This unannounced inspection took place on 13 December 2016. We last carried out a comprehensive inspection in June 2015 followed by a focused inspection in May 2016. During these inspections we found the service required improvement in the way it managed medicines and the way it trained staff.

Pinetree Lodge is a care home providing accommodation and nursing care for up to 34 adults. Care is provided to people living with dementia. Accommodation is across one floor divided into two separate units. At the time of our inspection there were 27 people living at the home.

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.

Although there were sufficient staff to meet people’s needs the provider was not using a dependency tool to support the setting of staffing levels. We made a recommendation about this.

The service managed medicines appropriately. They were correctly stored, monitored and administered in accordance with the prescription. People were supported to maintain their health and to access health services if needed. People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed.

Staff were trained to an appropriate standard and received regular supervision and appraisal. As part of their recruitment process the service carried out background checks on new staff.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff were aware of how to identify and report abuse. There were also policies in place that outlined what to do if staff had concerns about the practice of a colleague.

Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read and based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare.

Staff had developed good relationships with people and communicated in a kind and friendly manner. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak with about any concerns they had. There were no outstanding complaints in the service.

The home was well led by a registered manager who had a vision for the future of the service. A quality assurance system was in place that was utilised to improve the service.

We carried out an unannounced comprehensive inspection of this service on 22 and 30 June 2015. A breach of regulations regarding the safety and effectiveness of the service was found at that time. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

We undertook this focused inspection to check that the provider had followed their plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pinetree Lodge on our website at www.cqc.org.uk.

Pinetree Lodge is a care home providing accommodation and nursing care for up to 34 adults. Care is provided to people living with dementia. Accommodation is provided on one floor.

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.

We found action had been taken to ensure appropriate arrangements were in place in relation to the recording of medicines. There was a process for regularly monitoring these records to check that they were completed properly. Records for the application of creams and ointments by care staff were not fully completed and required further improvement.

Arrangement for training staff in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, as well as providing dementia awareness, had been improved. Staff had commenced training on these topics and further sessions and access to internet based learning was planned.

We found the provider had met the assurances they had given in their action plan.

At our previous inspection in April 2013 we found moderate concerns with the arrangements for the handling and recording of medicines. In response to our concerns the provider sent us an improvement plan detailing the actions they were taking to improve medicines handling.

During this inspection we found that improvements had been made to protect people against the risks associated with the management of medicines, and the action plan had addressed the concerns we had previously identified.

During this inspection we checked people were getting the medicines that they needed by looking at their medication records and the storage of medicines. We did not speak to people who used the service on this visit.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We decided to visit the home at 6am to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region.

Some people who used the service had complex needs which meant they could not share their experiences. We used a number of methods to help us understand their experiences, including carrying out an observation and speaking with visiting relatives.

During our observation we saw people were treated with consideration and respect. Relatives told us they were happy with the care which was provided. One relative said, "The staff are really on top of their game here. They react very quickly if things aren't right. I have no worries I know if my husband isn't well they'll get the doctor or take him to hospital. They are very good."

We reviewed four care records and saw that people's preferences and care needs had been well documented. Staff were knowledgeable about the people's care needs and what they should do to support them.

Staff training was kept up to date so that staff could care for people safely and to an appropriate standard.

However people were not protected against the risks associated with medicines because medicine records had not been accurately maintained and arrangements in place to obtain medicines were not robust.

People who used the service had complex needs so they couldn't share their experiences with us. We found the provider changed the mealtime routine, which gave staff more time to support people to eat. Staff and family members said it had improved people’s mealtime experiences. One family member said, “Things are a lot calmer over the mealtimes. There is more social interaction now as well. It’s working well.”

Care and treatment was planned in a way that ensured people’s safety and welfare. We saw care plans had been re-written since our last inspection and were now more specific and detailed. One family member said “I would recommend it to anyone. I think it’s marvellous, I can’t fault it. I work in care so I know what to look for and everything is great. I don’t worry about my dad anymore. I can sleep at night. It’s a weight off my mind knowing he’s being well looked after.” Another family member said, “Pinetree Lodge is a good home. No matter who you speak to and I know a lot of people who know of the home, everyone only has praise for it.”

We found that appropriate checks were in place to make sure people continued to receive appropriate and safe care. We also found that each person’s care records had been audited since our last inspection.

We found the quality of records had improved and most documents were named and dated with accurate entries made. This meant records were clear and easier to follow to ensure that people received appropriate and safe care.

We carried out an inspection of Pinetree Lodge on 22 and 30 June 2015. The first day of the inspection was unannounced. We last inspected Pinetree Lodge on 2 July 2014 and found the service was meeting the relevant regulations in force at that time.

Pinetree Lodge is a care home providing accommodation with nursing and personal care for up to 34 people. The service is primarily for older people, including people living with a dementia related condition. At the time of the inspection there were 29 people accommodated there.

The service had a registered manager in post, who became formally registered December 2012. 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.

Due to their dementia, most people were unable to provide detailed views about the service. Visitor’s told us they felt their relatives were safe and were well cared for. Staff knew about safeguarding vulnerable adults. Incidents and alerts were dealt with appropriately, which helped to keep people safe.

We observed staff provided care safely. At the time of our inspection, the levels of staff on duty were sufficient to safely meet people’s needs. Staffing levels were not formally calculated on the basis of a dependency rating, and staff highlighted the need for extra hours to be worked to provide cover. The registered manager told us new staff were being recruited and we saw new staff were subject to thorough recruitment checks.

We found that improvements needed to be made in regard to the management of medicines. Medicines were not always managed safely for people and records had not always been completed correctly. People did not always receive their medicines at the times they needed them and in a consistently safe way. There were instances when medicines were not administered and recorded properly.

As Pinetree Lodge is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. Staff obtained people’s consent before providing care. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests.

Staff had completed relevant safety related training for their role and they were well supported by the management team. Training included care and safety related topics, but didn’t cover dementia awareness and care. The design and adaptations in the building helped people with a physical disability but some areas were stark and few adaptations had been made for people living with dementia.

Staff were aware of people’s nutritional needs and made sure they were supported with eating and drinking where necessary. People’s health needs were identified and an external professional told us arrangements had improved to ensure staff worked effectively with other professionals. This ensured people’s general medical needs were met promptly.

Activities were arranged in house and there were occasional outside activities. We observed staff interacting positively with people. Visitors told us about the kind and caring approach of staff. We saw staff were respectful and explained clearly how people’s privacy and dignity were maintained. Staff understood the needs of people and we saw care plans were person centred.

People’s relatives and staff spoke well of the new registered manager and felt the service had good leadership. We found there were effective systems to assess and monitor the quality of the service, which included feedback from people receiving care.

We found a breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to medicines and staff training. You can see what action we told the provider to take at the back of the full version of the report.

We made a recommendation about environmental design suitable for people living with dementia.