Soham Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 34 people in one adapted building. At the time of the inspection there were 32 people living in the home.

There was a registered manager in place however they were not present during the 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.’

At the previous inspection in August 2017 the home was rated as Good. However, at this inspection the rating has changed to Requires Improvement.

The quality assurance system was not effective in making sure that people received the care and support they needed in a safe way. Although audits were being completed they had not found the issues we found during the inspection. Policies and procedures were in place but these were not always being followed to ensure people were being provided with the right care and support. .

Risks had not always been identified in a timely manner so that action could be taken to reduce the likelihood of accidents or incidents. Staff had not always taken the necessary action needed to reduce risks when they were identified.

Staff had not received regular supervisions or appraisals and it was not clear what training they were expected to complete. There was no training plan to ensure staff had the knowledge they required to meet people’s needs.

Information about the support people needed was not always accurate or up to date. This meant that staff were not always aware of people’s needs.

Medication was not always administered or managed safely. Management had not carried out competency checks on staff to ensure they were still competent to administer medicines safely. Not all medication administration records reflected the amount of medication in stock. This meant we could not be confident that people were always receiving their medication as prescribed,

The providers recruitment policy had not always been followed to ensure new staff were only employed once two satisfactory references had been received. Other recruitment checks such as a criminal records check had been carried out. There were sufficient numbers of staff to meet people’s needs.

People were offered a choice of food and drink. People health was placed at risk because special diets were not always followed.

Although there were policies and procedures for staff to follow regarding the Mental Capacity Act 2005 these were not always being followed in practice. This meant that people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

There was a complaints procedure in place. Complaints had been dealt with appropriately. However, records of the complaint, investigation and outcome had not been easy to access and were kept in various places rather than a clear record.

Staff were aware of what action to take if they thought someone had been harmed. They were aware of the internal and external reporting procedures and were confident to use them.

Staff provided care in a kind and compassionate way. They knew people well and

were aware of their history, preferences, likes and dislikes. People's privacy and dignity were respected. Staff provided end of life care and support in a way that each individual person wanted.

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

Soham Lodge is registered to provide accommodation, nursing and personal care for up to 34 people. At the time of our inspection there were 23 people living in the service.

This unannounced inspection took place on 1 August 2017. At the last comprehensive inspection on 27 July 2016 the service was rated as ‘requires improvement’. We undertook a focussed inspection on 16 November 2016 and found that improvements had been made. At this inspection we found overall the service remained ‘good’.

There was a registered manager 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.

Staff were clear about the procedure to follow to protect people from being harmed. Risks to people who lived at the service were identified, and plans were put into place by staff to minimise these risks and enable people to live as independent and safe a life as possible.

Staff treated people with kindness. Staff showed they genuinely cared about the people they were looking after. They respected people's privacy and dignity and encouraged people to be as independent as they could be. Visitors were welcomed and also had warm, friendly relationships with the staff.

Staff were only employed after the provider had obtained satisfactory pre-employment checks. Staff understood their roles and responsibilities and were supported by the registered manager to maintain and develop their skills and knowledge by way of supervision and observation. Staff were trained to provide safe and effective care which met people’s individual needs and they knew people’s care requirements well.

People had health, care, and support plans in place which took account of their needs. These recorded people’s individual choices, their likes and dislikes and any assistance they required. Medicines were well managed and people received their medicines as prescribed.

Staff supported people to make everyday decisions in the least restrictive way possible. The policies and systems in the service supported this practice.

People and their visitors were able to raise any suggestions or concerns they might have with the registered manager. They said that they felt listened to as communication with the registered manager and staff team was good.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. We found that people who lived at the service and their visitors were encouraged to share their views and give feedback about the quality of the care and support provided.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 23 and 24 May 2016. At this inspection we found a breach of the legal requirements. This was because the provider had failed to notify the Care Quality Commission about important events that had taken place.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Soham Lodge’ on our website at www.cqc.org.uk’

Soham Lodge provides accommodation, personal care and nursing for up to 34 people including those living with dementia or requiring mental health support. Accommodation is located over one floor, with communal areas for people and their visitors to use. There were 26 people living in the home when we inspected.

