This inspection took place on 19 November 2018 and was unannounced. We carried out a further announced visit to the home on 20 November 2018 to complete the inspection.

Pennine 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. Pennine Lodge provides nursing and personal care to 70 older people. The home has two floors, the upper floor accommodates people who have a dementia related condition and people who have general nursing and personal care needs live on the ground floor. There were 64 people living at the home at the time of the inspection.

At our previous inspection in February 2018, we found three breaches of the Health and Social Care Act 2008. These related to safe care and treatment, receiving and acting upon complaints and good governance. We rated the service as requires improvement. We placed the service into special measures because we had rated the well-led key question as inadequate at our previous two inspections.

Following the inspection, the provider formulated an action plan and sent us regular updates in response to the breaches and concerns we had identified.

At this inspection, we found that sufficient action had been taken to improve and we took the decision to remove the service from special measures. Continued improvements were still required in certain areas of the service.

The previous registered manager had recently left and an interim manager was in place at the time of the inspection. She had been in place for three weeks prior to our inspection and was not registered with CQC to manage the home. A registered manager is a person who has registered with 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 and associated Regulations about how the service is run.

We identified several medicines recording issues. In addition, information and guidance about the use of prescribed thickeners for certain people was confusing and inconsistent. Immediate action was taken to address these issues.

There were safeguarding procedures in place. There were two ongoing safeguarding issues. Internal investigations were being carried out.

We received mixed feedback about staffing levels. Some people and relatives told us that more staff would be appreciated. At the time of the inspection, we observed that people’s needs were met by the number of staff on duty. However, due to the mixed feedback we received, we recommended that the provider keeps staff deployment under review.

The service was clean and well maintained. Sufficient equipment was available to meet people’s needs. Checks were carried out to ensure the premises and equipment were safe. Attention had been paid to the ‘dementia friendly’ design of the premises especially on the first floor where most people with a dementia related condition lived.

Since our last inspection, further training had been carried out and more training was being undertaken.

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 place supported this practice.

We received mixed feedback about the meals at the service. Some people and relatives felt meals could be improved. Staff raised issues about the availability of certain foods such as oranges, tuna and yoghurts. Following our inspection, the interim manager told us that this had been addressed.

We observed positive interactions between staff and people. Staff displayed warmth when interacting with people.

Care plans were in place which aimed to inform staff how people's physical, emotional, social and spiritual needs should be met. People’s social needs were met. T

This inspection took place on 22 February 2018 and was unannounced. This meant that the provider and staff did not know we would be visiting. We carried out a further announced visit to the home on 23 February 2018 to complete the inspection.

Pennine 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. Pennine Lodge provides nursing and personal care to 70 older people. The home has two floors, the upper floor accommodates people who have a dementia related condition and people who have general nursing and personal care needs lived on the ground floor. There were 60 people living at the home at the time of the inspection.

At our previous inspection in September 2017, we found three breaches of the Health and Social Care Act 2008. These related to safe care and treatment, staffing and good governance. We issued a warning notice in relation to good governance and told the provider they needed to take action to improve.

Following the inspection, the provider formulated an action plan and sent us regular updates in response to the breaches and concerns we had identified.

We carried out this inspection to check whether the provider had met the breaches which were identified at our last inspection.

At this inspection, we found that the provider was taking action to address the previous concerns we had raised. Further improvements however, were still required.

There was no registered manager in post. The previous registered manager had left and an interim manager was in place at the time of the inspection. Following the inspection, the interim manager left to manage another of the provider’s homes. The regional manager wrote to us and stated that a new manager had been appointed. A registered manager is a person who has registered with 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 and associated Regulations about how the service is run.

Prior to our inspection, several relatives contacted us regarding safeguarding concerns. We passed this information to the local authority and used the information we received to plan our inspection.

We found that a system to monitor safeguarding concerns and ensure these were notified to CQC was not fully in place. In addition, there were no details of the outcome of all safeguarding allegations and any lessons learned.

Staffing levels had increased; however, they were not always deployed appropriately to ensure people's needs could be attended to in a timely way. We have made a recommendation about this.

The service was clean and well maintained. Safe infection control procedures were now followed. Attention had been paid to the ‘dementia friendly’ design of the premises especially on the first floor where most people with a dementia related condition lived.

We checked equipment at the service. There had been a delay in obtaining suitable equipment for one person. In addition, there was a lack of evidence to demonstrate that specialist medicines equipment had been serviced in line with the manufacturer’s guidance.

The management of medicines had improved, however we found shortfalls and omissions with regards to the recording of topical and ‘when required’ medicines. We have made a recommendation about this.

Since our last inspection, further training had been carried out and more training was being undertaken. There were still gaps identified on the training matrix which the interim manager told us was being updated as training was being completed. This meant it was not always clear which training had been undertaken. Evidence of staff competencies was not available and the clinical skills of agency staff were still not always known.

