This inspection took place on 31 July and was unannounced.

Green 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. The service is registered for 57 people and at the time of inspection there were 35 people living at the service. The service provided care to older people and people living with a dementia.

A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission (CQC) in December 2017. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

The last inspection of the service was carried out in June 2017 and found that the service was not meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. We found concerns relating to risks to people arising from their health and support needs and risks to the premises and equipment. Staffing levels were low and medicines were not administered safely. We also found systems and processes were not in place to ensure effective operations of the service, there were limited checks to ensure the safety of people living at the service and the dining experience did not meet people’s needs or promoted their wellbeing. Following this inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good.

At this inspection we found that the provider had made improvements. However, work was still needed to make the administration of medicines safe. We found some medicines were out of stock for up to ten days and staff were not completing the electronic medicine administration records correctly. This is the second time the service has been rated requires improvement.

Audits were taking place with a full action plan along with an analysis and lessons learnt. However, the medicine audit did not highlight any concerns.

Risks associated with people's support needs were now fully considered and correctly documented in care plans.

Staffing levels had increased, and recruitment was still ongoing.

We have made a recommendation about staffing levels.

Accidents and incidents were recorded, analysed monthly with an action plan to support any lessons learnt.

The registered manager understood their responsibilities in relation to the DoLS. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

Staff training was up to date. Supervisions and a yearly appraisal were taking place or booked in.

Feedback on the quality of the service had been sought and was positive.

People enjoyed the food provided and the dining experience had improved. Specific cultural diets were provided if needed.

People could access healthcare services as needed.

People who lived at the service were safeguarded from abuse. People told us that they felt safe at the service and that they trusted staff. Staff had received training in the safeguarding of vulnerable adults and said they would not hesitate to report concerns.

A number of recruitment checks were carried out before staff were employed to ensure they were suitable to work with vulnerable adults.

People received support from staff who were kind, caring and compassionate. People felt they were treated with dignity, respect and valued as individuals. People's right to independence and choice was promoted.

Staff demonstrated a person-centred approach to care and they knew people well. Care plans had in

The inspection was unannounced which meant the staff and provider did not know we would be visiting. This was the first inspection of the service since the new provider, Indigo Care Services Limited (also known as Orchard Care Homes) took over in April 2016.

Green Lodge is a purpose built care home providing accommodation across two floors. The home itself is positioned in a residential area and offers designated parking to visitors and people who use the service. The ground floor Ash unit accommodates up to 25 people with residential care needs. The upper floor is split into two units, Cedar and Oak. The Cedar unit offers accommodation for up to 15 people with residential care needs. The Oak unit is a dedicated dementia care unit designed for older people living with a dementia and can accommodate up to 17 people.

Each unit has its own kitchenette area, where people who use the service, their visitors and relatives can make tea and coffee. Each bedroom offers en-suite facilities and each unit also has additional bathing and showering facilities.

The service had a registered manager. 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. At the time of inspection the registered manager was on annual leave.

Risks to people arising from their health and support needs were not always assessed, and plans were not always in place to minimise them. Risks to people arising from the premises were assessed, and plans were in place to minimise them. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use. However the file that would be grabbed in case of an emergency such as a fire contained personal emergency evacuation plans for six people who no longer lived at the service. This meant that in the event of a fire, emergency services would be looking for people that were no longer there.

We found there was not enough staff to meet people's needs. On the ground floor there was one senior care worker and two care workers, nine people needed two to one care and nurse call alarms rang continuously throughout the day.

Medicines records for applying topical creams were inconsistent, controlled drugs had not been checked since April 2017 and the temperature of the fridge where medicines were stored showed temperatures of between nine and 12 degrees Celsius on 16 occasions from the 1st to the 27th of June 2017. Fridge temperatures should be between 2 and 8 degrees Celsius.

We found the care plans were not person centred, and did not reflect people’s current needs. One person was receiving end of life care and had a syringe driver in place but this was not documented in the care plan. One person had a do not attempt cardiopulmonary resuscitation (DNACPR) in place, however in their care plan a note stated the DNACPR had been returned to the GP to have the address changed. This had happened on 9 June 2017 and no staff member had chased this up for 18 days. The purpose of a DNACPR decision is to provide immediate guidance to those present, mostly healthcare professionals on the action to take should the person suffer cardiac arrest or die suddenly. It had been this person’s choice not to be resuscitated but due to the DNACPR not being available their wishes would not have been respected.

Audits were taking place, however were not robust enough to highlight the issues we found during our visit. Many audits did not have action plan in place.

Staff did not receive supervision in line with the home’s supervision policy. The manager completed senior care workers supervisions and the senior care workers completed care workers supervisions. However senior care staff said they struggled with the time to do th