About the service: Livesey Lodge Care Home is a single storey, purpose built residential home which provides care to older people including some people who are living with dementia. The service is registered to provide care for up to 24 people. At the time of our inspection there were 15 people using the service.

People’s experience of using this service:

• The provider had taken steps to make improvements to the service. However, there was insufficient evidence to demonstrate that the improvements would be sustained.

• There was no clear culture of transparency and open communication within the service.

• The management and administration of people’s medicines were safe. However, further improvements were required in the management and recording of support people received with prescribed creams.

• The provider had made improvements in the environment to make it safe for the people that used the service.

• The registered manager used a dependency tool to measure that there was sufficient numbers of staff to meet people’s needs.

• People were supported in accordance to relevant legislation. They were supported to maintain choice and control in their care planning.

• Staff supported people to meet their nutritional and health needs.

• Staff were kind and considerate to people.

• People were supported to engage in their interest and beliefs. They were supported to maintain relationships with people that were important to them.

• People had opportunities to raise any concerns they may have about the care they received.

Rating at last inspection: Inadequate; (published 14 December 2018).

Why we inspected: At our last comprehensive inspection on 15 May 2018 we found two breaches of the Health and Social Care Act 2008 (HSCA RA) (Regulated activities) Regulations 2014. These were breaches of Regulation 12 HSCA RA Regulations 2014; Safe care and treatment and Regulation 17 HSCA RA Regulations 2014; Good Governance. The service was rated as Requires Improvement. The Care Quality Commission (CQC) had also served the provider a warning notice for the breach of Regulation 17 HSCA RA Regulations 2014; Good governance.

On 25 October and 2 November 2018, we carried out a focused inspection to follow up concerns shared with the CQC. We inspected the service against two of the five questions we ask about services; 'Is the service Safe?' and 'Is the service Well Led?' This is because the service was not meeting some legal requirements in these areas and the information shared was relevant to these two key questions. At that inspection we found the provider had made some changes, but overall there was little improvement in the overall safety or governance of the service and the provider continued to be in breach of the regulations of the Health and Social Care Act 2008. The service was rated as Inadequate and went into special measures.

Following our inspection, the provider informed us what they would do to meet the regulations.

We carried out this comprehensive inspection to check their progress on improving the service and to check if they had now met the regulations. Our visit was unannounced. This meant the staff and the provider did not know we would be visiting. During this inspection we found the provider had implemented the necessary improvements, although some areas still needed further improvement. At this visit we found evidence to demonstrate and support the overall rating of Requires improvement. The service is no longer in special measures.

Follow up: ongoing monitoring; We will continue to monitor the home in line with our regulatory powers.

We undertook this unannounced, focussed inspection on 25 October and 2 November 2018. The inspection was prompted, in part, by information shared with the Care Quality Commission which indicated potential concerns regarding the health, safety and wellbeing of people using the service. This inspection examined these concerns and potential risks to people's safety. We inspected the service against two of the five questions we ask about services; 'Is the service Safe?' and 'Is the service Well Led?' This is because the service was not meeting some legal requirements in these areas and the information shared was relevant to these two key questions.

Livesey Lodge Care Home is a single storey, purpose built residential home which provides care to older people including some people who are living with dementia. The service is registered to provide care for up to 24 people. At the time of our inspection there were 20 people using the service.

Livesey Lodge Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Our last comprehensive inspection of this service was carried out on 15 May 2018. Two breaches of the legal requirements were found and we issued a warning notice. We found staff were not consistently following policies and procedures to ensure the safe management and administration of medicines, including those related to infection control. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe Care and Treatment. We also found the provider did not have effective quality assurance to monitor the quality of the care provided and ensure people received good care as a minimum standard. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance.

We rated the service as 'Requires Improvement'. The provider submitted information stating what they intended to do to address the shortfalls. You can read the report from our latest comprehensive inspection by selecting 'all reports' link for Livesey Lodge Care Home on our website at www.cqc.org.uk.

