This inspection took place on 12 December 2017. The inspection was unannounced which meant that the staff and provider did not know that we would be visiting.

At our last inspection of this service in May 2015, we awarded an overall rating of Good.

At this inspection we found the service remained good.

Lorna 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. Lorna House is an elegant two storey Victorian residence set in a residential area in Torquay. The service is a residential care home service providing accommodation for up to 24 people, some of whom are living with dementia. There were 22 people living at the home at the time of our inspection.

The home 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.

Why the service is rated Good:

People told us they felt safe at the home and with the staff who supported them, one person said “Yes I feel safe here, they’re very good and very caring.” There were systems in place to keep people safe. Staff were aware of safeguarding processes and how to raise concerns if they felt people were at risk of abuse or poor practice.

Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed. We discussed the storage of medicines which were prescribed for people at the end of their life to keep them comfortable. The Registered manager took action to ensure these were stored safely.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and had received training and developed skills and knowledge to meet people’s needs.

There were adequate staffing levels to meet people’s needs. The registered manager had recognised people’s dependency needs had increased and had raised the staff level to meet their needs.

People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. They were familiar with people’s history and backgrounds and supported them fairly and without bias.

People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes. Staff relationships with people were caring and supportive. They delivered care that was kind and compassionate. People said staff treated them with dignity and respect at all times in a caring and compassionate way.

The registered manager was putting in place a new care plan format. They were in the process of rewriting everybody’s care plans. The new care plans were personalised and guided staff how to meet people’s needs. We have made a recommendation about people being given access to information in a format that was accessible to them.

People were referred promptly to health care services when required and received on-going healthcare support. The healthcare professional was positive about the quality of care provided at the home and the commitment of the whole team to provide a good service.

People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them. People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the registered manager. There had been no complaints received at the service since our last in

This inspection took place on 11th May 2015.

The inspection was unannounced.

Lorna House is a residential care home service providing accommodation for up to 24 people, some of whom are living with dementia.

The home has a registered manager . A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law.

People were cared for by staff that were skilled, trained and supported in their role. There were enough staff on duty throughout the 24 hour period to meet the people’s needs. It was clear from our observations and discussions that staff knew people well. People told us they were happy living at Lorna House with one saying ‘ I couldn’t be better looked after anywhere’.

The registered manager set the standards the staff were expected to meet. She was available to hear the views of the people (and their families) and to support the staff in their work. Any problems or issues were investigated and dealt with swiftly. We saw care plans were based on people’s health and social care needs, and that their views were taken into account. We saw that all risks, or potential risks , to people had been assessed and clear plans formulated to minimise risk to individuals.

Staff understood people’s vulnerability and how to protect them from abuse, harm or injury. Staff had a good understanding of safeguarding procedures and how to report any incidents or concerns. Staff also had a good knowledge of the Deprivation of Liberty Safeguards (under the Mental Capacity Act). Further to the Supreme Court Judgement in March 2014 all residential care homes have to consider if the care they are providing may be considered to be depriving any of the individuals in their care of their liberty( for example, if people are not free to leave the care setting) If this is the case, the care provider has to ask the local authority to undertake ‘Best Interest’ assessments on the people using the service.

We saw that people were treated as individuals with respect, care and kindness. People were supported to pursue activities of their choice and to maintain links outside of the home. People’s care was delivered in a way that respected their individual needs and preferences, with staff using clear care plans. The registered manager had developed quality assurance methods and there was a clear complaints procedure.This ensured that people and their families could feed back any issues that arose. One relative said “If ever there is an issue we know it will get dealt with”.

We saw that medicines were managed to ensure people received their medications in a timely and safe way. People had access to a GP of their choice and some received support from other community health professionals like District Nurses or Community Psychiatric Nurses.

People received a nutritious diet with plenty of choice.

Staff recruitment procedures at Lorna House were robust. This protected people from unsuitable persons being employed to provide their care. Staff told us they felt well supported by the manager who they described as being approachable and knowledgeable.

The home was well presented and very clean , with no offensive odours.

On the day of our inspection 22 people lived at Lorna House. We spoke with four people who lived at the home and a relative of a person who lived there. We also spoke with the acting manager, two care workers and the cook. The manager was away on the day of our visit.

