This unannounced inspection took place on 03 and 09 May 2018.

Stanley Lodge is registered with the Care Quality Commission to provide accommodation and personal care for up to 23 residents. The home is situated in a rural area of Forton near Lancaster.

Stanley Lodge Residential Home 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.

We last carried out a comprehensive inspection at Stanley Lodge Residential Home in May 2016. The home was rated good but we identified some concerns in relation to the environment. We carried out a focussed inspection in January 2017 to check improvements had been made. We found the registered provider had made the improvements required.

At this inspection visit carried out in May 2018, we found the registered provider had not met the fundamental standards. We identified concerns in relation to premises and equipment, person centred care, staff training and good governance.

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.

At this inspection visit carried out in May 2018, we found the home environment was not always appropriately maintained. We found areas within the home which were in need of repair. For example, two toilets were out of use, only one bathroom was in use, two bedroom windows were secured with tape and a hole in a ceiling had been temporary boarded over but not repaired. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Because of the poor maintenance of the home, people were sometimes unable to have a bath when they requested it. This meant people’s preferences and wishes were not always met. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Staff did not always receive ongoing training and support to ensure them to carry out their roles safely. For example, only three staff who worked at the home had an up to date qualification in basic first aid. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Paperwork was not always suitably completed in order to ensure safe and effective care was delivered. We found paperwork was not always up to date and accurate. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Although people told us they felt safe we found risk was not always appropriately addressed and managed in a timely manner. We have made a recommendation about this.

Processes were in place to ensure medicines were suitably and safely managed in line with good practice guidance. However, we found these were not consistently embedded. We have made a recommendation about this.

On the first day of the inspection visit the registered manager told us they had recently introduced an electronic care recording system. They said however they had not had time to fully implement the system so staff were using two different care recording systems. We reviewed care records and found paperwork was disorganised and care records did not always reflect people’s needs. We fed this back to the registered manager who took immediate action. On the second day we were informed by the registered manager they had decided to revert to their original care recording system. They said they had taken immediate action and had reviewed all care records. We have made a recommendation about this.

During the inspection visit we were made aware the registered provider was having

We carried out an unannounced comprehensive inspection of this service on 18 and 24 April 2016. At this inspection breaches of legal requirements were found. 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 Stanley Lodge Residential Home on our website at www.cqc.org.uk

This unannounced focused inspection took place on 21 November 2016.

Stanley Lodge Residential Home is a care home managed by Unlimited Care Limited. It is located in the village of Forton, South of Lancaster.

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.

There were 23 people residing at the home at the time of the inspection.

The service was last inspected on 18 and 24 April 2016. At this comprehensive inspection we found the registered provider was not meeting all the fundamental standards. We identified a breach to Regulation 15 of the Health and Social Care Act 2014 as the registered provider had failed to ensure premises and equipment were suitable for use and appropriately maintained.

Following the comprehensive inspection in April 2016, we asked the registered provider to submit an action plan to show what changes they were going to make to become compliant with the appropriate regulations. The registered provider returned the action plan to demonstrate the improvements they intended to make. We used this focused inspection to look to check if the actions set out within the action plan had been completed and to ensure all fundamental standards were now being met.

At this focused inspection carried out in November 2016, we found the required improvements had been made.

Improvements to the living environment had been completed. Decoration within the building had taken place. Slips, trips and fall hazards had been reviewed and addressed.

Best practice guidance had been referred to and window locks had been fitted to all windows where there was risk of falls from height.

Electrical testing of all appliances had been carried out to ensure electrical appliances were suitable and safe for use.

Following the inspection visit we received confirmation that action was being taken to ensure infection control processes were consistently applied throughout the building.

This unannounced inspection took place on 18 and 25 April 2016.

Stanley Lodge is registered with the Care Quality Commission to provide accommodation and personal care for up to 23 residents. The home is situated in a rural area of Forton near Lancaster. There were sixteen people residing at the home at the time of inspection.

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.

The service was last inspected on 09 January 2014. We identified no concerns at this inspection and found the provider was meeting all standards we assessed.

At this inspection carried out in April 2016, people spoke positively about the quality of service provision on offer. People told us staffing levels were conducive to meet their needs and they benefited from staff who knew them well.

