Kings Lodge Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can provide accommodation and nursing care for 77 people in one, three storey detached building that is adapted for the current use. The home provides support for people living with a range of healthcare, mobility and sensory needs, including people living with dementia. There were 70 people living at the home at the time of our inspection.

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 managers, 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 the last inspection on 7 March 2016, the service was rated ‘Good.’ At this inspection we found the service remained ‘Good.’ This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People and relatives told us they felt the service was safe. One person told us they felt safe they were never rushed and the home was clean, “It’s all spotless.” People remained protected from the risk of abuse because staff had a good understanding of safeguarding and there were systems and processes in place to keep people safe. Risks to people’s safety had been assessed, monitored and managed to ensure people remained safe. Regular health and safety checks and audits of systems and processes including care planning took place to ensure staff had current guidance when supporting people’s needs. We observed audit activity for areas including, moving and handling equipment, fire safety and infection control.

Medicines continued to be managed safely. There were arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to have their medicine safely with their consent and when they needed it. People were supported to maintain good health; their nutritional needs were met and they had good access to health care services. One person told us, “When I was living alone, my relative was worried because I was losing weight. I eat really well here.”

People and their relatives felt there were sufficient numbers of skilled staff to effectively meet people’s needs. Staff were recruited using robust recruitment processes and confirmed they received training and specialist guidance to support their understanding of the needs of people living with dementia and other complex health needs.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. People were supported to have choice and control of their lives and the service continued to review and reduce restrictive practices to ensure people were supported in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People’s needs and choices were assessed prior to people moving into the service, and they were supported by staff that knew their background life experiences and likes and dislikes. One person told us, “The girls look after me well, I can’t fault the care.” Care continued to be personalised to meet people’s care, social and wellbeing needs.

We observed positive and responsive interactions between people and staff. People’s independence continued to be encouraged. Staff promoted and respected people’s equality, diversity and human rights and their right to maintain important relationships. This culture continued through to the provision of end of lif

We carried out this inspection to look at the care and treatment that people who lived at the home received. At the last inspection on 28 January 2014 we found that there were concerns with regard to the care and welfare of people; the management of medication and the systems in place to support staff. We found at this inspection that these issues had been addressed.

We spoke with 11 of the people who lived at the home. Some people were unable to tell us their experiences of living at Kings Lodge Nursing Home because of their complex needs. To ensure that everyone in the home was involved in the inspection we observed the care and support provided, and spoke with relatives and friends. People who spoke with us said, "I am very comfortable here, the staff are very good", and "I prefer to spend most of my time in my room, I like the peace and quiet, although I can go to the lounge if I want to”.

We spoke with five relatives and two visitors, one nurse, eight care staff, the activity person, the chef, the manager and the operations manager during the inspection. We reviewed six care plans and associated documentation; we looked at the management of medication and the systems in place to support staff.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

The care plans showed that staff were aware of people's capacity to make decisions, and there was evidence that relatives had been involved in assessing people's care needs if appropriate. We also found that ‘best interest’ meetings were held in relation to any restrictions that were in place.

We saw that staff had received training in safeguarding vulnerable adults. Relatives we spoke with told us they felt people who lived at the home were safe. Staff felt that they provided care and support in a way that ensured people’s safety, whilst also allowing them to take make choices.

Systems were in place to ensure the management and staff learned from events. The issues identified at the last inspection had been addressed, and the manager had recognised that there were some areas of the service that needed to be improved.

However, we found that some of the records did not reflect the needs of some people; or the support and care provided by staff, and the homes policies and procedures were not specific to the needs of people who lived at the home.

Is the service effective?

We saw that people were supported by kind and attentive staff. Staff were seen to interact with people when providing support and care.

A person who used the service said, ""People are all very nice." One relative told us, "I am 100% satisfied." "The food is outstanding. There is a choice of food. The staff are great you can have a bit of banter".

Is the service caring?

We saw that people were supported by kind and patient staff. People were encouraged to make decisions about how they spent their time and were support to do things, such as have their lunch or take part in an activity.

However, we had some concerns that staff did not interact with some people who used the service in a meaningful way.

Is the service responsive?

We saw evidence that when people’s needs had changed, the staff had made appropriate referrals to outside agencies, including GPs and the local authority.

Is the service well led?

Staff spoken with were clear about their roles and responsibilities. They said they had an understanding of the needs of people who lived at the home, and they felt well supported by the management.

We were told that a satisfaction survey was sent out to relatives and people at the home, but the results were not available.

Relatives told us they could talk to the manager at any time; they had been involved in planning care people received and staff responded when they put forward suggestions.

We spoke with five people who used the service and three relatives. All the comments we received were positive. People told us that they liked living at the home and were happy with the care they received. People were encouraged to be as independent as possible and could decide how and where to spend their time. Our observations showed that people were treated in a kind and respectful way by staff. We saw that staff were able to spend time with, and interact with people in a positive manner. This resulted in people showing signs of being relaxed in the company of staff and enjoying the interaction.

Relatives spoke positively about their experiences at the service and how the service cared for their relatives. They told us how attentive the staff were and how well they knew their relatives.

