The inspection took place on 12 and 13 September 2018 and was unannounced on the first day.

When we last inspected the service in March 2017 we found the provider was not meeting legal requirements in relation to Person-centred care – Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of a lack of organised activities and engagement from staff. During this inspection we found improvements had been made and the service was meeting legal requirements.

A dedicated activities coordinator had been employed who had implemented a wide range of organised activities for people who lived at the home. These included group activities, visits from local community groups, pet therapy and various outings. The activities coordinator had worked to provide activities that individuals would find meaningful to them. With regard to engagement, we found staff engaged well with people during our observations and were responsive to people’s needs.

The 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 home is registered to provide 24-hour care and support to up to 80 people who are living with dementia and require support with nursing or personal care. The home is divided into four communities, each with a separate lounge, dining room and kitchen. Shared bathroom and shower facilities are available in each community. Two of the communities provide care and support for people who may display behaviour which challenges the service.

The service had a 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.

The provider had systems to safeguard people against abuse or improper treatment. Staff had received training to spot abusive or inappropriate practices and knew how to report them. The service followed a robust recruitment process to ensure only suitable candidates were employed.

Staff assessed risks to the health and well-being of people who used the service and plans were put in place to lessen these risks. Environmental risk, for example around fire safety, had been assessed and appropriate plans put in place to lessen risks. The service promoted positive risk taking in order to help people maintain as much independence as possible.

The provider had systems which recorded any adverse incidents or events. We saw analysis of accidents and incidents was undertaken in order to make positive changes to reduce the risk of recurrence.

Staff had received training to reduce the risks related to the spread of infection. We observed staff follow good practice guidance whilst undertaking their duties. The home was clean and tidy during our inspection.

The service ensured a sufficient number of staff were deployed at all times. Staff retention had improved and more staff were available to cover shifts at short notice, if required. The registered manager reviewed staffing levels against people’s needs to ensure there were always enough staff.

The service followed best practice guidance in relation to the management of medicines. Regular checks were undertaken to ensure people received their medicines as prescribed. Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place to live. We found equipment had been serviced and maintained as required.

People were provided with a choice of meals. We saw regular snacks and dr

This unannounced inspection took place on 29 & 30 March 2017. The first day of the inspection was unannounced, which means the home did not know we were visiting. The home was last inspected on 11 and 12 March 2015 where one breach of the regulations was found. The home was previously rated as requires improvement overall and requires improvement for the key questions of safe and effective. The caring, responsive and well-led key questions were rated as good. At this inspection, we looked to see what work had been completed, to ensure the quality and safety of the service had improved or been maintained.

We found that improvements had been made at this inspection and the actions from the previous inspection had now been completed. However we found one breach to Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was due to the long term absence of a dedicated activities coordinator and planned activities taking place on a regular basis, which we felt was vital for the service and for the well-being of the people living at The Lodge. This had resulted in a lack staff engagement generally which we saw evidence of through observations, discussions with people, relatives and staff and via the homes own internal monitoring processes.

One other issue was the high use of agency staff deployed, particularly at night. We could see that attempts had been made to attract and retain staff at the home and that staff were supported. There was a large service restructure on-going at the time of the inspection which had created a certain level of anxiety within the staff team, which was evident from speaking with staff. We did not judge this to be a breach of regulation as we felt that the issue regarding the use of agency staff had been recognised and suitable efforts made to recruit and retain staff and the restructure had imposed some limits to staff recruitment activity. We discussed at length with the registered manager how the home had attempted to resolve the issue and what plans were in place going forward. We felt that many of the issues were out of the control of the home and that they were being proactive in finding ways to redress the balance of having the correct number of suitable staff in place to meet the complex needs of the people at the home.

The Lodge is located within Buckshaw Retirement Village, Chorley and accommodates up to 80 people who have a dementia related illness and who require help with nursing or personal care. There were 67 people living at the home at the time of our inspection.

The home was undergoing a service and staffing restructure at the time of our inspection. We discussed some of the detail of the restructure with senior staff. At the time of writing this report much of the detail of the restructure was still not finalised so we are unable to give much detail. The restructure has been mentioned as many of the staff we spoke with raised this with us, with some staff giving the restructure as a reason for some staff leaving. We therefore wanted to recognise this even though little detail can be referred to given the sensitive nature of any restructure. In addition to this the home had recently been given notice on a long standing block contract arrangement with the local Clinical Commissioning Group (CCG). This was being factored into the restructure and how the service would operate going forward. The Director of Operations told us that they were looking on this positively as it meant they were able to shape the service towards a more community model long term which was the original intention for The Lodge.

Since our last inspection there has been a large extension and refurbishment to the home. Previously the home was registered for 64 people. There are four distinct units or communities within The Lodge. Raleigh is a residential unit and there are three other units for people with varying degrees of dementia. Two of the units are for people who can dis

In this report the names of two Registered Managers appear, who were not in post and not managing the regulated activities at this location at the time of the inspection. Their names appear because they were still Registered Managers on our register at the time. The current Registered Manager is Donald Chapman.

During our visit to this location we concentrated our observations and discussions around Mountbatten Unit. We spoke with three people who lived there, although this was with only a small degree of success in terms of gaining responses to the questions asked. We also chatted with two visitors, who provided us with positive comments about the care and support their relatives were afforded, whilst living on Mountbatten Unit.

Comments received from those using the service and relatives included:

“I’m well."

“I’m very well thank you."

“Rooms are kept beautifully clean, the bedding is always clean."

“I’m generally happy and I know (Name removed) seems to be very happy."

At the time of this inspection we looked at how people's needs were being met and how people were protected from harm. We also assessed the recruitment practices, the arrangements for staff allocation and how employees were supported. Methods used for monitoring the quality of service provided were also established. We found that some areas needed to be improved and we discussed these with the manager of The Lodge at the time of our visit and through a subsequent telephone conversation.

