This inspection was carried out on 18 September 2018 and was unannounced a second announced day of inspection took place on 19 September 2018.

Ferguson Lodge is a residential care home providing personal care for 46 people some of whom may be living with a dementia. At the time of the inspection 43 people were living at the home.

At our last inspection 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 is written in a shorter format because our overall rating of the service has not changed since the last inspection.

At this inspection we found the service remained Good.

Why the service is rated Good.

The staff team treated people, and their relatives, with kindness, compassion and respect. Relationships were warm, friendly and caring. There was lots of laughter and smiles and everyone was relaxed in each other’s company. Staff were observant and responded to people’s needs in a timely and respectful manner.

People and their relatives had been involved in writing care plans and one page profiles so staff got to know the person and some of their history. This was useful in developing relationships and planning activities that were meaningful for people.

The provider had effective systems to ensure people were safe. Any identified risks had been assessed and minimised to keep people safe.

Safe, values based recruitment processes were used and there were enough staff to meet people’s needs.

There was a focus on good nutrition and hydration. All meals were freshly prepared using only fresh ingredients. This had a positive impact on people’s health and well-being.

People remained registered with their family doctor if they chose to and were supported with access to other healthcare professionals if needed, including dentists, podiatry, district nurses and specialist consultants.

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 understood safeguarding procedures and any concerns in relation to harm, accidents and incidents were logged and investigated. Lessons learnt were a key element to analysing any incidents or concerns which were used to develop the quality of the service.

Staff managed medicines safely and audits were used to ensure safe systems of ordering, storing, administering, recording and returning medicines were used.

The provider ensured there were enough, trained and well supported staff to meet people’s needs in a safe way.

An electronic system was used to make sure staff training was up to date. Staff attended training relevant to people’s needs including nutrition, dementia care and care of the dying person. In addition, staff attended moving and handling training, first aid, safeguarding and mental capacity training.

The premises were safe and dementia friendly. Appropriate checks of fixtures, fittings and equipment were completed. Thought and consideration had been given to the environment to support people to identify specific rooms whilst also maintaining a homely and welcoming atmosphere.

Everyone we spoke with said the service was well run and there were no areas that needed to improve. There were no complaints and any minor concerns were responded to immediately and shared with staff, where appropriate, so lessons could be learnt.

Systems were in place to monitor the quality of the service provided and action plans were used to drive improvements.

The registered manager was focused on innovation and sustainability using technology to good effect to ensure effective and efficient systems were in place.

A sister service known as ‘Home Care Services – Care Hub’ was available for people living in the local community. People who receive

At the time of the inspection there were 40 people living at the home. Due to their health conditions and complex needs not all people were able to share their views about the service that they received, but we did speak with fifteen people. We observed their experiences to support our inspection. We spoke with the registered manager, the deputy manager, seven care staff, two relatives and three district nurses.

During the inspection five key questions were answered; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Some people told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, “I feel very safe here. There is no cruelty here. We have regular meetings and I would speak to staff straightaway.” Another person told us, “I got information about the service before I came here. They are marvellous and I do feel safe here.”

We spoke with staff about Deprivation of Liberty Safeguards (DoLS). The deputy manager told us that there had been no applications and showed us the policy and procedures they followed. They told us that staff had received relevant training and had access to the policy and procedures.

We saw that the service was safe, clean and hygienic. The home had an effective infection control system. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and told us how they would manage an outbreak at the home so that the risk of infection spreading could be reduced.

Is the service effective?

One relative told us, “My relative has improved so much since she came here. She had been in hospital previously. We can see a positive change and the staff are so good.”

People explained how their care and welfare needs were met. All people told us that they had support with health appointments and felt that the service was flexible. One person told us, “It is lovely here. There is something new to do each day; there is always a choice of food and things to do.”

Is the service caring?

We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. We saw that they did not rush people in the home and we saw that the interactions were caring. All the relatives we spoke with said they felt the care was very good. One relative told us, “The staff are so on the ball. They really are good.”

