The inspection was carried out over two days on 17 and 20 January 2017. On 17 January the inspection was unannounced. We returned to complete the inspection on the 20 January 2017, this visit was announced.

Shakti Lodge provides accommodation for up to 26 people who need accommodation with personal care. However, the home currently does have rooms that are for two people which are being used as single rooms. This therefore means the total occupancy level available at present is 21. The acting manager told us that they would only use the double rooms for a married couple if requested. Communal areas, such as the lounge and dining room are on the ground floor with a few bedrooms. Bedrooms are mainly found on the first floor and are accessed by stairs and/or a passenger lift. There was a garden to the rear of the building which had been developed as an accessible space for people to use during the better weather. At the time of our visit, 16 people lived in the home. People had a variety of complex needs including dementia, physical health needs and mobility difficulties.

At the previous inspection on 16 and 17 May 2016, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to ensuring that people received appropriate person centred care that met their needs and reflected their preferences; failure to monitor the risk to people who may present with malnutrition; failure to reduce the risk of cross infection; ensuring that medicines were managed properly; and not operating effective auditing systems. The provider sent us an action plan telling us what steps they would be taking to remedy the breaches in Regulations we had identified. At this inspection we checked they had implemented the changes.

At the previous inspection on 16 and 17 May 2016, we also made four recommendations to assist the provider to make improvements to the service provided. These recommendations were in relation to seeking advice on how to keep people safe while awaiting further employment information; putting a system in place to monitor and ensure that people eat and drink enough through the day, to maintain their health and wellbeing; training staff about how to communicate with people in a way that protects their dignity, shows respect, and to put a system in place that makes sure that people’s interests and hobbies inform the activity plan either in group activities and one to one time.

At this inspection we found improvements had been made.

There was no registered manager employed at the service as the registered manager had recently resigned. 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. The deputy manager had stepped up and was currently the acting manager. Following the inspection we were informed that the acting manager had been successful at interview and would be applying to the commission to be the registered manager.

The staff knew their responsibility regarding reporting any safeguarding issues and made sure that safeguarding alerts were raised with other agencies. All of the people who were able to speak with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the acting manager.

The home had risk assessments in place to identify risks that may be involved when meeting people's needs. These risk assessments showed ways that these risks could be reduced.

Medicines had been administered following the provider's medicines policy and following good practice guidance. Medicines records were accurate and complete. There were no 'homely remedies' held in stock. We made a recommendation ab

This inspection took place on 16 and 17 May 2016 and was unannounced.

Shakti Lodge provides accommodation for up to 26 people who need accommodation with personal care. However the home currently does have rooms that are for two people which are being used as single rooms. This therefore means the total occupancy level available at present is 21. The manager told us that they would only use the double rooms for a married couple if requested. Communal areas, such as the lounge and dining room are on the ground floor with a few bedrooms. Bedrooms are mainly found on the first floor and are accessed by stairs and/or a passenger lift. There was a garden to the rear of the building which had been developed as an accessible space for people to use during the better weather. At the time of our visit, 20 people lived in the home. People had a variety of complex needs including dementia, physical health needs and mobility difficulties.

There was a registered manager at the home. 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.

The staff knew their responsibility regarding reporting any safeguarding issues and made sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager.

The home had some risk assessments in place to identify risks that may be involved when meeting people’s needs. These risk assessments showed ways that these risks could be reduced. However not all risks had been identified and therefore staff were not always putting in measures to keep people safe or reduce those risks.

Medicines had not been administered following the provider’s medicines policy and following good practice guidance. Medicines records were not accurate or complete.

The recruitment procedures were not robust in all cases. We have made a recommendation about this.

Training records showed that staff had completed training in a range of areas that reflected their job role. They were receiving supervision which had been planned to make sure staff received support on a regular basis.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved. The registered manager knew that CQC needs to be notified when Deprivation of Liberty Safeguards (DoLS) applications that had been agreed. The Registered manager had let CQC know about other events such as safeguarding concerns and deaths.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA), which included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights.

The menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The cook prepared meals to meet people’s specialist dietary needs. We found staff recorded some of what people ate and drunk in the daily notes. We found that some people who needed close monitoring of their food and fluid did not have charts to record this effectively. We have made a recommendation about this .

Staff supported people with health care appointments and visits from health care professionals. The staff recorded the outcome of these visits. Care plans were not always amended immediately to show any changes. However staff spoken with knew what care and support people were having. We have made a recommendation ab

Two inspectors conducted this inspection out of hours. We spoke with three people who lived at the service and five staff members. We looked at records relating to recruitment, staffing numbers and staff competency. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service caring?

The atmosphere at the service was calm and friendly. People we spoke with told us that the staff knew how to meet their needs. One person told us “Of course they do” when they were asked if the staff knew how to care for them. They added that they had “No complaints”. Another person told us that the staff knew how to look after them well and that the staff “Try their best”. This meant that people received care from staff who were skilled in meeting their needs.

