered manager had not identified the continued shortfalls found at this inspection.

Risks to people continued not to be consistently assessed and there was no detailed guidance for staff to mitigate the risks. There were no environmental risk assessments available and the provider did not have a contingency plan in place to keep people safe in the event of an emergency. Following the inspection, the registered manager sent us environmental risk assessments for the service.

Each person had a care plan that included information about their families, their lives before moving to the service. Nurses reviewed the care plans regularly and had recorded changes to people’s care needs briefly in the evaluation documentation. They had not changed or updated the care plans when needed so staff had up to date information and guidance. Care plans did not always include details about how staff should support people according to their preferences. Care plans did not reflect the care being given to people so were not accurate or up to date.

There was a stable staff group, who knew people well. Staff knew people’s preferences and described how people were different and if they were independent in any aspects of their care. Staff attended a handover when they arrived for their shift, staff discussed the care that people had received and if there were any changes to people’s care. People and relatives told us that staff supported them in the way they preferred.

People were not protected from the unsafe mana

This inspection was carried out on 13 and 14 December 2016 and was unannounced.

Eaton Lodge Nursing Home provides accommodation, personal and nursing care for up to 24 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to access the upper floors. The service has 14 single bedrooms and five double bedrooms that people could choose to share. There were 19 people living at the service at the time of our inspection.

We last inspected this service in May 2016. We found significant shortfalls and the service was rated inadequate and placed into special measures. We took enforcement action and served warning notices. We required the provider and registered manager to make improvements. 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. The provider sent us information about actions taken to make improvements following our inspection. At this inspection we found that improvements had been made in many areas. However, there were still areas where improvements were required.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Possible risks to people had been identified, however people had not always been involved in the assessments so they could share their experience and views and care could be planned to keep them safe in the way they preferred. People who were at risk of choking were not always monitored while they were eating to make sure action could be taken quickly if they choked. People's pressure relieving equipment was used correctly to reduce the risk of people sustaining skin damage.

Assessments of people's needs had not been completed with them before they began to use the service to make sure staff knew about their needs and preferences. Further assessments were not completed to gain more detail after people had moved in.

Care had not consistently been planned to support people to manage their catheters. People were supported to have health checks such as eye tests and blood tests.

People were not consistently supported to tell staff how they preferred their care provided. Guidance had not always been provided to staff about how to meet people's needs. Some people's care plans contained details of their care preferences but other people’s care plans did not. Care plans had been reviewed each month and any changes noted had been used to plan the care people received.

People received the medicines they needed to keep them well. Action had been taken to make sure medicines were ordered, stored, recorded or disposed of to keep people as safe as possible. However, further improvements were required to make sure people were always protected from the risks of unsafe medicines management.

Plans to evacuate people from the building in an emergency had not been amended to include all the information staff or the emergency services needed to evacuate people safely. Action had been taken to make sure fire escape routes were safe. Following the inspection we raised our concerns about fire safety with the local Fire and Rescue Service.

Since our last inspection checks the registered manager completed on the quality of the service had increased. However, they had not identified the shortfalls we found during our inspection. The provider and registered manager had improved their oversight of the service. Staff had been supported to provide a good level of care and were aware of their

This inspection was carried out on 5 and 6 May 2016 and was unannounced.

Eaton Lodge Nursing Home provides accommodation and personal and nursing care for up to 24 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over three floors and a lift is available to assist people to get to the upper floors. The service has 14 single bedrooms and five double bedrooms that people could choose to share. There were 22 people living at the service at the time of our inspection.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although people and their relatives told us that staff were kind and caring, people were not treated with dignity and respect at all times. Staff referred to people at times as ‘the feeds’ or ‘the normals’. The registered manager had not recognised that this was not a respectful way to refer to people.

The provider and registered manager did not have oversight of the service. They had not supported staff to provide a good level of care and staff were not all aware of their roles and responsibilities. Checks on the quality of all areas of the service had not been completed to make sure they were of the required standard. The provider and registered manager were not aware of the shortfalls in the service that we found at the inspection. The registered manager had not informed us of important events that happened at the service, without a delay, as they are required to.

There were no arrangements for the safe management of the service when the registered manager was absent or on leave. There were enough care staff, who knew people, to meet their needs. People’s needs had been considered when deciding how many staff were required on each shift. Staff worked as a team to meet people’s needs.

The provider’s recruitment procedures were not followed consistently. Staff had not all completed health declarations stating they were physically and mentally fit to fulfil their role. Gaps in employment had not always been questioned. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff had not completed all the training they needed to provide safe and effective care to people. The provider’s process of regular meetings between staff and a manager to discuss their role and practice had not been followed. However, staff told us they felt supported and were confident to raise any concerns they had.

Plans were not in place to keep people safe in an emergency, including plans to evacuate people from the building. Following the inspection we raised our concerns about fire safety with the local Fire and Rescue Service. Staff knew the signs of possible abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team.

Risks to people had not always been identified, including risks posed to people from the use of bedrails. Guidance for staff about how to manage risks had not always been provided or was not clear. Some people’s pressure relieving equipment was not used correctly and there was a risk that people would sustain skin damage because of this. Risks to people had not been reviewed regularly to identify any changes.

