About the service: Saxon Lodge is a residential care home that was providing personal care to 14 older people, some of whom were living with dementia, at the time of the inspection.

For more details, please read the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

• The provider had made many changes to improve the environment for people. The home was welcoming and homely with a caring atmosphere.

• The provider promoted a good quality of life for people. People were happy living at the home and were supported to access the healthcare they needed.

• Care was person centred, achieved good outcomes and people were offered choice and involved wherever possible.

• Feedback was sought and used to make improvements. Feedback from people, relatives, health care professionals and staff was all positive.

• Quality assurance systems were in place to ensure the safety and quality of the care provided.

• Some improvements were needed to ensure medicines were not left unattended; and to ensure guidance was available for staff for all ‘as required’ medicines.

• Lessons were learnt and used to make improvements. However, this needed to be more thorough around falls analysis to ensure all learning was used to prevent future reoccurrence.

Rating at last inspection: At the last inspection the service was rated Inadequate (report published on 07 December 2018). This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Why we inspected: This was a comprehensive planned inspection based on the previous rating.

Follow up: We will continue to monitor this home and plan to inspect in line with our reinspection schedule for those services rated Requires Improvement.

We inspected the service on 28 August 2018 and 30 August 2018. The inspection was unannounced. Saxon Lodge Residential Home Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Saxon Lodge Residential Home Limited is registered to provide accommodation and personal care for 23 older people and people who live with dementia. There were 17 people living in the service at the time of our inspection visit. The service was run by a company who was the registered provider. The company was owned and operated by a single director. There was 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. In this report when we speak about the director of the company we refer to them as being, ‘the registered provider’. When we speak about both the director and the registered manager we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 21 June 2017 the overall rating of the service was, ‘Requires Improvement’. We found that there were two breaches of regulations. This was because the registered persons had not reliably ensured that people who lived in the service consistently received safe care and treatment. In particular, people had not been fully supported to eat enough to have a balanced diet. In addition to this, we also found that the registered persons had not established and operated robust systems and processes to assess, monitor and improve the quality and safety of the service. We told the registered persons to send us an action plan stating what improvements they intended to make and by when to address our concerns and to improve the key questions of 'Safe' and ‘Well led' back to at least, 'Good'. After the inspection the registered persons told us that they had made the necessary improvements.

At the present inspection we found that sufficient steps had not been taken to address either of these breaches. This was because there were serious shortfalls in the arrangements used to provide people with safe care and treatment that had significantly increased the risk of people experiencing harm. This included suitable steps not having been taken to reduce the risk of infection and to enable lessons to be learned when things had gone wrong. There were also multiple and serious shortfalls in the systems and processes used by the registered persons to assess, monitor and improve the quality and safety of the service. This had resulted in the persistence of a large number of problems in the running of the service that had reduced people's ability to receive the high-quality care they needed and had the right to expect. In addition, we found the registered persons did not fully appreciate the seriousness of the concerns we had identified and there was no realistic prospect of them quickly being put right.

There were four additional breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because robust arrangements had not been made to safeguard people from situations in which they may be at risk of experiencing abuse. Sufficient care staff had not been deployed to enable people to promptly receive all the care they needed. In addition to this, care staff had not received all the training and guidance they needed and did not have all the knowledge and skills they needed to care in the right way for the people who lived in the service. The accommodation was not designed, adapted and decorated to meet people’s needs and expectation

This inspection took place on 21 June 2017 and was unannounced.

Saxon Lodge is registered to provide personal care and accommodation for up to 23 older people. There were 20 people using the service during our inspection; some of whom were living with conditions such as diabetes or impaired mobility.

Saxon Lodge is a large detached property situated in a village just outside Canterbury. There was a communal lounge, dining area and an enclosed garden with seating available for people to use.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected in February 2016 when it was rated as ‘Requires Improvement’. At that inspection we found that medicines had not always been managed safely. At this inspection the areas that we had highlighted had been resolved. However, there were some other, minor areas of medicines management which required further improvement.

Known risks to some people of losing weight had not been properly minimised and some risk assessments had not been updated with current information about falls. Other risks had been clearly assessed and actions to reduce the likelihood of them had been documented and carried out in practice.