Is the service responsive?

We saw a record that showed one person’s medication had changed and the senior staff member we spoke with who was administering medication had been informed about this change.

We saw records that showed the number of staff on duty had increased earlier this year in response to a change in one person’s needs.

Is the service safe?

There was a system in place to ensure staff received the necessary training to undertake their role safely. There was a system in place to ensure that staff were competent in administering medication to people who lived at the service. Staff undertook checks ensuring they were of good character and that they were entitled to work in the UK.

Is the service effective?

There was a process for deciding how many staff should be on duty to meet people’s needs. We saw that the amount of staff on duty reflected the amount of staff required. This was also reflected in a recent staff rota. There was a robust recruitment process that followed legal requirements.

Is the service well led?

One staff member we spoke with told us that they could talk to the manager if they considered that additional staff were required to meet people’s needs. They were confident that this would be responded to appropriately by the manager. Three members of staff confirmed they felt supported by the manager to carry out their roles and were able to discuss any concerns.

Our inspection team was made up of one inspector. We considered all the evidence we had gathered under the outcomes we inspected that included areas of non compliance identified during previous inspections. We used the information to answer the five questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found

Is the service safe?

Risk assessments had been completed to ensure people’s safety while promoting their independence. Staff were supported to undertake their role safely and effectively. There were systems in place to monitor health and safety within the service. Records showed that regular checks related to fire safety were carried out at the service.

Is the service effective?

At this inspection we saw that people’s care plans were person centred. They now contained information about their likes and dislikes and information about their personal history for staff to be able to know more about the person they supported. People were supported in promoting their independence. One person’s care plan showed what aspects of their personal care they were able to do themselves. People and their relatives were involved in the planning of their care.

Is the service caring?

People we spoke with told us that the staff at the service were caring, one person told us that the staff knew how to support them. Comments included “The staff are very good”, “The carers are good, they look after me well, they are easy to talk to,” and “The staff are alright”. When discussing the service the relative told us “I think it is excellent. The staff are really caring and friendly and always have time for my [relative].” They told us that the staff spend time talking with their relative. During the inspection we saw that staff spent time talking with people and both staff and people were laughing during these conversations. The atmosphere was friendly and relaxed.

We saw that staff took the time to provide care to people safely and carefully. For example a staff member carefully ensured a person was safely seated before they ate their meal and went at the person’s pace when providing this support.

Is the service responsive?

We saw that people’s needs were assessed before they moved into the service and ongoing needs were monitored and reviewed to ensure their welfare. Guidance was sought from health professionals when needed in response to changes in people’s needs and the monitoring of people’s needs. Records showed that one person had suffered from a health matter and the action taken in response to this that included a course of medication. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented.

Is the service well led?

There were systems in place to monitor the quality of service delivery. These included providing a survey for relatives to gather feedback about the service and a complaints process. There were systems in place to monitor staff training and competency that showed staff received training relevant to their role.

We found that people’s views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

We found people did not experience care, treatment and support that met their needs and protected their rights. We spoke to people who used the service and relatives who told us they were not involved in the care planning process.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found the provider did not have effective system to regularly assess and monitor the quality of service that people receive.

We found that the provider did not have an effective complaints system available. Comments and complaints people made were responded to appropriately.

People we spoke to told us they liked living at the home. Comments included “I like living here” and “I am happy here” and “The staff are lovely, I like them”.

People we spoke with told us that they were happy living in the home and the staff were kind. Comments included ‘I am very happy here’ and ‘staff are very pleasant”.

People spoke about the activities they liked doing and said that there was a good choice of activities on offer.

People we spoke with said that they were happy living in the home and that they enjoyed activities such as ‘bingo’. Comments included “I am looked after here”.

People we spoke to told us that they liked the meals provided, comments included “I enjoy the food” and “the meals are always nice”.

We spoke with people using the services but their feedback did not relate to this standard.

Staff we spoke to told us that they could speak to the manager at any time if they were unhappy about anything at the home.

Staff we spoke to said that they enjoyed working at the home and received the training and support they needed to do their jobs. Comments included “We all work as a team” and “I can go and speak to the manager at any time”.

Not all of the people who used this service were able to tell us about their experiences but those who were said that they were happy in the home and that they enjoyed the food and the activities. They said the staff were kind and that they enjoyed chatting to them.

Observation showed that those people who were unable to express their views were relaxed and enjoyed taking part in the activities in the home. One person said, “I love it here, we can do what we please and I love to talk to all the girls and boys (ie.staff).

Relatives said they were pleased with the care that the home gave and that the home had improved a lot over the past eighteen months. One person said, “The environment has improved a lot and I’m glad they are putting in a lift that can take a wheelchair. It will be much better for those who are not so steady on their feet. They have made great improvements to the garden and communication is much better now. Now I can be sure that anything I tell the manager, for example, what the hospital doctor has said about mum, how she is feeling and change of tablets, will be recorded and action will be taken. I have a lot more confidence in this manager".