Assessments of people’s needs had not been consistently completed to identify any changes. Detailed guidance had not been provided to staff about how to meet people’s needs and no guidance had been p

The inspection was carried out by two Inspectors over one day. During this time we met and talked with people living in the home and their relatives. We spoke with visiting professionals, the registered manager, the nurse on duty and care staff. We also observed staff supporting people with their daily activities. This all helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Eaton Lodge Nursing home can provide accommodation for up to 24 older people. There were 23 people using the service at the time of our inspection.

We considered our inspection findings to answer 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?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people and the management team and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Staff were able to identify when people may be at risk of abuse and knew how to raise their concerns inside and outside of the service. People we spoke with said they felt staff safe at the service

There were systems in place to make sure that the staff learned from accidents and incidents and kept up to date with current practice and guidance.

Assessments were undertaken and care was planned to ensure that people received safe and appropriate care. Care plans detailed each person's individual needs. When risks to a person were identified the service carried out a risk assessment. However, more information was required in some risk assessments to support staff to provide safe and consistent care.

Recruitment procedures were in place. All staff employed had been the subject of criminal records checks and potential risks had been assessed when staff had cautions or criminal convictions. The manager had a plan in place to take action where they had identified that a candidate’s full employment history or references had not been obtained.

There were effective systems to reduce the risks posed to people from the spread of infection and to ensure that the service was clean and hygienic.

Is the service effective?

People’s care and support plans were individualised and had been regularly reviewed to ensure they remained current and up to date.

Staff knew people well, they responded to people’s requests and offered them choices. Staff knew what people were able to do for themselves and supported them to remain independent.

The provider operated an effective system to regularly assess and monitor the quality of the service provided. There were systems in place to ask people using the service, their relatives and staff for their views about the service and these were acted on.

Is the service caring?

People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People we spoke with said that staff were polite and caring. People we spoke with said they liked the staff.

People were supported to attend health appointments, such as, chiropodists. The service worked closely with health and social care professionals to maintain and improve people's health and well-being.

We saw positive interactions from staff when supporting people throughout our inspection.

Is the service responsive?

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

Staff were attentive to people using the service and responded promptly when needed. A recent quality assurance survey showed that people using the service felt that staff were responsive and responded to their requests in a reasonable time period.

The service had a complaints process in place and information had been given to people about how to make a complaint. People told us they felt confident that the manager and staff would respond to any concerns they had.

Is the service well-led?

There was an effective system to regularly assess and monitor the quality of the service to protect people’s health, safety and welfare.

The manager had a process in place to receive and share the latest guidance and best practice in nursing home care and shared this with staff in a formal way. This was integrated into the practice of the service.

Audits of the care plans and other systems were completed to assess the quality of the care being provided. Where shortfalls had been found action had been taken to protect people using the service.

The service was led by a registered manager. Staff told us that they felt supported by the manager who was approachable. They told us that the manager was accessible at all times, through an on call system. The manager had taken action to ensure that they continued to develop their clinical and leadership skills and supported staff to do the same. Staff told us they were clear about their roles and responsibilities and that they felt supported by all the staff working at the service.

There were 22 older people living at Eaton Lodge when we completed our inspection. We met with many of the people who were well enough to speak with us, family members and staff. Everyone we spoke with said they were happy with the service they received. One person’s relatives told us they had chosen the service because the staff had given them all the information they needed to make a choice with their relative.

One person we spoke with said, “I do the same here as I did in my own home”.

We found that the staff knew people well. People told us that staff were kind and caring. One person said, "The staff are lovely, you couldn’t find better".

People told us that they felt safe and well looked after. They looked comfortable and at ease with staff chatted in a relaxed way.

People had been involved in planning of their care and were supported to make plans for their future care. People and their families were kept informed about their care and treatment. They were encouraged to remain independent and make decisions about their future care and treatment.

We found that the service worked closely with other providers of care and treatment to the people using the service, including their doctors and the local hospice.

People received their medicines in a safe way. The service had processes in place to ensure medicines were available when people needed them. We found that staff had received appropriate training to administer medicines.

The home was in the process of being refurbished and all areas of the home had been redecorated. We saw that the provider had plans in place to continue the improvement programme, including the fitting of new carpets and curtains.

The service had a process in place to assess and monitor the quality of the service people received. People and their relatives told us that they felt confident raise any concerns or worries they had with the manager and staff.

People who used the service said that staff treated them with respect and supported them to raise any concerns they had. They said that they received the health, nursing and personal care they needed and that they were comfortable in their home.

All of the five people with whom we spoke gave us positive feedback about the service. One of them said, “The staff are kindness itself and are always very willing to help."

People who use the service said that staff treated them with respect and supported them to raise any concerns they had. They said that they received the health, nursing and personal care they needed and that they were comfortable in their home.

All of the five people with whom we spoke gave us positive feedback about the service. One of them said, “I really like the staff because they’re usually happy and always willing to help. I never feel I’m being a nuisance when I ask for help.”

A carer (relative) said, “The residents get very good care here. I come a lot to the home and every time I find my mother to be neat, clean and obviously well cared for. The beds are made and the bed-linen is clean. I can leave knowing that my mother is safe and will be treated with kindness.”

We spoke with three people at the care home, and observed care being given to five people. People told us that Eaton Lodge was “a home from home”, and that “the care is fantastic and I don’t want to leave”, and that “staff are always there when you want them”.