At the time of our visit to The Lodge there were 61 people living there. We spoke with ten of these people, although were not able to record many verbatim comments, because most people were not able to verbalise. However, those we were able to converse with gave positive responses about the service provided. They told us that staff were kind and caring and that the meals, on the whole were of a good quality. Residents looked comfortable in the presence of staff members and appeared to be settled in their surroundings.

Comments from people living at the home included:

"It is super here. Everything is tip top."

"The staff are marvellous."

"I cannot complain. Everything is laid on. We want for nothing. There is always help at hand if we need it."

During our visit we saw staff talking to people with respect and always in a polite manner. It was evident that individuals were being supported in an appropriate manner. One relative told us, "I couldn't wish for anything better for my husband. He is cared for so well here. The staff are genuinely kind and considerate people."

In this report the names of registered managers appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still Registered Managers on our register at the time of our visit.

We were unable to obtain much feedback from people using the service, due to the client group living at The Lodge. However, we were able to speak with four relatives, who all provided us with positive responses about the service provided.

Comments received included:

"I have nothing but praise for the staff. They are very kind."

"The staff are very attentive and see to (name removed) needs well."

"(Name removed) room is very nice. He is very comfortable."

We also received comments from one relative, who had completed 'Your experience' form, which stated, 'My Husband is treated with respect and dignity by staff at all times. The care and support he receives is felt to be right. Staff are wonderful! He is kept safe and his privacy is respected. The home is kept clean & hygenic' and when asked, 'What was good about the service?' this person responded by writing, 'The understanding and togetherness of our wonderful staff. They make every effort to provide an exceptional service.'

In general people gave positive responses about the service provided. They told us that staff were kind, approachable and listened to their opinions.

Comments from people living at the home included:

“Our key worker is excellent. She will do anything for us”.

“Most of the staff are very good”.

“I am extremely happy living here. I get everything I need and more”.

“This place is second to none. There is nowhere else quite like it”.

During our visit we saw staff talking to people with respect and always in a polite manner. It was evident that individuals were being supported to maintain their independence, although assistance was consistently provided when required. One relative told us, “The staff are marvelous. They are very organised and they know what they have to do and they do it. You will never see any of the staff sitting around doing nothing, they are always with the residents” and another said, “The staff are so kind and caring. They are very pleasant and nothing is too much trouble”.

We saw that people living at the home were being supported to make informed choices, such as what to eat and what to do, as part of day to day life at The Lodge.

There was a lot of evidence available to show that support and advice was being sought from external professionals when needed and that people’s wishes were taken into consideration when making decisions about any health care issues.

Most of the people we spoke to told us that they enjoyed the meals provided. During our visit we saw lunch being served, which was a pleasant experience for those taking part and it was nice to observe a relaxed and unhurried atmosphere. One visitor told us, “My relative has a specialised diet and the home go out of their way to make sure he gets the food he needs”.

This inspection took place on the 11 and 12 March 2015, the first day was unannounced. We last inspected The Lodge on the 6 and 10 November 2014 to follow up on concerns at previous inspections which took place in May and June 2014. At the last inspection we found concerns with the management of medicines and how staff were supported. We found these issues to have a minor impact on the people who used the service.

As a result of our findings we asked the home to submit an action plan detailing how they would become compliant, and when, with regard to each regulation. During this inspection we reviewed actions taken by the provider to gain compliance. We found that the necessary improvements had been made against both regulations.

The Lodge is located within Buckshaw Retirement Village, Chorley and accommodates up to 64 people who have a dementia related illness and who require help with nursing or personal care. Most rooms are of single occupancy. There are a range of facilities within the home, including a bar, shops and a cinema. Each unit has a dining room and lounge areas. There are bathing facilities throughout the home. There are ample parking spaces available and public transport links are within easy reach. The home is spilt into four communities, two of which are for people who display challenging behaviour. The service will be increasing in size from 64 beds to 80 beds and was nearing the end of being extended and refurbished during our inspection.

There was a registered manager in place at the time of our inspection who had been in post for approximately three months. ‘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.’

During the inspection we saw staffing levels were not always sufficient to provide the assessed level of care to people. Staff and relatives we spoke with raised issues about the number of agency staff used by the service and the quality of information they were given prior to starting their shift. This was also raised as an issue by two of the three agency staff we spoke with. Discussions were taking place between the home and commissioners of the service regarding the required staffing levels needed to meet the requirements of peoples identified needs.

We looked at the systems for medicines management. We saw that medicines were safely administered. The medicines administration records were clearly completed at the time of medicines administration to each person, helping to ensure their accuracy.

Permanent staff received a thorough induction and there was a formal induction process for agency staff. However two of the three agency staff we spoke with said they could not remember having an induction or tell us about what their induction entailed. A team leader we spoke with on one of the communities was unable to produce evidence of inductions for agency staff when asked. We have made a recommendation about this.

The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We spoke with staff to check their understanding of MCA and DoLS. Most of the staff we spoke to demonstrated a good awareness of the code of practice and confirmed they had received training in these areas.

We saw within peoples care plans that referrals were made to other professionals appropriately in order to promote people’s health and wellbeing.

Observations of how the registered manager interacted with staff members and comments from staff showed us the service had a positive culture that was centred on the individual people they supported. We found the service was well-led, with clear lines of responsibility and accountability.

There were a number of systems in place to enable the provider and registered manager to monitor quality and safety across the service. These included regular audits and quality checks in all aspects of the service. This included medication audits, health and safety, infection control, fire safety and staff training.

We found a breach of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2010. This related to staffing.

This breach amounted to a breach of the new Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. This also related to staffing.

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