We saw that not all staff had undertaken the necessary training in order to help ensure that they are able to work safely with people. Shortfalls were found in the homes medication practices. Medication had been administered covertly without appropriate safeguards in place to ensure that people’s best interests were protected. We found that action had not been taken when people’s nutritional risk assessments placed them at risk. Some of the people living at the home had lost weight without any action being taken. People were not always protected from the risks of unsafe or inappropriate care and treatment.

During our visit we talked with three people, and five family members. Along with four members of staff. We also gathered evidence of people’s experiences of the service by indirectly observing the care they received from staff.

Everyone told us that they were happy with the care and support they received. One person told us, "They are very good here, the staff are so kind, they always look after me well".

Another person said, "I only have to ring my bell and they do their very best to help me, I can't say anything bad about any of them they all do there best for me".

As one family member explained, "My mum has thrived since she came here, she arrived in a terrible state and we really didn’t think she would last the night, but thanks to the staff here she is back on her feet and doing well".

People also told us that staff treated them with respect and promoted their privacy. They told us that they felt safe from harm living at the service and that they would be listened to if they raised any concerns. Our evidence gathered during this inspection supports the comments made by people who were receiving a service.

People told us that they were very happy living at Kings Lodge. They felt supported by the staff team and respected at all times.

Family members told us that the care and support was good and they had no concerns.

Staff told us that they felt supported and well trained to meet the needs of people who use the service.

During our visit we spoke with seven people who live at the home, three relatives, six staff and the manager. Following the visit we received calls from ten relatives and we were able to talk with them about their thoughts and experiences of Kings Lodge.

People living at the home smiled when asked about the home and said they liked the staff. One person thought it was their house and they allowed others to be there and that they have ‘staff’. One relative said that on the whole ”care and attention is excellent”. Others that we spoke with told us that the home was ‘homely’ and spoke about the manager respectfully; although they could also speak freely with staff sometimes they were conspicuous by their absence when they visited. There was some concern expressed that quiet people or people in their rooms could be over looked or assumptions made about them.

We observed lunch being served and how staff interacted with people and ensured choice. Relatives told us there were activities and games, people at the home told us with prompting that they help staff with the plants and garden. Activities on the day of our visit were pool, words games and planting

Staff told us that they receive regular training, are supported by the management of the home and that they can speak with senior staff about any concerns they have about the running of the home.

Kings Lodge Nursing Home is registered to provide accommodation and nursing care for up to 77 people. The service supports people who have nursing needs, older people and those living with dementia. On the day of our visit 71 people were living at the home.

At our last inspection to the service in September 2014 we made two compliance actions. We found the service did not have sufficient staff to support people effectively and records were not maintained securely. We asked the provider to take action and the provider sent us an action plan which told us what action they would be taking and said this would be completed by December 2014.At this inspection we found appropriate action had been taken and the provider was now meeting the requirements of those regulations.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

People told us they felt safe. Relatives told us they had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm. Risk assessments were in place to help keep people safe and these gave information for staff on the identified risk and guidance to mitigate the risks.

People were supported to take their medicines as directed by their GP. Records showed that medicines were obtained, stored, administered and disposed of safely. The provider’s medicines policy was up to date.

Safe recruitment practices were followed. Recruitment procedures ensured only those suitable to work in care were employed. There were sufficient numbers of staff on duty to keep people safe and meet their needs.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were three people living at the home who were currently subject to DoLS. We found the registered manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. People were generally able to make day to day decisions for themselves. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

Staff had undertaken training to ensure that they were able to meet people’s needs. The provider supported staff to obtain recognised qualifications such as National Vocational Qualifications (NVQ) or Care Diplomas. These are work based awards that are achieved through assessment and training. To achieve these awards candidates must prove that they have the ability to carry out their job to the required standard. All staff completed an induction before working unsupervised. Staff had completed mandatory training and were encouraged to undertake specialist training from accredited trainers.

People received enough to eat and drink. People spoke positively of the food and the choice they were offered. We were told “the food is good, there is always a choice”. People who were at risk were weighed on a monthly basis and referrals or advice were sought from suitable professionals where people were identified as being at risk.

Each person had a plan of care which was person centred and provided staff with the information they needed to support people. Staff received regular supervision including observations undertaken by a senior member of staff as they carried out their duties. Monitoring of staff performance was also undertaken through staff appraisals.

People’s privacy and dignity was respected and staff had a caring attitude towards people. We saw staff smiling and laughing with people and offering support. There was a good rapport between people and staff.

Staff were knowledgeable about people’s health needs and knew how to respond if they observed a change in their well-being. Staff were kept up to date about people in their care by attending regular handover meetings at the beginning of each shift. The home was well supported by a range of health professionals.

The registered manager welcomed feedback on any aspect of the service. The staff team said communication between all staff was good and they always felt able to make suggestions; they confirmed management were open and approachable.

The registered manager acted in accordance with the registration regulations and sent us notifications to inform us of any important events that took place in the home of which we needed to be aware.

The provider had a policy and procedure for quality assurance. The registered manager was visible and the area manager visited the home regularly. The registered manager operated an open door policy for both staff and people using the service and their relatives. Weekly and monthly checks were carried out to help monitor the quality of the service provided. There were regular residents’ meetings and people’s feedback was sought on the quality of the service provided. There was a complaints policy and people knew how to make a complaint if necessary.

Relatives spoke positively of the registered manager and told us they were very happy with the way the home was managed.