We carried out this unannounced inspection on 27 and 28 June 2018.

Farehaven Lodge is a service that is registered to provide accommodation for up to 40 older people, some of whom are living with dementia. Accommodation is provided over two floors and there are stair lifts to provide access to people who have mobility problems. At the time of our visit 28 people lived at the home.

Farehaven Lodge had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We previously inspected Farehaven Lodge on 2 November 2016 and found the provider failed to identify medicine errors and take appropriate action. This was a breach of Regulation 12 of the Health and Social Care Act 2008 Regulated Activities Regulations (HSCA RA) 2014 Safe care and treatment. We also found governance systems were not always effective. This was a breach of Regulation 17 of the HSCA RA Regulations 2014 Good governance.

At this inspection we found the provider had made progress and was no longer in breach of Regulation 12. Whilst governance systems did prompt improvement we found other areas of care delivery that were not consistently to the standard expected detailed in the regulations. We issued a repeated breach of Regulation 17. We also issued a breach of Regulation 18 HSCA RA Regulations 2014 Staffing, a breach of Regulation 15 HSCA RA Regulations 2014 Premises and equipment and a breach of Regulation 9 HSCA RA Regulations 2014 Person centred care.

The provider did not ensure sufficient numbers of staff were appropriately deployed to meet peoples’ needs at all times.

The provider did not ensure CQC were notified about incidents of possible abuse.

The provider did not ensure Farehaven Lodge was consistently meeting fire safety requirements.

People were not always supported to engage in meaningful activities and were often left without stimulation.

Further improvement was required to enable people living with dementia to navigate throughout the home safely and effectively.

Staff were aware of people’s individual risks and were able to describe the strategies in place to keep people safe.

Staff knew each person well and had a good knowledge of the needs of people.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. Appropriate arrangements were in place for people who were subject to DoLS.

Food menus offered variety and choice. The chef prepared meals to meet people’s specialist dietary needs.

Where possible, people and relatives were involved in care planning.

Staff supported people with health care appointments and visits from health care professionals.

Care plans were amended to show any changes and they were routinely reviewed every month to check they were up to date.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person, their relatives, and where appropriate other health and social care professionals.

The provider had appropriate arrangements in place should people require end of life care.

We issued four breaches of the Health and Social Care Act 2008. You can see what action we took at the back of this report.

This inspection took place on 2 November 2016 and was unannounced.

Farehaven Lodge is a service that is registered to provide accommodation for up to 40 older people, some of whom are living with dementia. Accommodation is provided over two floors and there are stair lifts to provide access to people who have mobility problems. There were three lounges on the ground floor and a dining room that people could choose to spend their time in. At the time of our visit 28 people lived at the home.

Whilst a person is named on our register as being the registered manager, this person was no longer working at the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A new manager had been appointed and started working in the home on 19 September 2016. They advised us they would be making an application to become the registered manager. Throughout the report we refer to this person as the manager.

Following our last inspection on 4 and 5 August 2015 requirement notices were issued for breaches in Regulations11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered person had not ensured appropriate application of the Mental Capacity Act 2005. They had not ensured that identified risks associated with people’s care had been appropriately assessed and plans developed to mitigate such risks. Service user records were not always up to date and systems to assess and improve the quality of the service were not always effective in driving improvements.

At this inspection improvements had been made. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider had suitable arrangements in place to establish, and act in accordance with people’s best interests if they did not have capacity to consent to their care and support. The manager understood their responsibility with regard to Deprivation of Liberty Safeguards (DoLS) and they had applied for authorisation under DoLS to ensure people were protected against the risk of being unlawfully deprived of their liberty. They were no longer in breach of Regulation 11 however we have made a recommendation that the provider review the system used to ensure best interests decisions are clearly documented and guidance for staff about authorised DoLS are referenced in care plans.

Improvements had also been made to the management of risk and the plans of care for people. Care records contained information to guide staff about the management of risk associated with people’s needs. Staff were knowledgeable of people’s needs and the support they required. The provider was no longer in breach of this element of Regulation 12. However the management of medicines needed to be improved. Multiple occasions were found which showed staff had signed to say medicines had been administered but this had not happened. This was a breach of Regulation 12.