Some audits designed to test the quality and safety of the service were not sufficiently detailed to pick up the shortfalls that were found during this inspection. Others worked efficiently to assist the registered manager in identifying and rectifying risks.

There were processes in place which helped to protect people from abuse or neglect .The environment people lived in was kept safe through regular maintenance and safety checks. Any accidents or incidents were fully documented and followed up.

There were enough staff to meet people’s needs and a full programme of training was in place. Staff received regular supervision with the registered manager to discuss their performance and highlight any training needs. Most recruitment checks had been thorough but gaps in applicants’ employment history needed further exploration.

People’s health was monitored and they had access to a range of supporting professionals. Meals were generous and appeared nutritious and appetising. People were offered plenty to drink.

The registered manager and staff understood the principles of the Mental Capacity Act (MCA) and ensured that people’s rights and choices were considered. Applications had been made to the correct authority for people who required deprivation of liberty safeguards (DoLS).

Staff were kind, caring and interacted well with people. We received only positive feedback from people and relatives about the care and compassion shown. People were encouraged to be involved in all aspects of their care planning and their independence was promoted. Respect was shown to people and they were treated with dignity throughout. Plans for end of life care had been sensitively prepared and gave people the opportunity to document in advance the things that were important to them.

People were treated as individuals and care was taken to ensure preferences were recorded and acted upon. Staff knew people very well and responded to them in ways that they liked. There was a programme of varied activities available to people delivered by an enthusiastic coordinator.

There had been no complaints since our last inspection, but a system was in place for recording, investigating and responding to them. People and relatives said they knew how to complain but had no reason to do so. Feedback had been sought and acted upon wherever possible.

There was a friendly, open culture in the service and the registered manager was well-liked and respected. They were undertaking a Diploma in social care and kept abrea

The inspection took place on 10 and 11 February 2016 and was unannounced. At the last inspection on 5 November 2014 we asked the provider to make improvements in relation to staffing levels and the potential risks associated with insufficient staff being available to meet people’s needs. The provider sent us an action plan which stated that action would be taken to meet these shortfalls by April 2015 and the relevant requirements have now been met.

Saxon Lodge Residential Home Limited provides accommodation and personal care for up to 23 older people, providing 19 single rooms and two double rooms. There were 17 people living at the home, in a single room, at the time of inspection. The accommodation is over two floors and upstairs bedrooms can be accessed by a passenger lift. There is a communal lounge, dining room and a garden with seating.

There was a manager in place but they were not registered with the Care Quality Commission. There had not been a registered manager at the service for 18 months. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

There was a medicines policy in place to guide staff how to administer, record and store medicines safely and appropriately. However, staff did not always follow this guidance. For example, there were not clear directions for staff, for medicines which were prescribed to be taken ‘when needed’, nor where medicinal creams should be applied.

Firefighting equipment’s was regularly checked and serviced to make sure it was in good working order and regular fire drills were carried out. However, the service’s assessment of the action it needed to take to minimise the occurrence of a fire, had not been reviewed since July 2011 and therefore may not be effective.

Assessments of individual risks to people’s safety and welfare had been carried out and action taken to minimise their occurrence, to help keep people safe. Accidents and incidents were recorded and the appropriate action taken to minimise their reoccurrence.

Staff knew how to follow the home’s safeguarding policy in order to help people keep safe. Checks were carried out on all staff to ensure that they were fit and suitable for their role. Staffing levels ensured that staff were available to meet people’s needs.

The home was clean and staff knew what action to take to minimise the spread of any infection.

People had their health needs assessed and monitored and professional advice was sought as appropriate. People were offered a choice at mealtimes and support was provided when people needed it.

New staff received an induction which included shadowing new staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager had submitted a DoLS application to request the time of an existing application to be extended and had contacted the local authority to seek guidance on whether further DoLS applications needed to be made to ensure that people were not deprived of their liberty unnecessarily.

Staff said there was good communication in the staff team that they felt well supported, and were able to make their views known through supervision, staff meetings and via the annual quality assurance survey.

