This inspection took place on 29 November and 3 December 2018 and was unannounced.

Gledhow 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.

Gledhow Lodge accommodated 18 people in one adapted building at the time of the inspection.

There was a registered manager in post at the time of the inspection. 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.

The service’s systems around health and safety checks were not robust. A legionella certificate had expired and there was no evidence that advisories made by professionals had been acted upon. Health and safety checks were in some cases not clearly documented or responsibilities had not been clearly defined.

The service’s systems around governance and leadership were not implemented in line with the service’s policies and procedures. The registered manager and the care manager were unable to locate key documents in the absence of the general manager. The service did not carry out an annual survey and it did not hold regular meetings with people who used the service and their relatives in order to gather feedback and improve the service.

Medicines were managed safely. Staff received training in medicines administration and had their competencies checked by experienced staff. Staff understood how to protect people from harm and abuse.

Mental Capacity assessments were carried out. However, they did not specify what the decision was being taken for. The service did make applications to deprive people of their liberty lawfully, and staff received training on this.

We have made a recommendation around compliance with the Mental Capacity Act 2005.

Staff told us they received good training and support and people told us staff were well trained. However, records showed that staff supervisions were not conducted in line with the service’s policies and procedures.

We have made a recommendation about staff training and support.

People’s body language was positive, and people looked well cared for. People and their relatives told us staff were kind and compassionate.

People’s privacy and dignity were upheld by staff who knew important details about them, their routines and preferences. People were encouraged to be as independent as they could be.

There was no structured programme or training for staff on delivering activities and stimulation to people. Staff told us they wanted to do more to meet people’s social needs by providing activities but there was no structure or resource in place to do this. The service did organise planned activities weekly, and we saw people were visibly engaged by the external activities providers.

We have made a recommendation around the provision of activities and stimulation for people.

Care plans contained good detailed information for staff on how to meet their needs. Care plans were reviewed regularly.

There were policies and procedures in place around complaints. However, none had been made in 2018. Relatives we spoke with told us they knew how to raise complaints.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 1 April 2016 and was unannounced. This meant that the provider did not know we would be visiting.

The service was last inspected in March 2014 and found to be compliant.

Gledhow Lodge is a large listed Georgian house situated in North Leeds close to bus routes, local shops and Roundhay Park. The home is registered to provide accommodation for up to 25 people who require personal care. The accommodation includes single and double bedrooms some are en-suite, three lounges and a separate dining room. The accommodation is situated on two floors that are serviced by the stairs and a passenger lift. There is level access to the enclosed garden. At the time of the inspection 20 people were using the service, most of who were living with dementia.

There was a registered manager in place and they are also the registered provider. 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. The registered manager visited the home several times a week and was making a decision about whether their long-term role would be as the registered provider or one that combined the registered manager role as well. There was a manager in place at the home who took the lead in managing the day-to-day care with support from the registered manager.

People told us that staff worked well with them. Staff outlined how they supported people to engage in activities and have fulfilling lives. We found that a range of engaging activities were provided at the home.

People we spoke with told us they felt safe in the home and that staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm.

People who used the service and the staff we spoke with told us that there were enough staff on duty to meet people’s needs.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work.

Staff received a wide range of training, which covered mandatory courses such as fire safety as well as condition specific training such as dementia care.

Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had been working hard to ensure capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice. They and the manager recognised that they were still developing the skills needed to always complete these accurately.

We observed that staff had developed very positive relationships with the people who used the service. Staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity.

People told us they were offered plenty to eat and we observed staff to assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. However the format of care plans meant the information was limited. The manager was aware of this problem and was in the process of changing to a format that would contain detailed information about how each person should be supported. We found that risk assessments were in place.

We saw that the registered provider had a

People who were able told us they enjoyed living at Gledhow Lodge and were complimentary about the care provided by staff. One person said "I have lived here a number of years; I am well looked after and have no concerns." Another person said "I like living here; I know the staff and have made some friends."

We spoke with two visitors and they told us they were pleased with the standard of care and facilities provided by the service. One person told us they were happy their relative was well cared for and were always made to feel welcome when they visited.

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted on.

These are some of the comments returned to the home from the questionnaires sent out by the provider:

• “I feel we have been very fortunate in finding Gledhow Lodge for my mother and I have every confidence that she is being well looked after”.

• “I would not hesitate to recommend the home to anyone, full of admiration for all the staff”.

• “The atmosphere is warm and friendly and I always feel welcome whatever time I visit”.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some of the people who used the service had complex needs which meant they were not able to tell us their experiences. We therefore observed care practices and talked to people's relatives and staff. People who were able to tell us of their experience of living at Gledhow Lodge told us they were happy living at the home.

Records we saw confirmed Gledhow Lodge had effective recruitment and selection policies in place to ensure staff members were of good character and had the required skills to perform their work.

We observed staff supporting people who used the service and saw good care being provided. Staff knew the people they were supporting very well. People who used the service also seemed comfortable with the members of staff who were supporting them. Staff told us people received very good care and support.

These are some of the words/phrases used by relatives to describe the home; “The staff are brilliant” “Excellent” “Caring” “Wonderful” and “Patient and kind.”

However, we were concerned care and treatment was not always planned and delivered in a way that ensured people's safety and welfare as written records were inadequate.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received. They did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

We were unable to speak with people using the service because the people living at the home were not able to communicate verbally with us in a meaningful way. However we gathered evidence of people’s experiences of the service by observing the care and support given to them by staff who worked at the home.

We spent a period of time observing staff delivering care to people who used the service. This method of observation is called the Short Observational Framework for Inspection (SOFI). Staff supported people appropriately and encouraged people to be as independent as possible. We observed lunch time that was unhurried which meant people had the time to eat their meal in a relaxed way.

We also used a number of different methods to help us understand the experiences of people who used the service. This included observing care, looking at records and talking to staff.

Equipment was properly maintained which promoted the independence and safety of people who used the service

Staff received appropriate support and training to ensure they were able to meet the needs of people living at the home. We found there were sufficient competent staff to meet the needs of people who used the service.

Complaints were investigated and responded to in a timely manner.

People using the service and visitors told us they are satisfied with the service they receive and they are respected. People said the environment is always clean and pleasant. People we spoke with said if they have any concerns they are happy to raise them with the staff or management and are confident they will be dealt with appropriately.

People spoken with during the visit told us they were happy with the food served at the home. We observed some people needing assistance to eat their meal and staff were respectful of their dignity during this time.

People told us the home is clean and does not have unpleasant odours. Visitors said "The place is kept clean throughout".

We spoke with some visitors. They told us they were happy with the care that is provided. One person said "I find the staff very helpful and I think people are getting good care. Another person said “you’re always welcomed”.