The registered manager carried out a monthly assessment of peoples support needs to determine staffing levels. We observed staff being patient and spending time with people who lived at the home.

People told us they felt safe and secure. Arrangements were in place to protect people from risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns.

Suitable arrangements were in place for managing and administering medicines. A designated staff member carried out audits of medicines to ensure systems in place were being followed correctly by staff. All identified medicines concerns were reported to the registered manager for investigation.

Recruitment procedures were in place to ensure the suitability of staff before they were employed. However these were not always consistently applied. We have made a recommendation about this.

People’s healthcare needs were monitored and managed appropriately by the registered provider. Guidance was sought in a timely manner from other health professionals when appropriate.

Care plans were in place for people who lived at the home. Care plans covered support needs and personal wishes. Plans were reviewed and updated at regular intervals and information was sought from appropriate professionals as and when required.

Feedback on the quality of food provided was positive from both people who lived at the home and relatives. People were happy with the variety and choice of meals available to them. Peoples nutritional needs were addressed and monitored.

There was a variety of social activities on offer. The registered manager had established links with various community groups who frequented the home and provided entertainment. Consideration was taken to ensure people who chose not to interact within groups were supported on an individual basis. Cultural needs were recognised by the registered provider.

We found premises and equipment were not appropriately maintained. Action commenced after we highlighted these concerns and we were assured work was on-going to improve the living environment. This was a breach of Regulation 15 of the Health and Social Care Act (2008) Regulated Activities 2014.

The registered manager had a training and development plan in place for all staff. We saw evidence that staff were provided with relevant training to enable them to carry out their role.

Staff had received training in The Mental Capacity Act 2005 and the associated Deprivation of Liberty Standards (DoLS.) We saw evidence these principles were put into practice when delivering care.

The manager had implemented a range of assurance systems to monitor quality and effectiveness of the service provided. Work had been undertaken to restructure staffing as a means to improve service delivery.

Staff were positive about ways in which the servic

During our inspection in February 2013 we found that people’s safety was at risk as care was not delivered as planned, robust recruitment procedures were not in place, there was not enough staff on duty at all times and there was a lack of effective management for monitoring the quality of service people received. We used this inspection to see what actions had been taken to meet the essential standards of quality and safety.

We spoke with a range of people about the home. They included the manager, staff members, residents and visitors to the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Stanley Lodge.

We spent much of the time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support with personal care. Sufficient skilled numbers of staff were available to meet the needs of people. Staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "I feel at home. The staff are excellent and I am very happy."

This inspection was to follow up on concerns identified during previous inspections since November 2012. Major concerns had been identified in relation to staffing levels at the home.

During this inspection we assessed the progress made by the provider in relation to the concerns raised in previous reports. We found that some minor improvements had been made. However there were a number of issues still outstanding that had not been addressed.

We visited the home on 09 January 2013 in order to monitor what action the provider had taken to address staffing issues identified as non compliant during the inspection of 07 November 2012 and during the responsive inspection on 17 December 2012.

Between 03 December 2012 and 17 December 2012, we had been contacted through a number of sources regarding concerns about continuing poor staffing levels at the home. In addition the provider contacted us on 17 December 2012, notifying us that she was experiencing problems with staffing the home.

The home was also visited by a Care Quality Commission Pharmacist Inspector on 10 January 2013. The visit was in response to concerns raised with the Commission about medication administration practices at the home.

We observed part of the morning medicines round and spoke with several people about their medicines. People we spoke with felt they received their medication on time. However, in one instance we found one persons medication had been administered after food when it should have been prior to food. In another instance the recorded stock of medication (inhaler) was incorrect. Also there was no evidence of formal arrangements in place to monitor staff competency in medication administration. This meant there were improvements required, to help make sure medicines were being managed safely.

We visited the home in order to monitor what action the provider had taken to address staffing issues identified as non compliant during the inspection of 07 November 2012 and during the responsive inspection on 17 December 2012.

Between 03 December 2012 and 17 December 2012, we had been contacted through a number of sources regarding concerns about continuing poor staffing levels at the home. In addition the provider contacted us on 17 December 2012, notifying us that she was experiencing problems with staffing the home.