Everyone gave positive feedback about the caring nature of the staff team. Staff communicated with people in a kind manner and treated them with dignity and respect.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gai

This inspection took place on 5 November and was unannounced. At the previous inspection in December 2013, we found that there were no breaches of legal requirements.

Saxon Lodge Residential Home Limited provides accommodation and personal care for up to 23 older people. There were 21 people living at the home at the time of inspection. The accommodation is over two floors and upstairs bedrooms can be accessed by a passenger lift. There is a communal lounge, dining room and a garden with seating.

There was no registered manager at the service on the day of our inspection. 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 not enough staff on duty to make sure that practices in the home were safe and to respond to emergencies. Three people out of 21 required two staff to support them with their mobility needs. However, there were times when only two staff were available . If staff were supporting one person who required two staff, no other staff were available to respond to the needs of the other people who lived in the home.

The homes’ procedures were followed in undertaking checks on all staff’s before they started work at the home.

Quality assurance systems were not robust as they had not identified the shortfalls in staffing at the home.

The home sought feedback from people who lived there and their relatives by using a quality questionnaire. Although questionnaire contained mainly positive views, the results had not been analysed to identify any shortfalls and therefore take the appropriate action to improve the service.

Staff stored and managed medicines safely, but a recommendation has been made about how to record controlled drugs in line with current guidance.

Visitors felt safe leaving their relatives in the care of the staff at the home. Staff understood how to recognise abuse and to report their concerns. There were policies and procedures in place for managing risk. Risk assessments were centred around the needs of the person to be as independent as possible.

The home kept the premises and equipment well maintained to ensure that it was in good working order.

Staff had regular training to ensure that they had the right knowledge and skills to meet people’s needs effectively.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Care plans contained mental capacity assessments and DoLS applications had been made to ensure that three people were not deprived of their liberty.

People experienced positive outcomes regarding their health. Appropriate referrals were made to health and social care services. Assessments were made to identify people at risk of poor nutrition and for other medical conditions that affected their health. People said that the food was good and mealtimes were relaxed.

People’s care, treatment and support needs were clearly identified in their plans of care. They included peoples choices and preferences. Staff knew people well and understood their likes and dislikes. They treated people with kindness and respect, but said that they did not always have enough time as they would like to spend with people. People were positive about the staff support that they received. They said that staff looked after people well and that staff were friendly and helpful

People were offered a range of activities which they said that they enjoyed. This included trips out into the community. However, the number of activities had reduced as the activities coordinator had recently left the home.

Staff understood the aims of the home, their roles, were motivated and had confidence in the deputy manager’s management of the service. There was good communication in the staff team and that everyone helped each other.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with seven people who were using the service, two relatives of people who were using the service, four members of staff and the registered manager.

We were told by the people who were using the service and the relatives that we spoke with that the service provided a good place to live. They told us that staff had been, "kind and caring", and that they had been happy with the standard of provision. One of the relatives that we spoke with said that they were confident that their relative was safe and well cared for and that they were happy living in the home.

One person who was using the service told us, "I love it here." One of the relatives described the service as having provided a, "...top home", and compared it favourably to other homes that they had had experience of and considered to be good in their own right but, "...not a patch on here".

We found a service that had provided a safe, clean and pleasant environment and that promoted the welfare of the people that had used it. The service had protected people from harm including against the risk of abuse and unsafe practices in relation to medication.

We found that the care, treatment and support of people using the service had been individualised and had taken into account their needs and preferences. Carers had respected the rights of the people who were using the service and had sought their cooperation, agreement and consent with regard to the provision of services.

People who use the service told us what it was like to live at this service and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality of food and drink available.

People said that they were happy with the care and support they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

Many comments received were complimentary of the service. One person said “It’s very nice here” another said “The manager is very approachable. I’m happy to talk to staff about any concerns”. Other people were complimentary of the food and had no concerns regarding the quality of care.

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had. They said that they received the health and personal care they needed and that they were comfortable in their home. One person said, 'The staff are wonderful people, kind and attentive and will do anything for you'. A carer (relative) said, 'I think that this is a really lovely little home where the residents come first'.