About the service: The service is a care home that can provide personal care for up to 28 older people some of who may be living with dementia. 28 people lived in the service when we inspected.

People’s experience of using this service: People could have been at risk of avoidable harm because the provider did not have effective systems to ensure safety and quality. Areas such as fire safety, equipment and environment safety management were not robust. We made a recommendation that the provider review their medicines system to ensure current best practice was implemented. Systems to manage these areas were either not in place or did not follow known current best practice. The provider did not have thorough oversight to understand areas that required improvement. The registered manager and provider responded positively to feedback and immediately started to act to implement changes.

The registered manager and provider had worked hard since the previous registered manager left the service to make changes in response to feedback from people, relatives and staff. Areas such as the environment refurbishment, increased activities, staff support and guidance and the implementation of a strong person-centred culture. There had been a positive impact on people’s experience of using the service because of those changes.

People said staff knew them very well and could anticipate their needs and that support was delivered in a timely way. People described good provision of activities and events that were tailored to their needs. People were supported to maintain relationships and afforded support to develop and build new relationships. People and their relatives described high levels of satisfaction with the service which impacted positively on their overall wellbeing.

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. People were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, this was carried out with compassion and dignity.

Staff had appropriate skills and knowledge to deliver care and support in a person-centred way.

The registered manager and management team were well respected. People, their relatives and staff all felt confident raising concerns and ideas. All feedback was used to continuously improve the service.

For more details please see the full report on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (Published 16 August 2016).

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

Enforcement: The provider was in breach of one regulation at this inspection relating to governance of the service. You can see the action we have told the provider to take at the end of the full report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. The overall rating at this inspection is requires improvement. We will continue to work with the provider to understand the action they have taken to improve the rating to at least good.

We carried out this unannounced inspection on 22 July 2016. At the previous inspection, which took place on 26 August 2014, the provider met all of the regulations that we assessed.

Heath Lodge provides residential, personal and social care for 28 older people. There is a separate, smaller unit named Alison Wing, which is used specifically for six people who are living with dementia. The home is a detached property, set in its own grounds approximately one mile from Harrogate town centre. There are secure gardens and plenty of seating outside for people to use. There is also parking within the grounds. The registered provider is Harrogate Neighbours Housing Association Limited.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At this inspection we found the service was being managed and operated in line with their legal responsibilities.

Staff told us the manager, deputy manager and other senior staff employed by the service were supportive, dedicated and approachable. They also confirmed to us that the on call arrangements were well organised, and that they could seek advice and help out of hours if necessary. This meant there was good oversight of the service, and staff were confident about the management arrangements.

The manager and staff team had a good understanding of the Mental Capacity Act. We saw consent was sought routinely before any assistance was given. People had also been supported to make their own decisions wherever possible. Where people were unable to make a decision, there was a best interest decision recorded within their support plan. We saw the person and relevant others had been involved and consulted. This meant people were given the opportunity to be involved in decision making and decisions were made in the person’s best interests. The service was in the process of implementing the Deprivation of Liberty Safeguards (DoLS) as required.

People who used the service and their relatives spoke highly of the staff team. People told us that staff treated them with kindness and respect. We saw many examples of good practice throughout our visit. People were appropriately assisted to move around the home and encouraged to eat and drink. There was a constant supply of drinks and snacks, including fruit and ice cream, during what was a very hot day. People told us this was a regular occurrence and that they could always request refreshments for themselves or visitors. Staff approaches were professional and discreet. Staff told us they had a shared interest in developing and improving the service for people. Staff also told us they had ample opportunities to reflect on the service they provided through supervision and regular contact with each other.

The service recruited staff in a safe and robust way. They made sure all necessary background checks had been carried out and that only suitable people were employed. Processes were in place to assess the staffing levels that were needed, based on people’s dependency and the layout of the building. People who used the service told us staff were always available, during the day and night when they needed them. Our observations during the inspection showed there was appropriate deployment of staff, including staff providing care, activities, catering and housekeeping tasks.

The manager had taken action to ensure that training was kept up to date and future training was planned. Records showed staff received the training they needed to keep people safe.

The service was well maintained, clean and comfortable overall. One area of the home was not fresh smelling. This was discussed during the inspection. Plans were in place to have th

In April 2014 we carried out an inspection of this service. We judged, at that time, that improvements were needed to some areas of the service.There was a lack of systems in place to monitor the quality and effectiveness of the support being provided to staff working at the home.There were a lack of systems and processes in place for monitoring the effectiveness of the care provided and policies and procedures were out of date and no longer relevant to the support that was being delivered on a daily basis in the home.

There were issues with the policies and procedures being used in the home as many of these were out of date which meant that practice may have been unsafe and in breach of current legislation in relation to areas such as health and safety.

Improvements were also required to the systems used to regularly assess and monitor the quality of the service that people received. We also found at the last inspection that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not being maintained.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people and the staff supporting them and from looking at records.

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

Is the service safe?

Not applicable. We did not inspect this area.

Is the service effective?

