This inspection visit was unannounced and took place on 17 July 2017. At our last inspection visit on 3 November 2015 we asked the provider to make improvements in relation to audits and how these reflect changes to the home. At this inspection, we found improvements had been made. The service was registered to provide accommodation for up to 46 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 42 people were using the service.

There was a registered manager in post. 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 provider and registered manager had developed a range of audits which reflected the running of the home and we saw how they had been used to drive improvements. Staff had received training in a range of areas to support their role and staff had been encourage to develop skills to share with other staff and cascade the learning. People who used the service felt safe and staff understood their role in ensuring people were protected from harm. Staff recruited to the home had received the appropriate checks to ensure they were safe to work with people. Risk assessments were in place to ensure people’s safety and the safety of the environment. There was sufficient staff to support people’s needs and this was under constant review to ensure the staffing levels reflected people’s needs.

The registered manager understood their responsibilities when people lacked capacity. We saw best interest decisions and assessments had been completed in line with guidance. Where people were being restricted of their liberty, the appropriate authorisations had been applied for. Staff sought peoples consent before care was provided.

We saw and people told us there had been improvements to the home and these had enhanced people’s experience of care. People had established relationships with the staff felt their decisions were respected. Staff provided a kind and friendly approach to the care they delivered. People had the opportunity to engage in activities and entertainment was provided.

Medicines were managed safely and in accordance with good practice. People enjoyed the meals and had the opportunity to choose the food they ate. Some people required meals to maintain their nutritional needs and good health and this was promoted. Staff made referrals to healthcare professionals in a timely manner to maintain people’s health and wellbeing.

People felt relaxed in the atmosphere of the home and there was continued improvements made to the environment. People felt confident they could raise any concerns with the provider and manager. There were processes in place for people to express their views and opinions about the home.

We saw that the previous rating was displayed in the reception of the home as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

This inspection took place on 3 November 2015 and it was unannounced. The service was registered to provide accommodation for up to 46 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 41 people were using the service.

The service had systems in place for auditing the quality of the care, however the care records lacked a personal element to support people’s experience and individual care needs.

The service did not have 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. The provider had recruited a manager our records confirm they were apply to register with us.

People felt safe in the service and the staff knew how to respond to incidents to protect people from the risk of abuse. There was sufficient staff available to support people’s needs throughout the day and night. The staff had received a wide range of training which provided them with the appropriate knowledge and skills to provide safe and individualised care. Medicines were administered and stored appropriately to support people’s requirements around pain relief and medical conditions.

People were supported to make decisions. Where there was a lack of capacity to make certain decisions, people were protected under the Mental Capacity Act 2005. The manager understood the requirements under the legislation relating to Deprivation of Liberty safeguards and had made appropriate referrals to the local authority.

People were provided with choices to meet their nutritional needs. We saw staff were kind and caring when supporting people. Individuals were treated with dignity and respect and had their choices acted on. The activities which were available provided a range of stimulation which people told us they enjoyed.

People knew how to complain and there was a process in place to respond efficiently to resolve any concerns.

There were 42 people using the service on the day of our visit. Due to people’s level of dementia the majority of people were unable to give us their views on the care provided. However people that were able to give their views told us; “the staff here are nice, they’re always having a chat with me and a laugh.” And “I think I’m very lucky to be here, the staff are marvellous and I am happy here.”

Information was available to the cook regarding people’s dietary needs and preferences.

We saw that staff were responsive to people’s needs and wishes, for example we observed staff offering choices at the lunch time meal and supporting people with their meal in a caring and patient manner.

We spoke with three visitors who confirmed they were happy with the care their relatives received. One visitor whose relative had been admitted within the last month told us, “I’m very happy with the care, the staff are always welcoming and seem very nice.” Another visitor said “the staff are very caring, I have no concerns and everyone is so approachable. I think if I had any concerns they would get sorted quickly.”

We observed a positive and friendly relationship between the staff team and visitors.

We checked the medication practices and found that these were well managed and that people received their medication as prescribed and in a safe way.

Sufficient numbers of staff were on duty to ensure people’s needs were met effectively.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service were not able to tell us their experiences. We spoke with relatives of some of the people.

Our observations throughout the inspection demonstrated that staff engaged in a positive way with people. We saw some good examples of people being treated with dignity and respect. Staff were polite and helped people in an unhurried way, taking time to listen to them and support them as needed.

Staff were observed supporting people to make choices, for example at the lunch time meal and regarding the various activities that were being provided on the day of our visit.

People that we spoke with appeared relaxed and comfortable and were able to move freely and safely both within the home and grounds.

Comments from visitors were generally positive regarding the care and support provided. Such as, “Staff always let me know if there’s a problem and I’m invited to reviews.”

One visitor told us about two accidents that involved their relative. They confirmed that they were happy that the correct actions had been taken, both at the time of the accidents and to minimise these risks occurring again to their relative in the future.

Comments from 24 visitors were viewed from the customer satisfaction surveys undertaken by the provider from June 2012. All of the people who returned their surveys felt that their relatives care needs were being met.

This inspection took place over two days on 5 November and 6 November the visit was unannounced.

At the last inspection on 15 October 2013 we found that the service was meeting the regulations we inspected against.

Longmoor Lodge provides accommodation and personal care for up to 46 people with health conditions including dementia. The accommodation is provided on two floors which are accessible via a passenger lift. There were 42 people living at the service when we visited.

The person managing the service [the acting manager] was in the process of applying to be the 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 and associated Regulations about how the service is run.

People told us they felt safe living at Longmoor Lodge and relatives agreed. They told us they were happy their relative was living there.

Staff had received training on how to keep people safe from harm however, senior staff had not always followed procedure, particularly when a safeguarding incident had occurred

Risks to the people who used the service had been assessed. This was to make sure that where and whenever possible, people were provided with a safe environment in which to live.

We found some concerns regarding the management of medicines. Records had not always been completed and we found one of the medicine trolleys unattended with the keys in the lock.

People told us there were not always enough staff around to meet people’s needs and staff members agreed. In one of the lounges, we observed people waiting up to 40 minutes to be assisted from their wheelchair to an easy chair. The management team acknowledged these concerns and told us they would investigate them.

Checks had been carried out when new staff had been employed to make sure they were suitable to work at the service. Training and ongoing support was then provided to enable the staff to effectively meet the needs of those in their care.

People’s needs had been assessed before they moved to the service and plans of care had been developed from the assessments. The staff team were aware of the individual needs of those in their care and they supported them well.

People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided. Staff were not always recording when they were providing people with food and fluids. This meant they could not demonstrate that people had received the nourishment they needed to keep them well.

People told us the staff were kind and caring and we observed this throughout our visit.

People who used the service and their relatives were supported to make complaints and when complaints were made, these were taken seriously and acted on.

Systems were in place to monitor the service being provided, though these were not always effective in identifying shortfalls within care records.

People told us they were encouraged to share their thoughts of the service by attending meetings and completing surveys. They also shared that the acting manager was always available to speak to on a one to one basis and her door was always open.