Lenthall House 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.

Lenthall House is registered to accommodate and personal care to 40 people; at the time of our inspection there were 37 people living in the home. Lethall House provides care and support to older adults and has an area of the building that is specifically tailored to meet the needs of people living with dementia.

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

At the last inspection in February 2016, Lenthall House was rated overall good. At this inspection we found that there had been continuous innovation and improvement and is rated overall good.

The registered manager and senior management team at Lenthall House were visible, approachable and acted as a role model for staff within the service. There was a clearly articulated person centred culture.

Staff were encouraged and enabled to work creatively which achieved consistently good outcomes for the people receiving care and support. There was a strong system of quality assurance led by the provider and manager that ensured people consistently received good care and support.

The people living at Lenthall House had an enhanced sense of well-being and quality of life because staff worked innovatively to enable people to have meaningful experiences and to become active members of the local community. People were consistently treated with dignity and respect and the staff team consistently showed empathy for people.

People were safeguarded from harm as the provider had effective systems in place to prevent, recognise and report concerns to the relevant authorities. Staff knew how to recognise harm and were knowledgeable about the steps they should take if they were concerned that someone may be at risk.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) and had applied that knowledge appropriately. Staff understood the importance of obtaining people's consent when supporting them with their daily living needs.

People experienced caring relationships with staff and good interaction was evident, as staff took time to listen and understand what people needed.

There were sufficient numbers of experienced staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person. Recruitment procedures protected people from receiving unsafe care from care staff unsuited to the role.

People's care and support needs were continually monitored and reviewed to ensure that care was provided in the way that they needed. People or their representative had been involved in planning and reviewing their care and plans of care were in place to guide staff in delivering their care and support.

People's health and well-being was monitored by staff and they were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People's needs were met in line with their individual care plans and assessed needs. Staff took time to

At the time of our inspection the Registered Manager had left to take up another position with the Provider. We had not received notice of this change, therefore the report show the name of the former registered manager. The new manager was in an acting capacity.

As part of our inspection we looked at the care and welfare of the people who lived in the home and how their care and support needs were assessed and met. We reviewed some care plans and saw that the Provider was in the process of changing the system of recording information. The files we reviewed had some information missing or contained inaccuracies.

We found that people felt welcome and happy in the home. We saw that the staff treated the people who lived in the home with respect.

One person who lived at the home told us, “I have some good days and some not so good, but I like it here.”

We spoke to family members of some of the people who lived in the home. One person told us, “I don’t have any problems with Lenthall House. Care is exemplary.”

We found that some of the Provider's policy documents would benefit from review and updating. We saw appropriate measures were in place to ensure information and records were stored securely. However, the incomplete nature of the care files, with missing and inaccurate information presented a minor risk to the appropriate care and support being provided to the people who live in the home. A compliance action has been set against this Regulation.

The inspection took place on 20 October 2015 and was unannounced. We returned on 27 October 2015 and this was announced.

The service provides accommodation for up to 40 people. At the time of our inspection there were 35 people using the service. It provides care and support to people with needs associated with age, physical disability and people living with dementia. Accommodation is on the ground and first floor, which is accessible using the stairs or the lift. People have their own bedrooms and use of communal areas and garden.

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.

People we spoke with and relatives were satisfied with the care and support provided. Some people raised concerns about staffing levels but all said that they felt people were safe. People also said that staff understood their individual needs and wishes.

We found most staff were caring, kind and compassionate in their approach. They understood people’s individual needs and treated people with dignity and respect. People we spoke with and relatives told us that they were involved in discussions and decisions about their care and treatment. People said they knew how to make a complaint and they would feel confident to do so if required.

Staff received appropriate training and development opportunities to review and develop their practice. Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work.

Staffing levels were based upon people’s dependency needs. The provider took appropriate action when people’s needs had changed to ensure needs were met. However, concerns were raised by visitors that staff did not appear to have sufficient time to spend with people.

Staff were aware of how to protect people from avoidable harm and were aware of safeguarding procedures. This meant that any allegations of abuse were reported and referred to the appropriate authority.

People had been asked for their consent to care and treatment and their wishes and decisions respected. The provider adhered to the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2008.

Medicines were safely stored and people received their regular medicines as prescribed. We found gaps in recording how creams were administered and staff did not always observe people taking their medicine when it was given covertly in a drink.

People were supported to access additional healthcare professionals whenever they needed to and their advice and guidance had been included into people’s plans of care. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided. However people had to wait a long time before being served their midday meal.

There were systems in place to assess and monitor the quality of the service. This included gathering the views and opinions of people who used the service. People’s complaints and issues of concern had been responded to promptly and appropriately. The provider worked closely with both CQC and the local authority to improve the service.