Staff we spoke with were knowledgeable about the people they supported and knew people very well. Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. Staff received the necessary support from their managers to ensure they did their job well. This ensured that the outcomes for people would continue to improve.

Is the service caring?

People looked well cared for and we observed good care practices taking place. We observed the lunchtime experience and saw that staff were calm and unhurried and they spent time with people.

People we spoke with told us that the overall care at the home was good. One person said “We get well looked after” another said “Overall I am very happy here.”

Is the service responsive?

Not applicable. We did not inspect this area.

Is the service well-led?

At this inspection, we found improvements had been made and the issues we identified at the last inspection had been addressed.

Effective management systems were in place to promote and safeguard people's safety and welfare. Such as health and safety records and people's care records were up to date and had been reviewed regularly.

The quality assurance system included audits and checks carried out by staff at the service and by other people from within the organisation. Records showed that issues were identified and responded to in a timely way. As a result the quality of the service was continuously improving.

Effective management systems were in place to promote and safeguard people's safety and welfare. Such as health and safety records and peoples care records were up to date and had been reviewed regularly.

All the homes policies and procedures had been reviewed and updated. This ensured that staff were following up to date and current practice.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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

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

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was appropriately maintained. There were some checks that were not being carried out to ensure that the environment was safe. Staff were recruited safely and given training to ensure that they were able to meet the needs of the people living at the home. A member of the management team was available on call in case of emergencies.

Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

There were issues with the policies and procedures being used in the home as many of these were out of date which meant that practice may have been unsafe and in breach of current legislation in relation to areas such as health and safety.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us. "I am quite happy. Staff listen and are respectful”. Staff had received some training to meet the needs of the people living at the home.

There was a lack of systems in place to monitor the quality and effectiveness of the support being provided. This had not improved since our last visit when these issues had been highlighted.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us “When I have needed extra help the staff have provided it and are very good". Another person told us "The staff have asked me if I am happy with everything and I told them that I am”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. There was a keyworker system in place although there was not consistent recording of keyworker activity. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded although these were sometimes inconsistent. People had access to activities.

Where medical assistance or intervention was required this was sought appropriately and staff followed instructions from medical and social care professionals when caring for people.

There was some evidence of the provider gathering feedback from staff or people who used the service but there was no action planning in place regarding ongoing improvements to the service or any planning relating to analysing this feedback.

Is the service well-led?

Staff had a good understanding of the ethos of the home. People told us that they could talk to the manager or staff about any issues. Staff told us they were clear about their roles and responsibilities. They said the management were approachable and that they felt generally well supported by the manager. One person told us “The manager is very nice but needs to be sterner with staff”. Another person told us “The manager does listen to grumbles although they can be slow to react”.

There were senior roles in place to act as manager when the manager was not in the home. The manager lived on site and attended for part of the inspection.

There were a lack of systems and processes in place for monitoring the effectiveness of the care provided and policies and procedures were out of date and no longer relevant to the support that was being delivered on a daily basis in the home.

All the people we spoke with were complimentary about the care they or their relative received. Comments from people included “It is great; the staff are very good. I have no complaints at all”, “The staff treat me with respect, give me independence and everyone is very approachable” and “The staff are very good to us. I have never found anything wrong.”

Appropriate arrangements were in place in relation to obtaining, handling, storing and administering medication. We looked at the medicines records and stock for all the people’s controlled drugs and found these to be correct.

Appropriate arrangements were not always in place for assessing and monitoring the quality of service provided at Heath Lodge. We have asked the provider to address this issue.

We found suitable arrangements were not in place for maintaining clear, accurate records that were fit for purpose. We have asked the provider to address this issue.

Appropriate arrangements were not in place for the reporting of incidents at Heath Lodge. This is a legal requirement and by not submitting them the provider is committing an offence. We have written to the provider separate to this report to inform them of this offence.

We used a number of different methods to help us understand the experiences of people using the service, including talking to people and observing the care provided.

We spoke with a number of people who use the service and they told us that it was “a good place to be”. People said that staff were “kind and helpful”; that the food was “lovely” and that there was a good programme of activities.

We asked people whether their privacy and dignity was respected and everyone we spoke with said it was.

People told us that they were well looked after and that they were happy with the care they received. People made comments such as "It is lovely here. I have never regretted coming here"and "It is a very nice place"

People were also positive about the staff who looked after them. People made comments such as "Staff are very kind" and "The staff here are very caring"

Most people we spoke with also made positive comments about the quality of the food at the home and the choices available. For example, one person told us "The food is pretty good" People said they would either speak to a member of staff or the manager if they did have a concern or a complaint.

We also talked with several relatives who were visiting the home. They all spoke highly about Heath Lodge. Some relatives told us that they visit the home on a daily basis. One relative said "It is absolutely wonderful here, they motivate residents. There is a nice atmosphere. I could not do any better for my relative. Staff are very helpful they all speak to you when you visit - they can't do enough" Other relatives made comments such as "Heath Lodge is very good. I feel comfortable about the home. The staff are so welcoming and they treat people as individuals"

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.