We inspected Lydgate Lodge on 3 and 9 April 2018. Both days of the inspection were unannounced.

Lydgate Lodge is registered to provide personal care and ensuite accommodation for up to 64 older people, some of whom live with dementia. There were 54 people living at the home at the time of the inspection. The home has two floors accessed by passenger lifts. Each floor has one unit for people with residential care needs and one unit for people living with dementia. Units contain communal bathrooms, a lounge and dining area. Outside there is an enclosed garden with seating areas.

Lydgate 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 home 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 last inspection in January 2017, the service was rated ‘requires improvement’ and there were three breaches identified in the regulations for staffing, safe care and treatment, and good governance. At this inspection we found improvements were ongoing but there were still areas in need of improvement, some of which were featured in the previous inspection. These were understood by the management team and there was evidence these were being addressed.

Lydgate Lodge had a welcoming and professional approach; the environment was pleasant and homely, people said they felt happy and safe and staff reported good morale in the teams.

Systems for managing risks were in place, but were not sufficiently robust or individualised for some aspects of people’s care. Not all staff were confident in the fire evacuation procedures.

People said that they felt safe at all times and were really clear about who they could turn to if they were worried or had any concerns. The staff were also aware of the role they played in keeping people safe by reporting any concerns. Staff understood procedures to follow to ensure people were safeguarded against abuse.

Staffing deployment at times did not ensure people’s needs were met in a person-centred way; the rotating deployment of staff did not ensure consistent understanding of people’s needs. Relatives felt that there were times when the team were short staffed although staff did not share this view.

The home was visibly clean in most areas, although the kitchenettes within each unit were not cleaned thoroughly and some equipment was not cleaned or stored appropriately.

The administration and management of medicines at Lydgate Lodge was safe. An issue with topical medicines recording had been identified prior to this inspection and a solution identified.

There was effective teamwork and staff communicated well with one another about people’s needs. Staff understood people’s rights and the legislation which supported this, such as the Mental Capacity Act.

Staff felt supported through training and supervision, although training records were cumbersome.

People enjoyed their meals on the whole, although where some people had received specialist advice this was not always followed properly.

Staff used new technology to update information about people’s care as it happened, although there were some inconsistencies in recording identified at this inspection.

People were aware of the complaints procedure and we saw complaints were responded to. Some relatives raised concerns about the laundry system and the provider was working to address these.

There was a range of suitable activities available for people at Lydgate Lodge, although not all people were able to participate in these.

The managem

The inspection of Lydgate Lodge took place on 25 and 26 January 2017. This was the first inspection of the home with the registered provider, Ideal Carehomes (Number One) Limited.

Lydgate Lodge provides care and support to a maximum of 64 people. The home is purpose built over two floors with a total of four separate units, two of which provide care and support to people who are living with dementia. One the day of our inspection there were 62 people living at the home with another person being admitted on the first 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 told us they felt safe and staff understood their responsibilities in keeping people safe from the risk of harm or abuse. Accidents and incidents were reviewed and analysed to enable possible trends to be identified and appropriate action taken.

People’s care plans contained a variety of risk assessments, but they were not always a precise reflection of people’s care and support needs. We also found staff had not always assessed people’s risk correctly. This raised the risk of people receiving unsafe or unsuitable care.

External contractors were used to service and maintain equipment at the home, however, the internal checks completed by the maintenance staff could not be located on the day of our inspection. Information was readily available for staff in the event of an emergency, this included contractor telephone numbers and personal emergency evacuation plans for people living at the home.

We found staff recruitment was safe, but we were concerned there were not enough staff on duty on a daily basis to meet people’s needs. Relatives and staff told us there were not enough staff on duty and we observed staff were busy and lacked time to spend with people other than part of a task related activity.

People’s medicines were managed safely, however, we could not accurately tally all the medicines we audited. Staff’s competency to administer people’s medicines was assessed and staff were also provided with training in medicines awareness.

Staff attended a handover prior to their shift although we found the information on the handover record was not always reflective of people’s current needs.

New staff completed a two weeks corporate induction programme although evidence of this was missing in two of the four staff files we reviewed. There was a programme in place to ensure staff received regular refresher training and management supervision.

Staff respected people’s right to make decisions. Where a person lacked the capacity to decide they wanted to live at the home, a capacity assessment had been completed but there was a lack of capacity assessments regarding other aspects of their care. A number of applications had been made to the local authority to ensure that where people were deprived of their liberty, this was lawful.

People were happy with the meals provided at Lydgate Lodge. We found people were offered a choice of meals but the method staff used to help people choose was not consistently appropriate to people’s needs.

People were not offered the choice of a hot drink during or immediately after their lunchtime meal and staff did not always record the date or the amount of food people had been offered on people’s food records.

People told us staff were caring. During the inspection we also observed staff to be kind and helpful. Where people became upset, staff intervened, supporting them and de-escalating the situation. Staff were knowledgeable about people’s needs and the routine of the home was led by the needs of the people and not the staff. Staff respected people’s right to privacy