We saw that people were treated with respect and dignity by the staff. We saw that people were given choice in their care and all the relatives we spoke to told us they were very happy with the care. All the people we spoke with also told us that they were happy with the care and support they received.

Is the service responsive?

All the people told us that they were very happy with the service. One told us, “If you feel ill at any time, even during the night, you can ring the buzzer and the staff will come. They come straightaway.” A relative told us, “They let us know everything that is going on with my relative’s care. The district nurse visits regularly too. I feel my relative’s care is very good.”

We saw that staff responded to people's requests for help in a timely way.

Some of the people we spoke with told us they were involved in decisions about their care. They told us that the staff were flexible and responded to their requests at times they had asked, for instance in their rooms when they had pressed the buzzer for assistance or personal care tasks.

We saw that there was a complaints policy at the home. People told us they found the registered manager very approachable and would not hesitate to raise any issues or complain.

People’s care needs had been reviewed at least every six months. We saw that when people's requirements had changed the provider had responded and reviewed their care needs so that they could meet their changed support requirements.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well-led?

We spoke with the registered manager and deputy manager. They showed us that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people using the service and their carers, family and relatives were also regularly recorded. The manager showed us that activities had been arranged in response to the views and opinions they had received.

We saw the home had systems in place to make sure that managers and staff learnt from any accidents, complaints, whistleblowing or investigations. This reduces the risks to people and helped the service to continually improved.

Staff also told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality care service at all times.

At our previous inspection in April 2013 we found moderate concerns with the arrangements for the handling and recording of medicines. In response to our concerns the provider sent us an improvement plan detailing the actions they were taking to improve medicines handling.

During this inspection we found that improvements had been made to protect people against the risks associated with the management of medicines, and the action plan had addressed the concerns we had previously identified.

During this inspection we checked people were getting the medicines that they needed by looking at their medication records and the storage of medicines. We did not speak to people who used the service on this visit.

We found people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with five people who lived in the home, told us they were happy with the care which was provided to them. One person told us, “It’s lovely, I’m very happy here.” Another person said, “It’s clean, I get well fed, I get watered and the staff are nice. What more could I want?”

People told us that they enjoyed the range of activities which were available within the home. One person said, “They have a lot of activities on, today was good, they put the old songs on and we had a sing along.”

Some of the people who lived at the home had complex needs which meant they were not able to tell us their experiences. We used a number of different methods to help us understand their experiences, which included speaking to relatives, health professionals and observation. During our visit we saw that staff treated people with respect and courtesy.

The inspection took place on 17 and 18 December 2015 and was unannounced. This means the provider did not know we were coming. We last inspected Ferguson Lodge in April 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

Ferguson Lodge is a care home that provides accommodation and personal care for up to 46 older people, including people with dementia related conditions. Nursing care is not provided at the home. At the time of our inspection there were 38 people living at the home.

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 2008 and associated Regulations about how the service is run.

We found that people were protected from harm and their care was delivered safely. Appropriate arrangements were made to assess and minimise risks and safeguard people against abuse. A safe environment was provided that was clean, comfortable and suitably equipped to meet people’s needs.

A robust process was followed when new staff were recruited. Enough staff were employed to provide people with safe and consistent care. Staff were trained and supervised to support their personal development and meet people’s needs effectively.

Medicines were managed safely and people were well supported in meeting their physical and mental health needs. People received a varied diet with choices of food and drinks and their nutritional needs were closely monitored.

People and their relatives were able to be involved in and direct their care and support. The implications of mental capacity law were understood and implemented where people were unable to make important decisions about their care.

Staff had formed positive relationships with people and had a good understanding of their individual needs and preferences. The staff were caring and respectful in their approach and ensured that people’s privacy and dignity were promoted. Further improvements were being made to create a dementia friendly care environment.

People had personalised care plans for meeting their needs and their care was kept under regular review. A stimulating range of activities was offered to help people meet their social needs and the service had good links with the local community. People were happy with their care and had no complaints.

There was a clear management structure that provided staff with leadership and support. Systems were in place for obtaining people’s views and feedback was acted on. The quality of the service was routinely checked and a number of developments were planned to continue to improve the service.