Cambrian Lodge provides accommodation and personal care for up to 28 older people. Some people living at the home were living with dementia. The home is large converted villa in a residential area of Portishead. The accommodation is set out over four floors which are accessed via two lifts and a staircase. At the time of our inspection there were 22 people living at the home.

There was a registered manager in post. 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.

This was a comprehensive inspection carried out on 8 November 2018. The inspection was unannounced.

At our last inspection in November 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People remained safe at the service. During the inspection we were shown an area where work had started for the installation of a new boiler. Since the last inspection the service had acquired an additional hoist which can access all areas of the building. Staff understood safeguarding procedures and said they would not hesitate to report any concerns. Risk's to people safety and well-being were managed without imposing unnecessary restrictions on people. Medicines were managed safely ensuring people received their medicines as prescribed.

There were adequate hand washing facilities available and staff used personal protective equipment such as gloves and aprons when required. People also had personal evacuation plans in place in case of an emergency. The service ensured people had an assessment before moving into the home to confirm they could meet people’s needs. Care plans contained important information relating to peoplesslikes and dislikes, their previous occupation, families and routines. Care plans also contained risk assessments and support plans that confirmed people’s individual needs.

The care plans contained consent documents and assessments to demonstrate the service was working within the principles of the Mental Capacity Act 2005. Capacity assessments were in place including best interest decisions if required. People are supported to have maximum choice and control of their lives and staff do support them in the least restrictive way possible; the policies and systems in the service do support this practice. Both people and staff were happy in the service and all felt it was a homely positive environment which encouraged them to be as independent as possible.

People and staff felt that their views were sought and improvements were made to the service following this feedback. Where complaints were raised these were investigated and people had access to the provider’s complaints policy and procedures.

People felt supported by staff who were kind and caring and who respected their privacy and dignity. They were given choice about what they would like to eat and were complimentary about meals provided. People were supported and encouraged to spend their time on activities of their choice and visitors were free to visit when they wished.

There was access to a variety of activities which suited different abilities and interests such as gardening, chair exercises, singing and church service. Family members attended activities at the service and were free to come and go as they pleased. The service had a positive working relationship with professionals.

Staff had daily handover meetings and sta

Cambrian Lodge provides accommodation and personal care for up to 28 older people. Some people living at the home were living with dementia. The home is large converted villa in a residential area of Portishead. The accommodation is set out over four floors which are accessed via two lifts and a staircase. At the time of our inspection there were 22 people living at the home.

There was a registered manager in post. 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.

People, their relatives and staff said the home was a safe place for people. Systems were in place to protect people from harm and abuse and staff knew how to follow them. The service had systems to ensure medicines were administered and stored correctly and securely.

People were supported by a sufficient number of staff to keep them safe. Risk assessments had been carried out and they contained guidance for staff on protecting people. The provider followed safe recruitment procedures to ensure that staff working with people were suitable for their roles.

People were complimentary about the food provided. Where people required specialised diets these were prepared appropriately.

People’s rights in relation to decision making were upheld.

Staff had enough training to keep people safe and meet their needs Staff understood people's needs and provided the care and support they needed. People received support from health and social care professionals.

Staff had built trusting relationships with people. People were happy with the care they received. Staff interactions with people were positive and caring.

There were organised activities and people were able to choose to socialise or spend time alone. People and relatives felt able to raise concerns with staff and the manager.

Staff felt well supported by the registered manager and felt there was an open door policy to raise concerns. People and relatives were complimentary about the manager and deputy and said they had a good relationship with them.

There were quality assurance processes in place to monitor care and safety and plan on-going improvements. There were systems in place to share information and seek people's views about their care and the running of the home.

During a CQC inspection on the 11 and 12 July 2013 we found Cambrian Lodge non -compliant in outcomes relating to care and welfare of people who use services and cleanliness and infection control. We re-examined these outcomes during an inspection on 29 October 2013. We found that appropriate action had been taken to address the identified shortfalls.

We found that the risk analysis of people's falls had improved. Staff routinely established the cause of falls or linked them to problems people may have had at the time. Appropriate measures had been taken to evaluate the risk in relation to falls.

