Francis Lodge Residential Home is a privately owned residential care home. It provides personal care and accommodation for a maximum of four older people who may have dementia. During this inspection, there were four people using the service.

There was manager in post who is the registered provider of this service. 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. As the provider is an individual they are not required to also have a registered manager. At this service the registered provider is also the manager. We call the registered provider / manager “the provider” throughout the report.

At our last inspection of 23 December 2014, the provider had not taken appropriate steps to ensure there were sufficient staff numbers in the home. This meant the provider was in breach of Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan setting out the actions they would take to meet the regulation. At this inspection, we found that the provider had followed their action plan and met the regulation. We observed and records showed two members of staff were allocated during the morning and there were sufficient staff available during the day.

Although there were some positive aspects to the service such as people were being cared for and supported to have access to healthcare services, we found failings in each of the five domains resulting in people who used the service receiving lower standards of care than they should.

Individual risk assessments were completed for each person. However, the assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. For example three people using the service all need support with their mobility however there were no risk assessments in place to prevent the risks of falls occurring.

Care plans were not person centred and did not reflect people’s current needs. Complete and contemporaneous records had not been kept about people’s care and support they needed and were receiving.

There were suitable arrangements in place to manage medicines safely and appropriately.

Training records showed staff did not receive regular and appropriate training for them to gain the necessary knowledge and skills they needed to carry out their roles and responsibilities effectively.

We saw people being treated with respect. Care workers had a good understanding and were aware of the importance of treating people with respect and dignity and respecting their privacy.

People were supported to maintain good health and have access to healthcare services and received on going healthcare support.

Although the provider had contact with people’s relatives, there had been no formal review meetings with people using the service and relatives in which people’s care was discussed and reviewed to ensure people’s needs were still being met and to assess and monitor whether there had been any changes.

Three people using the service were elderly with dementia care needs, however, there were no reasonable adjustments made to the environment of the home to ensure it was a dementia friendly and help people to recognise and navigate around the home.

The management structure of the home consisted of the provider and a team of care workers including two volunteers. However, the roles of the volunteers were not clearly defined which could place people at risk of receiving support which is inappropriate.

We made three recommendations about reviewing safe recruitment practices, surveillance being operated in line with current guidance and reasonable adjustments for people with dementia.

We found five 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 the report.

We carried out an inspection on the 27 June 2014 and we found people who used the service were not protected against the risks of unsafe or unsuitable premises. There were no risk assessments to ensure their safety in using the steps to the garden and the stair lift to the first floor. The provider had failed to comply with Regulation 15 HSCA 2008 (Regulated Activities) Regulations 2010.

We received an action plan from the provider which detailed what they would do to comply with the regulations.

We undertook a responsive follow up inspection on 23 December 2014 to see if the provider took action to comply with Regulation 15 HSCA 2008 (Regulated Activities) Regulations 2010.

We received information from the local authority about concerns for people’s safety and welfare in relation to this service. We looked into these concerns as part of this inspection and to answer the following key questions: is it safe, is it effective and is it responsive.

People who used the service were older people with dementia. There were three people using the service however at the time of this inspection we spoke to two people as one person had been admitted to hospital.

We also spoke to one relative, two visiting district nurses, one care worker and the provider. We observed how the staff interacted with people who used the service and looked at how people were supported during the day and meal times.

We reviewed three care plans, one staff file, training records and records relating to the management of the service such as audits, policies and procedures.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed 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?

Some aspects of the service were not safe. When we arrived at the home, the provider was the only member of staff on duty to provide personal care and support to two people who require full support with their personal care needs. Staff rotas showed and staff told us there were times when they worked on their own and in the morning when people needed personal care it was felt that for three people who require full support with their personal care and mobility, one care worker was not enough however the provider was always available if required. Care plans also indicated that people in the home would require one to one support from care workers. The provider did tell us that she was going to be reviewing the staffing levels in the home.

The provider did not take the appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons in the home to ensure the safety and welfare of people using the service. The provider had failed to comply with Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010.

The service identified when people were at risk. Risk assessments had been completed which provided guidance on how to minimise risks for people.

Is the service effective?

The service was effective. People were cared for by staff that felt they were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities.

People were supported to be able to eat and drink sufficient amounts to meet their needs and had access to health and medical services.

Is the service responsive?

The service was responsive. Care plans were person-centred and specific to each person and their needs. People’s care preferences and routines were clearly reflected in their plan of care.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? We received information from the local authority that they had asked the provider to address specific areas of concern. We included these areas in our inspection

We spoke with three people who were currently using the service, and four members of staff, including the provider. We observed how staff interacted with people who used the service.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed 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?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Assessments were carried out and reviewed regularly for aspects of health and safety. Care plans and risk assessments, for example for mobility, personal hygiene and communication, provided details of how best to support each person. However there were no risk assessments in place to ensure that people using the service used the steps to the garden and the stair lift to the first floor safely

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Staff we spoke with told us that they felt well supported and received appropriate training and supervision to enable them to carry out their responsibilities and to care for people appropriately.

People were provided with a choice of suitable and nutritious food and drink and staff supported them to eat and drink sufficient amounts to meet their needs. Care plans recorded how each person ate and the support they needed. Staff were aware of the need to assess people for the risks of poor nutrition, and the signs that they should be aware of.

Is the service caring?

Care plans contained information about each person's specific needs for staff to follow.

People expressed their views and were involved in making decisions about their care and treatment. Care plans showed how people preferred their care to be provided.

We observed that staff interacted with people in a respectful and sensitive manner. They took time to assist people and spoke with them while they assisted them.

Is the service responsive?

The provider carried out satisfaction surveys and monitored the responses and any concerns.

We saw that staff carried out monthly evaluations of each person’s individual care plans and that care plans were updated when required.

Is the service well-led?

At the time of our inspection the provider did not have a registered manager in place.

Staff we spoke with said that the provider gave them with good support and they were clear about their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They carried out regular health and safety audits of the premises and annual quality surveys of the views of people using the service and their family members.

At the time of our inspection, the home was providing care for four elderly people with dementia.

People who used the services received appropriate care and support that met their individual needs and they were treated with dignity and respect.

There were processes in place to protect people using services from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

The staff were supported to provide care and treatment to people who used the service and were being trained, supervised and appraised appropriately.

There was an effective complaints system available.

We talked with two people who use the service who told us that they enjoyed living at the home and they were well cared for. One person said ,"It's alright here, its not home but the girls are good, I always get plenty to eat and there is always lots to do if you want it".

We found people had comprehensive care assessments that included their wishes and views. We found the systems in place prevented people receiving inappropriate or unsafe care.

We observed that the environment people were cared for in was clean and that the provider had systems in place to reduce the risk of the spread of infections.

We looked at how medication was administered and found that there were systems in place to ensure that people received their medication correctly.

We found at a previous inspection in July 2011 that people were not always cared for by sufficient numbers of staff. We found at this inspection that the provider had made improvements and people were now cared for by sufficient numbers of staff.

People who use the service were involved in making everyday decisions about their participation in activities and their choice of food and drinks. They told us that staff were “alright” and available when they wanted or needed them. Staff were aware of people’s personal preferences and adapted their approach and care accordingly. People told us that they liked the food that was served but couldn’t always remember what was on the menu.

We saw that staff interacted positively with people and were caring and respectful when they talked with people but staff rotas show that at times there are insufficient staff on duty to adequately meet peoples needs.