At this inspection we found the provider had made some changes, but overall there was little improvement in the overall safety or governance of the service and the provider continued to be in breach of the regulations of the Health and Social Care Act 2008.

The overall rating for this service is 'inadequate' and the service is therefore in 'special measures.' Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If no improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

There was a registered manager in post who was also the provider. 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 respo

The inspection visit was carried out on 15 May 2018 and was unannounced.

At the last comprehensive inspection in April 2017 the service was rated, 'Requires Improvement.' We found the service had made some improvements since our previous inspection in January 2017. However, further improvements were needed to ensure there was sufficient staffing to meet people's needs, risk assessments included the detail and guidance staff needed to keep people safe and meals were sufficiently varied and provided in a way in which people's needs were met.

At this inspection, we found the provider had made some improvements to meals and staffing. However, further improvements were needed to the management and administration of medicines, the safe deployment of staff and quality assurance to ensure people received consistently good care. The provider had failed to make sufficient, sustainable improvements to the quality of the service. The overall rating for this service remained 'Requires Improvement'. The service has been rated as 'Requires Improvement' for over three consecutive inspections.

Livesey Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Livesey Lodge Care Home accommodates up to 24 older people in one purpose built building. At the time of our inspection there were 18 people using the service, many of whom were living with dementia.

The service had a registered manager 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.

Improvements were needed in the management and administration of medicines to ensure people received these safely. Staff demonstrated they did not consistently follow policies and procedures in managing medicines, including those related to infection control.

There were sufficient numbers of staff to meet people's needs but staff were not always deployed effectively to ensure people received the supervision they needed.

Staff demonstrated a good understanding of actions they needed to take to keep people safe. Records showed potential risks to people had been assessed, but did not always include the detail and guidance regarding the measures and interventions staff needed to take to reduce risks.

The provider had systems in place to monitor the quality of the care people received. These were not used consistently or effectively in ensuring staff followed systems and processes and people received good care as a minimum.

There were arrangements in place for staff to make sure that action was taken and lessons learned when accidents or incidents occurred. Reviews and analysis of records was not always undertaken in a timely manner to identify trends and patterns.

People were offered a limited range of activities. Further improvements were needed to ensure people were supported to engage in meaningful activities and were provided with sufficient stimulation to meet their needs and wishes.

Staff had completed training to enable them to recognise signs and symptoms of abuse and felt confident in how to report concerns.

Staff were protected from the risk of unsuitable staff because the provider followed safe recruitment procedures.

Staff received on-going development training and supervision of their role. The registered manager reviewed and evaluated training to ensure it was effective. This supported staff to gain the skills and knowledge they needed to provide effective care.

People were provided with sufficient to eat and drink. Improvements had been made to the variety and provision of meals in the service.

We carried out an announced comprehensive inspection of this service on 16 and 18 November 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to assessing and monitoring the quality of the service, providing person centred care, safeguarding people from abuse and receiving and acting on complaints. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements.

Livesey Lodge provides residential care for older people. It is registered to accommodate up to 24 people, there were 21 people using the service on the day of our inspection.

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.

People and their relatives told us that they felt safe. Staff were aware of their responsibility to keep people safe. Safe recruitment practices were followed. People told us that there were not enough staff to meet their needs.

Risk associated with activities of people’s care had been assessed. Guidance was provided to staff to keep people safe from the risk of harm. The environment and equipment was checked and maintained in order to keep people safe. However, risks associated with hot radiators had not been assessed.

Staff had received training and supervision to meet the needs of the people who used the service. Staff told us that they felt supported.

People received their medicines as required. Medicines were administered safely by staff who were appropriately trained and competent to do so. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People were supported in line with the requirements of the Mental Capacity Act (MCA). People’s capacity to consent to their care had been assessed when there was a reasonable belief that they may not be able to make a specific decision.

People were supported to have enough to eat and drink.