The provider met with relatives on 17 December 2012 to make them aware of the staffing problems at the home. A relative we spoke with expressed their concerns about the situation and was anxious that staffing levels were not stable.

A meeting took place between the provider and the Care Quality Commission on the 19 December 2012. The Commission requested that the provider supply evidence of what action they would take to ensure the home would be suitably staffed during the Christmas and New Year Period.

Stanley Lodge cares for people with a range of dementia conditions and conversation with some people who lived at the home was limited. We spoke with a variety of people about the home. They included the senior person in charge, people who lived at the home and a family member visiting their relative. Staff we spoke with told us of their concerns that staffing levels were not consistent and they had found it difficult to manage at times.

We visited the home in response to concerns raised with the Commission since our last inspection. We had been contacted from a number of sources with concerns about staffing levels at the home. In addition the provider contacted us on 17 December 2012, notifying us that they were experiencing problems with staffing the home. The provider told us that an emergency resident’s meeting had been arranged for that morning.

The home currently provides accommodation for eighteen people. On arrival at the home at approximately 4.45pm, we found two members of staff on duty, one of whom was the manager. A relative of a person who lived at the home was assisting the staff by washing up the tea time pots.

We spoke with a range of people about the home. They included the home manager, people who lived at the home and a family member visiting their relative.

This home cares for people with a range of dementia conditions and conversation with some people who lived at the home was limited. However the people we spoke with told us they felt safe and well cared for.

We spoke with a range of people about the home. They included, the provider, the home manager, people who lived at the home and three family members visiting their relatives. We also spoke to visitors to the home. In addition we had responses from external agencies such as Lancashire County Council in order to gain a balanced overview of what people experienced.

Lancashire Fire Service was in attendance on the day of our visit carrying out a routine fire safety inspection at the home.

This home cares for people with a range of dementia conditions and conversation with some people who live at the home was limited. However the people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, “It is homely here and I am very happy.”

We spent time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support. Staff treated people with respect and dignity.

We had been contacted prior to visiting the home with concerns about staffing levels and staff training. We found that there were occasions when there was not enough staff on duty to meet people’s assessed needs. We also found that suitable arrangements are not in place to ensure that staff receive appropriate training in key areas.

People who use the service told us that staff were kind and friendly. This was confirmed by

the visitors we spoke with. They said that on the whole there were sufficient staff around to ensure that there needs were met. They said that call bells were answered promptly and yes there were times when they were particularly busy when they would have to wait. One person told us that "If they had double the staff there would still be times when I may have to wait but I accept this as the staff are so wonderful"

A visitor told us that they were very happy with the care provided and that their relative

had "thrived since they came into the home"

People who used the service told us that they felt safe at the home and that staff were “kind and caring”. They felt that the food was usually “excellent” or “lovely” and that they were given plenty to eat at times that suited them. They said that the cooked meals were always appropriately hot when served. They said that they were able to make suggestions for the menus and that the menu was generally varied. Two people commented that it was “not easy though to please everyone all of the time”, but that they had no complaints as they food was “wholesome” and “generally what we like”. No relatives or friends of the residents were available at the time of the visit to gain their views

All of the people living at the home said that their rooms were warm and comfortable and that they felt safe during the day and also at night. They said there was always plenty of staff around and if they needed assistance this was usually given promptly. They said that they were able to go to their room for privacy when they wished and that staff left them alone for a reasonable time when they did not want to be disturbed. Staff seemed “patient enough most of the time and never seemed hurried.”

They told us that they were given regular baths or showers and were assisted with their personal hygiene where this was needed. At all times staff respected their privacy and dignity and they were able to attend to their own personal hygiene on their own if they were able.

People who use the service said that the home provided some activities for them to participate in each week and they were able to join weekly outings if they wished. Activities were discussed at the residents’ meetings which took place every 2 months, and new activities had been added including handicrafts.

They told us that they felt the staff were supported well by the management and that there was a good working atmosphere at the home. Most of the people we spoke with knew who their key worker was and had regular reviews of their care plans, where they, their family and/or friends were asked to contribute. They were asked to sign care plans in order to demonstrate that they had contributed and approved of the care that was to be provided.

We spoke with the Local Authority monitoring team and they told us that they felt the manager co-operated with them in improving the care being delivered and corrected identified shortfalls in a timely manner.