This inspection took place on 26, 27 and 29 November 2018. The first day of inspection was unannounced.

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

Stonedale Lodge is a purpose-built home comprising of six separate units, situated within a residential area of Croxteth. The service has two residential units and one nursing unit dedicated to people living with advanced dementia. There are two further units for people with general nursing needs, as well as a residential unit. The service can accommodate up to 180 people. At the time of the inspection, there were 151 people living at the home.

This is a large setting and to achieve a fair and proportionate rating for the service as a whole, we inspected all six units, then compared findings to make our judgements. This means we identified what the service did well overall, but also where there were themes of improvement needs or concerns. We also checked whether any individual examples of the care people received were particularly good or equally put the person at risk.

At this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These related to themes we found in different parts of the service, regarding the safety of the home’s environment, as well as record keeping and auditing aspects. You can see what actions we told the provider to take at the end of the full report.

The service had no registered manager when we visited, as the previous manager had left the provider’s employment prior to our inspection. A registered manager is a person who has registered with 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.

In the absence of a registered manager, the two deputy managers were leading the home, together with the provider’s improvement manager for the North West. We found all three demonstrated passion about the quality of people’s care in the way they engaged with people, relatives and staff. Their focus was to achieve improvement by promoting a caring, dedicated culture within the service. From development plans it was clear that there was much to do in the way of improvement, but it was also clear that the team had worked hard over the last months towards making those improvements.

This was our first inspection of the service since Advinia Care Limited became its registered provider. We found that the service was still being developed under the new provider and was in a ‘step-by-step’ transition when we inspected, to introduce changes gradually.

We found that the personalisation of people’s care varied across the service. This was both in the planning, as well as the delivery of care. Information in people’s care plans was not always clear or correct. At times, information needed to be more accessible for people.

We considered that the adaptation of the service to make it dementia-friendly, as well as activities on offer to meet people’s needs and provide stimulation also varied and needed improvement.

We found that recorded complaints were managed well. However, we considered that at times the service needed to develop how they listened to those who had an improvement wish, but did “not want to complain”.

There was enough staff to meet people’s needs and keep them safe. The service had taken measures to significantly reduce the use of temporary workers and create greater stability.

Safeguarding concerns had been recorded and investigated appropriately. Staff were aware of their responsibilities to keep people safe and had confidence t