This inspection took place on 20 April 2017 and was announced.

This was the second comprehensive inspection carried out at Lovat Fields retirement village.

ExtraCare Charitable Trust Lovat Fields Village has 258 homes and over 300 people using the service. Dependent on individual circumstances they can support people from housekeeping to personal care, including supporting people with dementia. At the time of our inspection there were 59 people receiving support with personal care.

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 and associated Regulations about how the service is run.

People's experiences of care were overwhelmingly positive. They told us that they had a voice, felt listened to and that they mattered. Staff supported people and their relatives to fully engage in discussions about their care and support. They worked proactively to help people to make choices and decisions about their care and lifestyle choices and to experience new activities or take up past ones. The registered manager and the staff knew each person as an individual and knew what mattered to them.

People's needs were comprehensively assessed and care and support plans gave clear guidance on how people were to be supported. Care was personalised so that each person's support reflected their preferences. We saw that people were at the centre of their care and found clear evidence that their care and support was planned with them and not for them. People were supported to attend a range of support groups and there was an extensive range of activities on offer to ensure people led meaningful and fulfilling lives. The service was flexible and adapted to people's changing needs and desires, enabling positive outcomes for all concerned. Each person was treated as an individual and as a result their care was tailored to meet their exact needs.

People, relatives and staff were very positive about the leadership of the service and about the support they were able to provide for people. Staff demonstrated a passion and commitment to providing excellent care that supported people to lead gratifying and independent lives. People told us the service engaged consistently and meaningfully with families. There were excellent communication systems ain pace and people reported feeling involved and being part of village life. We found the service had a positive culture that was person centred, inclusive and empowering.

The service was exceptionally well led by a dedicated registered manager, who was very well supported by a forward thinking and self-motivated management team. The culture and ethos within the service was transparent and empowering; staff told us that they were proud to work for the service and wanted it to be the very best it could be. Best practice guidelines were followed and the service used innovative approaches in its efforts to support people.

Links with the local community had been established and people were supported to participate in community events and other events that were important and meaningful to them. This provided people with a sense of purpose and wellbeing.

The registered manager and the staff team strived for excellence and it was clear from our discussions with people that staff worked tirelessly to ensure people were cared for in a holistic manner. Numerous initiatives implemented had resulted in reduced physical ailments and improved health and mental well-being for people.

There was strong oversight of the service and the registered manager demonstrated that they were highly committed to improving the service they provided. Their passion and determination to deliver exceptional care for people was clear in the way they spoke about what they

ExtraCare Charitable Trust Lovat Fields Village has 258 homes and over 300 people using the service. Approximately a third of people within the village receive help with their care. Dependent on individual circumstances they can support people from housekeeping to nursing care, including supporting people with dementia.

The inspection was announced and took place on 28 January 2015.

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 and associated Regulations about how the service is run.

People were protected from abuse and felt safe. Staff were knowledgeable about the risks of abuse and reporting procedures. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Safe and effective recruitment practices were followed.

There were suitable arrangements for the safe management of medicines. We found that, where people lacked capacity to make their own decisions, consent had been obtained in line with the Mental Capacity Act (MCA) 2005.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People told us their needs were met and they were supported to take part in meaningful activities and pursue hobbies and interests. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required.

We saw that people were encouraged to have their say about how the quality of services could be improved and were positive about the leadership provided by the registered manager. We saw that a system of audits, surveys and reviews were also used to good effect in monitoring performance and managing risks.

We found that the service had good leadership and staff were positive in their desire to provide good quality care for people. The manager demonstrated a clear vision and set of values based on person centred care and independence. These were central to the care provided and put into practice by staff for the benefit of everyone who used the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

During our inspection of Lovat Fields Village we set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found.

Is the service safe?

We saw evidence that where staff were not performing in line with the organisation’s procedures and best practice guidelines; these were being addressed with individuals in a formal manner. This meant that action was being taken to address staff poor performance and unsafe practice.

We found discrepancies with people’s medicine administration. This meant that people’s medicines were not being managed safely.

Is the service effective?

We found evidence in two of the care plans we looked at which indicated staff were not always staying for the allocated timescale as stipulated in their care plan. This demonstrated that some people’s care and support needs were not always consistently undertaken within the agreed timescale.

We saw that people had individualised care plans and risk assessments in place. We found however, that two people’s risk assessments had not been appropriately maintained and kept under regular review to promote their safety and welfare.