At the time of this inspection 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. 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.

At our focused inspection on 4 November 2016, we found that the provider had followed their plan which they had told us would be completed by 30 June 2016, and legal requirements had been met.

Records showed that notifications had been submitted to the CQC in a timely manner.

Arrangements were in place to ensure that people’s medications were stored, administered and disposed of safely. Records regarding the administration of people’s prescribed medication were kept.

Soham Lodge provides accommodation for up to 31 people who require personal care or nursing care. The home provides support for older people, some of whom are living with dementia. There were 24 people living in the home at the time of our inspection.

This unannounced inspection took place on 23 and 24 May 2016.

At the time of the inspection the manager was in the process of applying to the Care Quality Commission [CQC] to become the 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.

Not all staff were following the correct procedures when administering medication. Medication was stored securely and medication administration records were accurate

The provider had not notified the CQC of all events as required.

The CQC is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider could demonstrate how they supported people to make decisions about their care and the principles of the MCA were being followed.

There were enough staff on shift to ensure that people had their needs met in a timely manner. Not all staff were aware of what actions to take if they thought that someone had been harmed in any way. Risks to people had been assessed and the necessary action had been taken to reduce the risks where possible.

The recruitment process had been followed to ensure that staff were only employed after satisfactory checks had been carried out. Staff received the training they required to meet people’s needs and were supported in their roles.

Staff were kind and caring when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were usually respected.

Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed. People were provided with a choice of food and drink that they enjoyed. Staff supported people to maintain their interests and their links with the local community to promote social inclusion.

Care plans and risk assessments gave staff the information they required to meet people’s care and support needs.

There was a complaints procedure in place and people and their relatives felt confident to raise any concerns either with the staff or manager.

People’s views about the quality of the service were being obtained.

We found one breach of the Health and Social Care Act 2008 Registration Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 19 March 2015. One breach of legal requirements was found. This was because the storage, administration and recording of medication did not always protect people against the risks associated with unsafe use and management of medicines.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection on 1 December 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Soham Lodge on our website at www.cqc.org.uk.

Soham Lodge provides accommodation for up to 26 people who require personal care or nursing care. The home provides support for older people, some of whom are living with dementia. There were 24 people living in the home at the time of our inspection.

There was a new manager in post at the time of the inspection but they were not yet registered with the commission. 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 our focussed inspection on 1 December 2015 we found that the provider had followed most of their plan which they told us would be completed by 10 June 2015 and legal requirements had been met.

Since the last inspection changes had been made so that people had sufficient medicines available in the home. They were supported to take their medicines at the prescribed time and in line with the prescriber’s instructions.

Training in medicine administration could not be evidenced and was to be completed again on 19 January 2016.

Medicines were stored safely and at the correct temperature and audits had been completed.

The processes in place to audit systems were not robust enough. This meant that the provider was not able to assess, monitor and improve the quality and safety of the service.

We carried out an unannounced comprehensive inspection of this service on 19 March 2015. One breach of legal requirements was found. This was because the storage, administration and recording of medication did not always protect people against the risks associated with unsafe use and management of medicines.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this focused inspection on 1 December 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Soham Lodge on our website at www.cqc.org.uk.

Soham Lodge provides accommodation for up to 26 people who require personal care or nursing care. The home provides support for older people, some of whom are living with dementia. There were 24 people living in the home at the time of our inspection.

There was a new manager in post at the time of the inspection but they were not yet registered with the commission. 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 our focussed inspection on 1 December 2015 we found that the provider had followed most of their plan which they told us would be completed by 10 June 2015 and legal requirements had been met.

Since the last inspection changes had been made so that people had sufficient medicines available in the home. They were supported to take their medicines at the prescribed time and in line with the prescriber’s instructions.

Training in medicine administration could not be evidenced and was to be completed again on 19 January 2016.

Medicines were stored safely and at the correct temperature and audits had been completed.

The processes in place to audit systems were not robust enough. This meant that the provider was not able to assess, monitor and improve the quality and safety of the service.

