The inspection took place on 16 April 2018 and was unannounced.

Clare Lodge Care Home 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. Clare Lodge Care Home accommodates up to 24 older people some of who may live with dementia. The home is arranged over four floors and is purpose built. On the day of this inspection there were 21 people living at the home.

The service had a registered manager who was also registered with CQC to manage another Grange Care Services learning disability service locally. 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.

At our previous inspection in November 2015 we rated the service as 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.

People felt safe living at Clare Lodge Care Home. Staff were knowledgeable about how to safeguard people from avoidable harm. Potential risks to people's health, well-being or safety had been assessed to help keep people safe. Staff helped people to move safely using appropriate moving and handling techniques. There were enough staff available to meet people’s needs in a timely manner. Safe and effective recruitment practices were followed to help make sure that all staff were of good character and suitable for the roles they performed. There were suitable arrangements for the safe storage, management and disposal of medicines and people were supported to take their medicines by trained staff. Some improvement was identified in medicine record keeping. Regular fire and health and safety checks were completed to help maintain safety.

There were systems in place to help promote infection control.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received training to support them to be able to care for people safely. People were provided with a good choice of food and that they were supported to maintain a healthy diet. People’s day to day health needs were met in a timely way. The environment was appropriate to meet people’s needs.

People and their relatives were happy with the staff that provided the care. Staff took prompt action to address people’s discomfort and to help meet people’s individual choices and wishes. Staff respected people's dignity, promoted their dignity and privacy and made sure that they supported them in the way they wished whilst encouraging them to remain as independent as possible. The environment throughout the home was warm and welcoming. Information was available and accessible to guide people and their relatives about how to access to external advocacy support if required. Relatives and friends of people who used the service were encouraged to visit at any time.

Staff were knowledgeable about people's preferred routines, likes and dislikes, backgrounds and personal circumstances and used this to good effect in providing them with personalised care and support that met their individual needs. The service was managed in a way that responded to people’s changing needs. Regular meetings were held for people who used the service and their relatives to share their opinions about the service and facilities provi

The inspection was carried out on 23 November 2015 and was unannounced. At the time of our inspection there were 23 people living at Clare Lodge.

Clare Lodge is care home for up to 24 older people or people living with a dementia. There were two people who were on end of life care pathways at the time of our inspection.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. At the time of the inspection we found that people’s freedoms had been restricted by the service to keep them safe and some applications were completed and awaiting authorisations while others were in progress. Staff had received training in Mental Capacity Act 2005 (MCA) and were aware of how to protect people’s rights. People were asked for their consent before staff carried out any care or support.

People told us that they felt safe and well cared for by the service, relatives confirmed their relatives were kept safe. Staff had received training in how to safeguard people from abuse and knew how to report and elevate concerns, both internally and externally.

There were safe and effective recruitment practices in place to ensure that staff were suitable to work with vulnerable people. There were sufficient numbers of staff on duty to meet people’s care and support needs. However people told us staff at the weekend had less of a ‘presence’, so it felt like there were less of them, although rotas confirmed that the numbers were the same. The manager told us they did not work at the weekend and also there was no admin staff or laundry staff so there were fewer staff around.

Staff were appropriately trained in how to administer medicines safely and we saw that they supported people to take their medicines regularly and at the right times. Potential risks to people’s health and well-being had been identified and were reviewed and managed effectively.

People were supported to participate in a range of activities, some provided by staff and some provided by outside entertainers who visited the home.

Staff were respectful of people’s privacy and dignity. We saw that interactions between staff and people were positive, caring and respectful. Staff were observed to be patient, when assisting people and demonstrated a good knowledge of people’s needs and wishes.

People and their relatives told us that they were listened to and complaints were investigated, recorded and responded to appropriately. There was a clear complaints procedure which was also in pictorial form. We saw many letters and cards of gratitude and saw that compliments and comments were also recorded.

People were offered a choice of food and drinks and people told us the food was good. There were arrangements in place for people who required additional dietary support. Staff supported people to maintain their health and wellbeing.

There were effective systems in place to monitor the quality of the service and there were on-going plans in place to demonstrate the manager and staff worked hard to achieve continuous improvement. The manager had undertaken a survey which was sent to all stakeholders about the quality of the service including people who used the service, their family and friends and professionals. The results had been evaluated and actions were in place where required.

This was a follow up visit to check that the required improvements had been made. We observed people who used the service sitting in various places throughout the home, including the lounge, the dining room and in the garden. People looked happy and relaxed in their environment. We saw staff interacting and assisting people who used the service and noted that people were treated with courtesy and respect. People were asked what they wanted to do and were able to choose where they wanted to sit, and what activities they wanted to participate in.

We looked at people's care plans and noted people had an assessment of needs carried out, there were care plans in place and these in most cases, these had been reviewed recently to reflect people's current care needs. We observed that food was plentiful and of a good standard. When we asked people what they thought of the food, most were very complimentary.

People told us they liked the staff and the manager and said they were well supported.

We saw that there was an action plan in place and progress had been made on addressing identified concernsand the manager was continuing with getting things up to date. We found that, although the home had a number of ways of collecting feedback and people's views about the quality of the service, they had not yet collated the results of the quality assurance data. However this was sent following the inspection.

Although two managers are currently registered for this home, we were told that one of them has not been in post for over one year. We saw staff speaking to people who used the service with courtesy and respect and we saw evidence that people were involved in decision making. Their views were respected and their human rights were protected because appropriate steps were being taken to obtain their consent. We found evidence that people’s safety and welfare was protected through risks being identified, assessed and managed. We observed that food was plentiful and of a good standard. When asked if there was enough to eat a person told us 'yes! I'll go bang!'. People told us they found the manager approachable and staff told us she was supportive. One staff told us 'she has brought us together, given us stability and structure'. We saw that, although there were gaps in training, the manager had made good progress to address this over the last year. We saw that plans were in place to continue bringing training up to date. Supervision was not taking place regularly and this could mean that staff were not being supported adequately to provide good care. We found that, although the home had a number of ways in which they gathered views about the quality of the service, there was no evidence that the information had any impact on the care provided. Monitoring visits by the Provider take place regularly but we found an example where concerns had not been followed up as agreed.