People were supported by staff who understood that they should be treated with dignity and respect. People’s independence was promoted and encouraged. People’s relatives were welcomed to visit them without undue restriction.

People were supported to engage in activities that they enjoyed. People’s relatives had been asked for feedback about the service. People themselves had not yet been offered opportunity to feedback about the service.

People received support that was centred on them as individuals. Records reflected that people’s care needs had been met.

People’s relatives felt that the service was well-led. They knew how to complain should they have needed to.

Staff felt supported and that communication between them and the registered manager was good. They were clear on their role, the expectations of them and the aims and objectives of the service.

The registered manager had taken action to address concerns raised at our previous inspection. Systems were in place to monitor the quality of the service being provided.

The registered manger was aware of their responsibility to report to CQC and external agencies events that occurred within the service.

We carried out our inspection visit on 16 and 18 November 2016. The inspection was unannounced on the first day.

At the last inspection on 9 April 2015 we asked the provider to take action to make improvements. We asked them to improve practice relating to ensuring that people’s care was centred on their wishes and assessed needs and with regard to the way that the service was run. At this inspection we found that the provider had not made the necessary improvements. We identified that the provider was in breach of four of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. You can see at the end of this report the action we have asked them to take.

The service provides accommodation for up to 24 older people and people with dementia and physical disabilities. On the day of our inspection there were 22 people using the service. Some of the people that used the service had advanced levels of dementia.

There was 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.

People did not feel safe at Livesey lodge. Staff had received training to keep people safe and understood how to raise concerns. The registered manager was not aware of their duty to report and respond to safeguarding concerns.

Some people displayed behaviour that could have caused harm to themselves and others. Staff were not clear about how best to support people whose behaviour posed a risk. Staff did not always have the knowledge and skills to meet the needs of people who were living with dementia.

Safe recruitment checks had not taken place prior to staff employment. There were not always enough staff to meet people’s needs.

People were not protected from risks relating to their support needs for example when they needed support to maintain a balanced diet.

People could be assured that they received their regular medicines as prescribed by their doctor. People’s health needs were met and when necessary, outside health professionals were contacted for support.

People were not supported in line with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s consent was not routinely asked.

Where people were at risk of dehydration this was not monitored appropriately. People were not consistently offered choices about their meals.

Staff treated people with dignity and respect but people’s bedrooms were not respected as private. People were not offered the opportunity to contribute to the planning of their care. People were not consistently supported to engage in activities that they enjoyed

Records were not always detailed and did not always reflect the support that people had received particularly around people’s anxieties. People were at risk of being over medicated when experiencing behaviours that could cause harm or distress to themselves or others.

People’s care plans did not include enough information to guide staff on the activities and level of support people required for each task in their daily routine. There was a risk that people would not receive the care that they needed. People’s changing needs were not formally assessed.

Feedback about the service had not been sought and complaints were not dealt with in line with the provider’s policy. People could not be confident that the registered manager would act on their concerns even when these were expressed to staff. There were no systems in place to challenge poor staff practice and take action where concerns had been raised.

Systems were in place to monitor the quality of the service being provided however, these were not always effective. Not all of the concerns raised a

The inspection took place on 9 April 2015 and was unannounced.

At our last inspection on 30 December 2013 the service was meeting the regulations.

Livesey Lodge Care Home provides accommodation and care for up to 24 people. On the day of our visit there were 16 people at the service. Accommodation is arranged over one floor.

There is a registered manager at the service. 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.

People and relatives that we spoke with made positive comments about the staff. People’s privacy and dignity was respected. Staff had a good understanding of how through their daily work they could ensure that this was maintained. People had care plans in place that contained information about their preferences. We saw that people’s preferences were recorded and respected by staff.

People often had to wait for staff to support them as they were busy carrying out other tasks.

There were limited opportunities for people to be involved in activities and people told us they were bored.

Staff had a good understanding of the types of abuse and how they were to report any concerns. People told us they would be able to raise any concerns. Staff told us that the registered manager was approachable and that they felt well supported in their roles.

