Dawson Lodge provides accommodation and personal care for up to 43 older people, some of whom are living with dementia. The home is set in its own grounds near to local facilities and shops. The accommodation comprises a large lounge and dining room which overlooks, and has direct level access to the landscaped gardens. At the time of our inspection there were 42 people living at the home.

The inspection was unannounced and was carried out on 29 August 2018 by a lead inspector, a second inspector and an expert by experience. An expert by experience is someone who has experience of using, or has cared for someone who uses this type of service. The lead inspector returned on 31 August 2018 to complete the inspection.

Dawson 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.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their relatives consistently told us they thought the home was extremely well run. The registered manager was visible and approachable and was interested in what people had to say. Reviews and surveys included exceptional feedback and the home was highly rated in the most recent survey.

The provider and registered manager had a positive vision for the home which promoted person centred care within a happy environment. The registered manager promoted an open culture where feedback was welcomed to help drive continuous improvement within the home which was supported by the senior management team. The provider had received many awards for delivering high standards in care.

The registered manager worked pro-actively with the local community to provide innovative opportunities to enhance people’s quality of life. Intergenerational programmes encouraged fun interaction between children and people living at Dawson Lodge which developed learning and reduced stigma around dementia.

There was a strong person-centred culture within the home. Staff took time to listen to people and their relatives to help understand their life stories and what was important to them, and to develop individual plans of care.

There was a vibrant, homely and relaxed atmosphere at Dawson Lodge. People and their relatives told us consistently that the staff were exceptionally kind, caring and helpful and went the extra mile to ensure their needs were met. Staff took time to offer calm and gentle reassurance if people became upset or anxious.

All staff shared responsibility for providing a wide range of fun and meaningful activities which met people’s preferences, and responded spontaneously to ‘golden moments’ when people showed an interest in something. People were empowered and encouraged to share their ideas and contribute to the running of the home.

Staff had completed an end of life care programme at a local college to develop skills and knowledge which supported them to deliver sensitive and compassionate palliative care. This was confirmed by health care professionals. Relatives appreciated the practical and emotional support they received when their loved ones were nearing the end of their lives.

Staff spoke very highly of the registered manager. They felt extremely well supported, listened to and valued by the management team. There were a number of initiatives to help develop team working and to reward staff and recognise their contributions to the home.

Relatives told us they felt welcomed, valued and respected by staff. They could visit at any time and staff always had time to talk to them ab

This was a follow up inspection to see if action had been taken by the management to improve the system of administration of topical medicines. We spoke with four members of staff, viewed a sample of six people's records and checked that a system was in place to ensure that revised practices were monitored. We found that sufficient action had been taken to ensure that people living in the home received their prescribed medicines regularly.

We found that assessments of people's individual needs before and after an admission to the home informed care plans. This included information about people's previous lifestyles, wishes and preferences including religious and cultural needs. Not all people spoken with could remember planning their care but we found evidence of consultation, wishes and preferences in records.

People told us about food choices and were satisfied with the quality. Dietary needs of people at risk were being monitored. However, records did not demonstrate that adequate action was taken to ensure that some people were supported to eat and drink enough.

Work was taking place to improve the information available to staff about 'as required ' prescribed creams. However we have continued concerns that records of their application remained inconsistent. Records indicated that twenty one people had not regularly received all of their topical medicines.

We found sufficient staffing which was kept under review taking people’s dependency levels into account. We found that people were able to influence the service and many had chosen to join in with a day trip on the day we visited. Questionnaires, residents' meetings and comment cards were used to obtain feedback about the service. Auditing systems were in place and demonstrated that the service had a quality assurance system and action was planned to address issues that arose.

We spoke with seven people using the service and four visitors. Feedback about the care received by people living in the home was positive. They said that they had the help and support they needed. One person said that the staff were “very nice and helpful and they had no complaints”. Another person said that staff would listen in they needed something and that “you can interrupt them” and they would respond and deal with any issues.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. This was used due to a high number of people with dementia living in the home. We found that people were supported in a friendly and supportive manner with attention to individual needs.

During this inspection we also checked that since our inspection in April 2011 the provider had taken action and made improvements regarding outcomes 7 and 9.

A resident we spoke with was aware of their care plan and told us that staff regularly discussed it with them and they knew what was written in it. The person told us they were independent in some aspects of their care and that staff respected this, supporting the resident where they needed and asked for support. They also said they could do as they wished in their flatlet and it was like living in their own home.

We spoke with two residents about whether they felt staff provided them with the care and support they needed and both confirmed that they did.

People told us they felt safe at the home and one resident who we asked said they would feel able to tell someone if they saw behaviour or attitudes which worried them.

We spoke with a resident who said that staff gave them their medication at the time they needed it. We spoke with another resident who looked after and took their own medication but were able to discuss medication issues with the staff, when necessary.

A resident told us they were looked after very well and two residents we spoke with told us the staff provided the care and support they needed. One told us they were able to undertake their own personal care as well as getting some of their meals and the staff supported them where necessary to maintain this level of independence. A resident told us staff came quickly when they used their call bell and that the call bell was always placed within their reach.

Dawson Lodge is registered to provide accommodation for persons who require personal care for up to 43 older people who may also be living with dementia. This service does not provide nursing care.

The home is located approximately six miles from Southampton city centre and is accessible by public transport. The home has 43 single flats (rooms) with en-suite facilities and a small kitchenette. Accommodation at the home is provided over two floors, which can be accessed using stairs or passenger a lift. There is a large garden area which provides a safe and secure private leisure area for people living at the home. On the day of our inspection 37 people were 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 and associated Regulations about how the service is run.

This inspection took place on 16 and 18 November 2015 and was unannounced.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People who were able to talk with us said that they felt safe in the home; and if they had any concerns they were confident these would be quickly addressed by the staff or registered manager.

People were involved in their care planning and staff supported people with health care appointments and visits from health care professionals. Care plans were amended to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People had risk assessments in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and arrangements were in place to manage these safely. Staff knew each person well and had a good knowledge of the needs of people.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe and effective recruitment procedures.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained. Training records showed that staff had completed training in a range of areas that reflected their job role.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection 24 applications had been submitted by the managing authority (care home) to the supervisory body (local authority) and had yet to be authorised. The manager understood when an application should be made and how to submit one. They were aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

The food menus offered variety and choice. They provided people with a nutritious and well-balanced diet.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

People spoke positively about the way the home was run. The registered manager and staff understood their respective roles and responsibilities. The registered manager was approachable and understanding to both the people in the home and staff who supported them.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.