Systems were in place to monitor and assess the quality of the service provided. Some records required further work to personalise them and ensure they were accurate and reflected people’s needs. The manager had identified this need and developed and action plan to address this as well as other areas which required improvement. However, as the manager was new to the service they needed time to make the changes and embed these.

People felt safe and staff knew their roles and responsibilities in safeguarding people.

Thorough recruitment checks were carried out to check staff were suitable to work with people. Staffing levels were mostly appropriate to meet people’s needs, although we have made a recommendation that the provider revi

During this visit we spoke with six people who use the service, two relatives, five care staff and both of the management team.

One person told us "it is a wonderful home, staff are so helpful". Others told us how good the service was.

Both relatives that we spoke with said that "staff were attentive to the needs of their Aunt". They said that the home was "the best that they found in the area" and that they were very happy with the service.

People we spoke with said they felt safe in the home and said they were confident that staff would respond appropriately to any concerns they raised. People told us the manager regularly asked them how they were.

All of the care staff working at the home have completed National Vocational Qualifications (NVQ) at level 2, 3 or 4.

People told us they are happy living at the home. They receive the care and support thy need in a way they prefer because staff listen to their wishes and involve them in care planning processes. They commented that the home arranges for them to see health care professionals such as General Practitioners (GP’s) and Community Nurses when they need to.

People told us that one of the best things about the home was that they were allowed to make their own choices. This included choices of activities, when to get up and go to bed, and for those who were able to whether to access the local community independently.

People confirmed that they are able to influence the running of the home in a variety of methods that include resident meetings, general discussions, surveys and care plan reviews.

This inspection took place on 4 and 5 August 2015 and was unannounced.

Farehaven Lodge is a service that is registered to provide accommodation for up to 40 older people, some of whom are living with dementia. Accommodation is provided over two floors and there are stair lifts to provide access to people who have mobility problems. At the time of our visit 28 people lived at the home.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Identified risks associated with people’s needs had not always been assessed and clear plans developed to ensure staff could mitigate such risks. People felt safe and staff knew their roles and responsibilities in safeguarding people. Where concerns required reporting the provider had ensured this was done. Medicines were stored and managed appropriately. The registered manager had identified some issues of concern in the signing of creams and ensuring all creams were dated when opened and was taking action to address this.

Thorough recruitment checks were carried out to check staff were suitable to work with people. Relatives and staff raised concerns about staffing levels, however our observations did not support these concerns and we found there to be enough staff to meet people’s needs at the time of our visit.

Staff were supported to develop their skills through training and the provider supported staff to obtain recognised qualifications. Supervisions were not consistently taking place although staff told us they felt very supported and could approach the manager at any time for advice or to discuss concerns. We have made a recommendation about the supervision and appraisal process.

Consent was sought from people who were able to provide this and we saw people making their own decisions throughout our inspection. However staff and the registered manager did not demonstrate an understanding of the Mental Capacity Act 2005. This had not been applied appropriately. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service had submitted applications for DoLS for everyone living in the home, although they had not fully assessed people’s capacity and had applied for some people who they said had capacity.

People were satisfied with the food provided and said there was always enough to eat. People were given a choice at meal times and were able to have drinks and snacks throughout the day and night. Improvements were needed where people’s nutrition and hydration needs required monitoring and we have made a recommendation about this. Staff supported people to ensure their healthcare needs were met.

People told us the staff were kind and caring. No one had any concerns and said they were happy with the care and support they received. Staff respected people’s privacy and dignity and used their preferred form of address when they spoke to them. Observations showed that staff had a kind and caring attitude. People told us the manager and staff were approachable. Relatives said they could speak with the manager or staff at any time.

The registered manager operated an open door policy. Staff felt there was a culture of learning encouraged by the manager. They felt the manager and other senior staff were approachable and they could talk to them at any time.

The provider had a number of auditing processes in place however we were not always assured of their effectiveness in identifying areas of concern and driving improvements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.