The inspection took place on 26 March and 12 April 2018 and the first day was unannounced.

This was the service’s first inspection since it had been taken over by this provider.

Stockton 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 service accommodates 48 people in one purpose built building. At the time of our inspection there were 33 people using the service.

There was no registered manager in place at the time 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. The provider had appointed an acting manager on a part time, temporary basis and was in the process of recruiting a permanent manager. Following the inspection we received confirmation that the successful candidate had accepted the post and would begin the registration process as soon as possible.

Medicines were stored in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). Staff responsible for administering medicine had received appropriate training.

We found MARs were fully completed, contained required entries and were signed to confirm administration. Controlled drugs were stored securely and stock counts were accurate. We found a number of stock discrepancies in other medicines and as a result of the findings daily stock checks were introduced. Guidance for staff was not in place for all medicines prescribed ‘as required’.

There was a business contingency plan in place that covered a variety of situations including keeping a correct temperature within the home. One of the boilers within the service had recently failed however room temperatures were not checked or recorded. This meant the provider had not taken steps to ensure the temporary solution of using portable heaters had been effective in maintaining a safe and comfortable temperature for the people.

The records of one person who required regular checks due to a pressure area showed that necessary positional changes had been missed. On one occasion there was a 14 hour gap instead of the recommended four hours. As a result of these findings a safeguarding alert was raised with the local authority and an internal investigation was to be undertaken.

People and their relatives told us they felt safe living at Stockton Lodge. Policies and procedures were in place to safeguard people from abuse. People were protected from discrimination, particularly in relation to protected characteristics under the Equality Act.

Fire evacuation training had been conducted by an external trainer but in-house fire drills were not conducted in line with the provider’s statement of purpose, policies and procedures.

Observations during the two days of inspection and people’s comments indicated there was a sufficient number of staff on duty to care for people safely. However, the way people’s dependency levels were calculated was not very precise. The provider was planning to develop a new method for setting staffing levels.

Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken.

Care records contained detailed risk assessments. People had individual personal emergency evacuation plans in place. Accidents and incidents were recorded and analysed monthly to look for patterns or trends. Regular maintenance checks and repairs were carried out and all areas of the service were clean and tidy.

We saw in one person’s records they had lost a significant amount of weight in recent months. A dietician referral had been made but this c