Lillibet 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.

Lillibet Lodge can accommodate up to 25 older people who have a range of care needs including dementia, mental health, physical disabilities and sensory impairments. Long-term placements as well as respite and / or rehabilitation needs are catered for. The accommodation is arranged over three floors and can be accessed using a passenger lift. There are two communal areas, accessible outside space and 23 bedrooms - two of which are shared rooms. At the time of this inspection there were 21 people living at the home.

A registered manager was in post. 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 last inspection on 14 February 2017, the home was rated Requires Improvement. During this inspection, which took place on 24 April 2018, we found the home remained Requires Improvement. This is the second time the service has been rated Requires Improvement. Despite this, there was evidence of real progress being made in all the areas we identified for improvement at the last inspection. The registered manager and provider have accepted our findings from this inspection and have already sent us a plan which includes appropriate actions to address all of the areas we identified for improvement on this occasion. We will carry out another inspection in due course, to check their progress with the actions they have proposed to take.

Systems were in place to ensure people received their medicines in a safe way however, these were not followed on the day of the inspection. The registered manager took swift action to ensure this didn’t happen again.

People were protected by the prevention and control of infection but more work was needed to ensure the home was free from offensive odours. The registered manager had already taken steps to address this, including appointing a member of staff to carry out deep cleaning in the home.

The provider carried out checks on new staff to make sure they were suitable and safe to work at the home. However, changes were needed to ensure all required employment checks were carried out for new staff before they started working at the home. We found a small number of checks were missing, such as unexplained gaps in employment history.

Staff received training to support them in their roles, but work was needed to improve the quality of the training provided. Staff we spoke with confirmed they had received training but were unable to articulate their learning adequately.

People were supported to eat and drink enough, but improvements were needed to enhance their enjoyment of the food provided, and to ensure that people’s dietary and religious needs were always adhered to. We observed someone being given something to eat that they should not have been given. Once again, the registered manager took swift and responsive action to address this. Risks to people with complex eating and drinking needs were being managed appropriately.

People were protected from abuse and avoidable harm. Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure risks to people were managed safely.

Improvements had been made to ensure there were sufficient numbers of suitable staff to keep people safe and meet their needs.

There was evidence that the home responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

The building provided peop

This inspection took place on 14 February 2017 and was unannounced.

Lillibet Lodge is a residential care home providing a service for up to 25 adults, who may have a range of care needs, including physical disabilities, mental health, dementia and sensory impairments. There were 24 people living at the service on the day of the inspection.

A new manager was in post who had applied to register with us, the Care Quality Commission. 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 found some areas that required improvement:

Staff had the right skills and knowledge to meet people’s needs. However, people told us they were often left waiting for help when they called for assistance, and records we looked at supported this.

Care plans had been developed to record how people wanted to receive their care and support. However, these sometimes lacked important information about the person involved, or they were not followed consistently.

People were given opportunities to participate in meaningful activities when staffing levels allowed for this. This meant that there wasn’t a regular programme of activities, particularly for those people who were not able to, or chose not to, leave their rooms.

Systems were in place to monitor the quality of the service provided and drive continuous improvement. However, these were not always effective because we found that concerns identified during this inspection had not always been picked up within audits that had been carried out.

The manager and provider acknowledged our findings and following the inspection, provided an action plan and clear assurances that all these areas would be addressed.

We also identified many areas during the inspection where the service was doing well:

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service and staff were confident about reporting any concerns they might have.

Processes were in place to manage identifiable risks within the service to ensure people did not have their freedom unnecessarily restricted.

The provider had carried out appropriate checks on new staff to make sure they were suitable to work at the service.

Systems were in place to ensure people’s daily medicines were managed in a safe way.

Staff had received training to carry out their roles, including support to complete nationally recognised induction and health and social care qualifications.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

Systems were in place to ensure the service worked to the Mental Capacity Act 2005 key principles, which state that a person's capacity should always be assumed, and assessments of capacity must be undertaken where it is believed that a person cannot make decisions about their own care and support.

People had a choice of food, and had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

The service worked with external healthcare professionals, to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

We saw that people were given opportunities to express their views on the service they received and to be actively involved in making decisions about their care and support.

A complaints procedure had been developed to let people know how to raise concerns about the service if they needed to. People were confident in raising concerns