People felt that there were enough staff to meet their needs but staff were expected to carry out laundry and domestic jobs within their roles. This led to the time they had available to spend with people that used the service being limited. People often had to wait for their requests to be actioned. The general environment was in need of a deep clean as staff did not have the time to do this.

People were provided with food to meet their dietary needs but people were not provided with opportunities to express their wishes or preferences.

The service had failed to ensure that people’s risk assessments had been updated following incidents to ensure that they continued to meet people’s needs and reduce the risks of them occurring again. The service had failed to ensure that they had regard for people’s wellbeing where they were responsible for meeting people’s nutritional needs.

Quality assurance audits that were undertaken by the service failed to identify the concerns that we found. Environmental hazards to people that used the service had not always been identified. The service did not have an effective system in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users.

We found two 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 spoke with five people who use the service and asked them for their views about the care and support they received at Livesey Lodge. People’s comments included: “Well it’s good, the staff are fine and whatever you ask for they give.” “The staff here are lovely, we don’t have to wait for help, even in the night.” “The care is good; If I press the buzzer they’re quickly here. They look after me.” We spoke with two people who were visiting their relative. They told us their relative was always well presented and they didn’t have any concerns about the care provided.

People’s needs and the support they required were recorded within care plans. People were supported by a range of health care professionals in the monitoring of their health and wellbeing. Staff we spoke with had a good understanding of the needs of people who used the service.

We found people’s nutritional needs were assessed through the services assessment process. We observed the lunchtime dining experience for people, which was positive. People we spoke with gave mixed views about the meals provided. One person told us: “The food isn’t that good, I’d like a bit more meat and roast potatoes instead of mashed.” Whilst two other people told us: -“The food is alright.” And “the food is reasonable, however there’s no choice, but if you didn’t like something they’d cook you something else.” The Chef, who was new to the service, told us they had begun consultations with people about their meal preferences and were hoping in conjunction with the provider to revise the menu and the meals provided.

Records we viewed confirmed staff had undergone an effective recruitment and selection process and had accessed the appropriate training. We viewed records which showed the service had effective systems for the maintenance of the property.

We inspected Livesey Lodge in October 2012 and have returned to check compliance with regulations. We saw people who used services finish their breakfast, talking together and with staff. We spoke with three people they told us they were very happy at the home and felt the care they received was good. One person told us: "The staff are brilliant." Another person said: "The activity person painted my nails for me, they look lovely." We saw people were dressed well and observed staff talking to people about their hair and skin care needs and meeting their requests. During our inspection we saw new windows and doors being installed and the manager confirmed further improvements were being made with new carpets, bedroom furniture and blinds purchased. This would improve the environment and people's comfort.

People told us they were well looked after and had confidence in the staff. Two visitors told us they had no complaints but if they had, they would contact the staff or the manager. One person asked for water to be served with her meal each day instead of fruit juice. We passed these comments onto the manager to address.

" They clean my room well and I have a new mattress on my bed."

" There is plenty of food to eat, it is very nice here."

" Nothing concerns me here."

" Two staff always use the hoist when they assist me."

During our inspection visit we saw people sitting in lounges, reading papers, taking a midday meal, and talking with the activity coordinator. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The home had not been adequately cleaned and maintained. We saw staff appeared hurried when meeting people’s needs. There were staff vacancies and insufficient staff on duty. The provider was unable to show us evidence of ongoing formal quality and safety checks. We saw standards had dropped and had not been noted by the provider.

We observed people finishing breakfast in the dining room, in the lounge reading newspapers and magazines, talking in small groups, and having a meal. We observed people and their interactions with each other and with staff.

We spoke with four people. They told us they were happy with the care and liked the staff and the activity coordinator. People told us staff were polite, kind and caring and they were addressed by their preferred name. We also spoke with one visitor to seek their views on the care provided. Visitors told us the care was good and their relative enjoyed joking with staff.We also received comments that the running of the home was disorganised and there were not enough staff.