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Pennine Lodge is a purpose built care home that provides personal and nursing care to a maximum of 70 people, including people who live with dementia. There were 63 people living in the home when we inspected.

We last inspected Pennine Lodge in January 2017 and rated the service as good. We found that they were meeting all the regulations we inspected.

We carried out the inspection on 7, 8, 25 and 27 September 2017. Our visits on the 7 and 25 September were unannounced. Our visits on the other days were announced.

Prior to the inspection, we received information of concern regarding staffing levels, the maintenance of records and certain aspects of people’s care. We brought forward our planned inspection in order to check the concerns raised.

A registered manager was in place. 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.

There were safeguarding policies and procedures in place. The provider had not notified CQC of all safeguarding incidents in line with legal requirements. These omissions meant that CQC did not have oversight of all safeguarding allegations to make sure that appropriate action had been taken.

We raised five safeguarding alerts during our inspection. These related to the management of people’s medicines, concerns from a relative about their family member’s care and a whistleblowing alert raised by a member of staff. We will monitor the outcome of these safeguarding alerts and action taken by the provider.

At the time of the inspection, we found there were insufficient suitably qualified, competent, skilled and experienced staff deployed to ensure care was delivered as planned. We identified delays in seeking advice from health and social care professionals. We also identified shortfalls in record keeping.

There were shortfalls and omissions with regards to the management of medicines. We also identified concerns with certain staff practices in relation to infection control. Checks and tests had been carried out on the premises and equipment to ensure safety. The registered manager was unable to locate the electrical installations safety certificate during the inspection. They sent CQC a copy of the certificate following the inspection. This stated that the electrical installations were ‘unsatisfactory.’ We spoke with the registered manager about this issue. She told us the provider had recently changed to a new facilities management company who were in the process of addressing the deficits highlighted in the electrical installations report.

There were shortfalls regarding some people’s clinical care. There was a lack of evidence to confirm the competency and skills of nursing staff.

We received mixed feedback about meals at the home. One person put one thumb down and then both thumbs down when we asked them about the meals they received. On the first and second day of our inspection, there was a lack of fresh fruit available. On the third day of our inspection, the chef informed us that this had been addressed and people now received fruit options on the drinks and snack rounds in the morning and afternoon.

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.

Some people’s care records contained omissions. This meant it was not clear whether care and treatment had been provided. Some staff, relatives and health professionals considered that communication could be improved at the service. We found that advice from health care professionals had not always been sought in a timely manner.

There was a complaints procedure in place. However, we noted that not all

This was an unannounced inspection which we carried out on 23 January 2017. We last inspected Pennine Lodge in August 2015. At the August 2015 inspection we rated the home as Requires Improvement and made four recommendations.

Pennine Lodge is a purpose built care home that provides personal and nursing care to a maximum of 70 people, including people who live with dementia. There were 66 people living in the home when we inspected.

A registered manager was in place. 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.

On this inspection we found improvements in all the areas we had made recommendations in. There was a tangible upbeat atmosphere within the staff team who were enthusiastic and motivated to provide “The best care they could for people” they told us. Staff were positive about the opportunities for growth and improvement. People living in the home were benefitting from a more engaged workforce and people appeared more responsive and animated.

People living in the home and their relatives were happy with the care and support given. People told us that they felt safe and that staff were kind and treated them well. One person said, “It’s very nice, the girls look after you. I have all my things here and my family comes in.” A number of relatives said they had noticed improvements since the last CQC inspection. One relative said “The care is good now, it’s improved a lot lately, the girls are lovely to (relative).

People were treated with respect and dignity. A health professional said, “The staff are very respectful." A visitor said, “My (relative) passed away here and the care was brilliant, I come back to help sometimes now, I could not fault it.” And another relative wrote to tell us, “Pennine Lodge gave our relative exceptional care throughout their stay. We as a family observed the professionalism and total dedication of each and every member of Pennine Lodge. Our relative was nursed with love and respect. They also gave us comfort and support especially when they became so very ill. We were so very fortunate to find Pennine Lodge where my relative called home.”

However we received mixed views on the quality of the food and how it was presented. We recommended that the home looks at how this can be improved for people.

The accuracy, quality and detail recorded in people’s risk assessments had significantly improved. Risks to people, as a result of reduced capacity due to dementia, were now well managed. All staff we spoke to, from nurses to carers to auxiliary staff, were now fully aware of how to ensure people’s safety.

We saw the way staff were being utilised and deployed in the home had improved. This particularly helped at mealtimes. The mealtimes were better organised with clearer delegation of staff roles. This meant that people were receiving the support required to enjoy a calm and pleasant mealtime experience.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

We found that improvements had been made to people’s care and support plans. These had been made simpler and staff reported that these were easier to use in knowing exactly what support needs were required by each person. People’s care plans were also more individualised and staff demonstrated good knowledge of people’s backgrounds and how they liked to spend their time. We observed that there were interesting and appropriate activities available for people.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed adv