People who lived the home and their relatives were positive about the care delivered at Lorna House. One relative told us “I looked at 30 homes and this was the best of those 30.” People’s needs had been assessed and were delivered in line with their care plan.

There was a wide choice of healthy and nutritious food and drink for people. The home had an experienced cook. One person said “There’s always good food here and I can eat where I like.”

People were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse. Care workers understood their responsibilities and knew how to identify and raise concerns. People told us they felt safe at Lorna House.

We saw evidence to show that background checks had been made which ensured that staff were suitable to work with vulnerable people.

We looked at the quality assurance systems in place to monitor the quality of care delivered. We saw that the provider monitored the service and sought regular feedback. One person had commented “Well maintained, constant standard of care and cleanliness with a welcoming and happy atmosphere.”

At our last inspection we found that assessments were not being consistently completed to ensure people's capacity to make decisions was identified. Where people lacked the ability to make decisions for themselves, records were not being maintained of decisions made in their best interests by staff. This included their wishes for end of life care or treatment they might wish for in the case of a sudden deterioration in their health.

Following that inspection the home sent us an action plan identifying what actions they intended to take to improve.

On this inspection we looked at those actions. We found that the home had obtained information to help staff understand the principles and legal principles of consent and capacity. The staff member we spoke with was clear about the day to day issues with regard to ensuring people's views about their care were listened to.

We found the home had implemented new systems to ensure people were involved in making decisions about their care. Where they were not able to do so, forms had been provided to help staff identify when additional support would be involved from professionals supporting the service. This might include for example community psychiatric nurses.

We found that people were being involved in giving their wishes with regard to day to day as well as end of life care. Healthcare professionals such as general practitioners were supporting the home with regard to providing treatment escalation plans where indicated.

We spoke with five people receiving care and three staff on our visit. We also observed the care being delivered. Some of the people at the home had memory loss.

The files that we saw showed us that people's care needs had been assessed and the care plans were based upon people's needs. The plans had been reviewed regularly and following discussions with staff we found they were a reflection of the care being delivered. Staff told us about the ways in which people liked their care to be delivered and the plans we saw contained some information about the person's life before coming into the home. This helped staff to care for them and understand their behaviour in the context of the life they had lived. However where people lacked capacity, decision making was not recorded well.

People we spoke with told us the home was well run. They also told us the manager was a warm person and that they trusted her abilities. One told us the manager "is lovely, and the staff are really good too. I don't think I could be anywhere better".

We saw that care had been taken to make Lorna House a homely place for people to live in . As an example there were flowers on the dining tables and folded napkins. Fresh fruit was set out in the lounge for people to help themselves.

We saw there were activities every day, including craft, exercises, dancing, memory games and music.

The staff group had not changed for a long time and the staff we spoke with understood people's needs well.

We spoke to six people using the service and two visitors whilst we were at the home. We also observed the care being delivered to a number of other people who lived there.

The people that we spoke to told us that they could be involved in making decisions about the care they received, and a relative told us that they had been consulted about care plans and the previous lifestyle choices made by their relative, who was no longer able to fully discuss some areas of their care.

We saw people being offered choices in relation to where they wanted to sit, food and drinks they wanted, and activities they wish to engage in. During the afternoon a member of staff asked people what they wanted for their evening meal, and although there were several set choices, the people we saw also requested other options which were not on the list but were willingly provided.

Suggestions are raised by people at the home about activities they would enjoy and some raised at a recent meeting that they would enjoy swimming, which is currently being explored by the manager. One person felt they would benefit from going out more, and this was echoed by a relative. People we spoke to showed us a framed tapestry they had completed and a glass topped table which had also been made as a group activity. People were proud of the items they had produced which were displayed and used in the home.

People told us that the staff were busy but that they were able to respond if they needed help. They told us the staff were kind and looked after them well. One person said “they all do their best to look after us and they work very hard”.

We saw staff working well to support people. Relationships were friendly and people living at the home responded well to staff interaction. A relative we spoke to told us that they always felt welcome when they came and that the staff were good and cared for their relative well. They told us “I have no concerns”.

People we spoke to told us they knew what to do if they were unhappy or worried about something and wanted to make a complaint. One person told us

“I’m not frightened. I’ve got a tongue in my head and I know what to say”. Another person said they would talk to their family if they were unhappy and they would raise it with the manager on their behalf.