During our inspection we looked at how people were cared for and how staff supported people living with dementia. We spoke with the registered manager, the activities co-ordinator, one staff member , four people who used the service living with dementia and eight relatives visiting on the day of our inspection. We also received 10 comment cards from relatives of people who used the service. All the comments we received were complimentary about the service and its staff.

We found that staff were caring and attentive to people's needs. We saw that people had enough to eat and had access to snacks throughout the day. The service had a dedicated activities co-ordinator that worked with people and their relatives to deliver tailored activities on an individual basis and in groups.

We saw that the service had effective working relationships with other providers and accessed other professionals to support people when this was required. The registered manager told us that the hospitals worked well with them to support people who were being admitted or being discharged.

We saw that the service had effective quality assurance processes in place to monitor the dementia care people received.

We visited the home on 10 April 2013 to check compliance with a warning notice that had been served on the provider in February 2013.

We found that the warning notice had been complied with as the provider had ensured that the records in relation to the people living in the home had been updated and were an accurate record of their needs and the care and treatment that they were receiving.

We also found that the provider had taken proper steps to ensure that each person had an assessment of their needs and a care plan in place so that the staff had the information they required to meet people's needs in a safe manner. We talked with people living in the home and they were all complimentary about the care they had received, one person told us "I like living here, the home couldn't be improved". One relative of a person living in the home told us "Since the new manager has been here it is much better. My (relative) is always treated with absolute dignity". The records showed that when people's needs had changed the assessments and care plans had been updated to ensure that people still received the care that they required.

The effective recruitment policy and procedure in place was followed to ensure that the right people had been employed.

We visited the home on 6 February 2013 to check compliance with a warning notice that had been issued to the provider in December 2012.

We found that improvements had been made to the assessments and care plans although these were not all up to date and accurate. We found that not all of the care plans were being followed by all staff and this could place people at risk of receiving unsafe or inappropriate care.

On this occasion we did not speak to any people who used the service about the way their medicines were managed. People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

A concern had been raised about the lack of staff with the right skills to care for the needs of those living in the home. As a result there was a risk that people’s needs might not have been fully met. As the purpose of the inspection was to look at the numbers and qualifications of staff identified in the concerns, we did not request information directly from people using the service on this occasion.

Soham Lodge is registered to provide accommodation and nursing care for up to 26 people. There were 22 people living at the home when we visited. The home is on one floor with two dining and lounge areas and single bedrooms. There is an enclosed garden area.

This unannounced inspection took place on 19 and 23 March 2015. The previous inspection was undertaken on 21 February 2014 when we found that the regulations which we assessed were being met.

At the time of the inspection there was no registered manager 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.

Not everyone received their medication as prescribed and safe practices had not always been followed in the administration, recording and storing of medicines.

People felt safe and staff knew what actions to take if they thought anyone had been harmed in anyway.

People confirmed that there were enough staff available to meet their needs but that they would like it if staff had more time to sit and talk to them. Other than when staff were attending a short meeting call bell’s were responded to promptly and people were not rushed when being assisted by staff.

Staff monitored people’s health and welfare needs and acted on issues identified. People had been referred to healthcare professionals when needed. Not all nurses employed to work in the home had the competencies they required to meet people’s nursing needs. These needs had been met by the district nurses.

The requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were being followed to ensure that when needed decisions were made in people’s best interests and they were not having their liberty restricted unless the correct procedures were followed.

People enjoyed the food and always had enough to eat and drink. When needed, people were given the support to eat and drink.

Staff were kind and compassionate when working with people. They knew people well and were aware of their history, preferences and likes. People’s privacy and dignity were upheld.

People had been involved in the assessment and planning of their care. Care records were detailed and gave staff the information they required so that they were aware of how to meet people’s needs.

There was a complaints procedure in place and people felt confident to raise any concerns either with the care staff or the manager.

A management company had been appointed to oversee the running and of the home and had appointed a new manager. The management company had an action plan in place to make ensure improvements were made where necessary.

We found a breach of the Health and Social Care Act 2008(Regulated Activities) Regulations 2010 which correspond to breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.