Delamere Lodge

The inspection was prompted in part by notification of a serious incident. The incident is subject to further investigation by CQC as to whether any regulatory action should[KW1] be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about risk management and the inspection examined this.

There was a manager at the home who was not registered with us but was supported by a regional manager and the provider.

We identified areas that needed to improve such as gaps in fire drills and issues

around environmental cleanliness, infection prevention and control (IPC) Although the provider had taken some action to address concerns during and after the inspection, we found that improvements were not yet fully sustained.

Staffing levels were appropriate, and people received care from experienced staff. However, the home was supporting people living with mental health issues and more specific training and changes to their registration with us was required for this.

Staff told us they felt more supported, recent changes in leadership had led to an increase in staff morale, and staff spoke positively about the new manager, describing them as approachable and responsive.

The service had made some progress addressing previous oversight issues. Audits, provider visits and governance checks were regular and documented. The management team were visible, and there were clear plans for further improvements, including staff supervision, training, and an environmental refurbishment.

Medicines were administered safely and well managed overall. Staff recruitment was carried out safely with the appropriate checks in place.

People experienced positive outcomes and told us they felt respected, supported, and able to maintain important relationships. Staff promoted people’s wellbeing, and we saw a caring, inclusive culture. The provider had taken meaningful steps to be responsive to concerns.