Is the service caring?

As part of this inspection we visited a person in their home. We found that the support workers were aware of the person’s care needs. The support workers were observed treating the person with kindness and compassion. This ensured that their dignity was respected and promoted.

Is the service responsive?

We found that there was not enough detailed information in some people’s care records in relation to their identified needs and how care should be provided. This meant that people’s support needs may not always be appropriately met.

Is the service well-led?

We were made aware that there had been changes to the management of the service. A new manager was appointed but has not yet been registered with the Care Quality Commission.

Staff spoken with said that the new manager had brought in lots of changes to improve on the care provided. A staff member said, “We all have to support the manager during this transition, she really wants to improve the service for the good of the clients.” It was evident that staff were happy to work under the new manager’s leadership.

We looked at the care records for three people who used the service. We spoke with two people who used the service and they expressed satisfaction with the services they received.

The people we spoke with told us they had been provided with information about the services provided by the agency. They told us the staff treated them with respect and preserved their dignity when carrying out personal care tasks.

Some people told us that they were happy with their care. Others told us that their care was inconsistent, rushed and that on occasions their calls were late or left unanswered.

People commented that staff were kind, caring and treat them well. Some people told us that some staff were unsympathetic and made them feel like they were a nuisance.

People told us that they felt safe and knew how to make a complaint. People who had recently commenced a package of care did not recall having received a copy of the complaints procedure. One person told us that they knew how to make a complaint but was worried about the consequences of doing that. Another person was concerned about the outcome for them of talking to the Care Quality Commission.

Some people told us that they were consulted with on how the service is run.

Other people told us that they and less able people had little or no involvement in how the service was run. They felt they were not listened to.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

During our inspection of Lovat Fields Village we set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Below is a summary of what we found.

Is the service safe?

We found that people's needs had been appropriately assessed before they were provided with domiciliary care and support. We saw documentary evidence of this in the five care files we looked at. This meant that staff had the information they needed about people’s care needs and were able to provide safe care. We found that some people’s records had not been reviewed at the time set down by the provider which meant that care and support may not be meeting people’s needs safely. We also found that records which contained information on the amount of food and fluid that people had taken did not contain sufficient detail to ensure people were prevented from the risk of dehydration and malnutrition.

We found that records evidenced that regular checks on equipment, water temperature, fire fighting equipment was in place. We also found that the general maintenance logs showed that the service was managed safely and that urgent repairs were prioritised and managed promptly.

Is the service effective?

We saw that individualised care plans and risk assessments were in place. We saw that one person’s risk assessments had not been reviewed following two falls. However another person’s risk assessment had been reviewed and a referral made to a physiotherapist following falls.

It was clear from our observations and from speaking with staff that they had a good understanding of the individual care and support needs that people required. We spoke with people and their family members and they all told us that they had seen recent improvements in the service at Lovat Fields Village. They told us that “Communication is much better now” and “things are now being sorted out”. They also told us “the new manager has made a difference”.

Is the service caring?

We observed staff responding to people with patience and gave them time to be as independent as possible. We saw that people were supported by knowledgeable and approachable staff. We heard staff speak to people in an encouraging and sensitive way which evidenced their knowledge of people’s individual needs. We heard staff and people laughing and joking together, and it was clear from our observations that staff knew the people very well. We found that whenever possible people had been involved in the planning of their care and support requirements so that their wishes were respected.

Is the service responsive?

Assessments included identifying any risks to people and detailing how staff should care for people to support their safety and well-being. This meant that care and support had been provided in accordance with peoples wishes. We read that when people had become unwell the GP or district nurse had been contacted promptly so that assessment or treatment could be given. We observed staff respond effectively to emergency calls from people. We also saw that regular reviews of one person’s care needs had led to a prompt referral to a dietitian.

Is the service well led?

The staff we spoke with had a good understanding of the ethos of Lovat Fields Village and their individual part they played to ensure that people were well supported in all of their day to day needs. We found that there was a system in place to monitor some aspects of the quality and safety of the care and support for example, by via monthly medication audits.

We saw that complaints had been responded to promptly and that there was a system in place to record any issues and the outcome of the concerns raised. We were made aware that there had been some recent changes to the management of the service. People and their relatives told us that “things are now moving in the right direction, we have confidence in the manager”. Staff told us that they were able to discuss any concerns and that they could see that management were responding to these and making improvements.