The provider's infection control procedures met with the recommended guidelines for the prevention and control of infection within the home.

At the time of our visit there were 24 people living in Cambrian Lodge. We spoke with four people living in the home, and people told us they were happy with the service they received. Comments included: "it is lovely the staff are fabulous and I couldn't wish for better". Another person told us “It’s very pleasant here".

We also spoke with the registered manager, deputy manager and care staff. Staff we spoke with were knowledgeable about the people they supported, and care plans were detailed, person centred, and evidenced that people were involved in the process.

We observed staff supporting people in a respectful way, offering people choices and giving them appropriate time to respond. Staff we spoke with believed that people were treated well by the team, and they had no concerns about the safety of people living in the home. Two people we spoke with told us they felt safe living in the home, and would know who to talk to if they didn’t.

This inspection took place on the 5 and the 9 February 2015 and was unannounced.

Cambrian Lodge provides accommodation and personal care for up to 28 older people. Some people living at the home were living with dementia which means their ability to understand and communicate their needs and wishes was limited. Most people were dependent on the staff to meet all of their care needs. At the time of our inspection there were 20 people living at the home.

Cambrian Lodge is large converted villa in a residential area of Portishead. The accommodation is over 4 floors which is accessed via two lifts and a staircases.

A registered manager was in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection carried out on the 17th and 18th July 2014 we found the provider was not meeting the regulation in relation to consent to care and treatment, care and welfare, infection control, assessment and monitoring the quality of the service and records. Following that inspection the provider sent us an action plan telling us what improvements they were going to make. During this inspection we found that the provider had made positive steps towards achieving their action plan but there were still some areas of concern relating to poor practice in the administration of medicines.

The management of medicines was not always being delivered in a safe manner. This practice on the day of our inspection was putting people at risk of not having medicines as required whilst also having access to medicine that was not intended for their use. We informed the registered manager of this practice.

On this inspection we found staff were undertaking appropriate best practice to manage infection control within the service. Previous areas relating to shortfalls had been actioned. The service at the time of our inspection had failed to undertake a current risk assessment relating to a current infection control procedure. This was sent through immediately after the inspection.

People who required support and assistance at night were receiving appropriate care and support they needed from staff. We found on the day of our inspection there were adequate staffing levels to meet people’s needs. .

Risk assessments were in place and identified where people were at risk of dehydration and malnutrition. The food and fluid charts confirmed what amounts people had consumed these had all been signed.

Care plans identified peoples mobility needs and risk assessments included details of what equipment the person required and how many staff. People and relatives told us they felt people were safe. There were policies and procedures in place which were available for staff. Training had been provided to the staff but on talking to some staff they were unable to clearly give a good account of their knowledge after receiving safeguarding training.

The service had robust recruitment and selection processes in place and we saw appropriate paperwork for all staff.

The home was undertaking when required all assessments in relation to The Mental Capacity Act and Deprivation of Liberty Safeguards. We found not all staff were able to demonstrate clearly their knowledge relating to the Act. It was also hard to establish they were competent and knowledgeable about the training they had undertaken.

The home had a variety of choices relating to meals and people we spoke with were all happy with the meals and choice within the home. We saw there were snacks available throughout the day.

We found that not all people received respectful and positive interactions from staff. People told us staff were kind and considerate but we did not always see this was the case.

Care plans related to most people’s changing needs. But one had not been updated following an incident and a change to their current need. There were a variety of activities and there was a weekly activity programme. People chose to access areas of the home as they wished throughout the day.

We found people felt aware of how to complain and confident that they could do so. We saw that were the service had received complaints that these had been responded to and actions taken.

The home was not undertaking robust quality audits that identified areas of concern in relation to building’s maintenance, health and safety and infection control. Concerns we found have since been addressed. However we require the home to have their own robust quality audits that identify shortfalls and for there to be a plan regarding completion of those shortfalls.

Staff felt well supported by the manager and that there was a open door policy. People and relatives were complimentary about the manager and deputy and said they had a good relationship with them. The service was gaining views from people who received care within Cambrian Lodge but there was only the compliments and complaints box in situ for staff and relatives to use. There was a system for recording incidents and accidents and there was a monthly analysis conducted and a log of what actions had been taken.