This unannounced inspection of Lostock Grove Rest Home took place on 21 August 2018.

At the last inspection in September 2015, the service was rated ‘Good’. We found during this inspection that the service remained ‘Good.’

Lostock Grove Rest Home is a large detached house which can accommodate up to 37 older people who require support with their personal care. Accommodation is provided over two floors. There are single bedrooms and all have en-suite toilets. A lift provides access to the first floor. There are two communal lounges and a separate dining room. There is a ramp to the front entrance, with car parking available, allows easy access for people with limited mobility.

During our last inspection in September 2015, we found that the service was in breach of regulations in relation to safe care and treatment. This was because there were issues and discrepancies with regards to the storage, recording and administration of medication. The safe domain was rated as requires improvement. After the inspection in September 2015, the registered provider sent us an action plan which described the actions they were going to take to assure these concerns were rectified. We checked this at this inspection.

Medication was stored, administered and recorded safely. Spot checks and audits routinely took place on medications to ensure that they were being given to people correctly. Staff who were responsible for administering medication had attended medication training and had their competency assessed by the registered manager. The service was no longer in breach of regulation.

Staff were able to describe the course of action they would take if they felt anyone was at risk of harm or abuse and this included ‘whistleblowing’ to external organisations. The registered manager had systems and processes in place to ensure that staff who worked at the service were recruited safely. Rotas showed there was enough staff at the home to support people safely. Risks were well assessed and information was updated as and when required. We were able to view these procedures and how they worked. We particularly looked at falls management to ensure that all required action had been taken to prevent falls occurring in the home. We saw that the registered manager analysed falls and provided explanations of why they occurred and any action that had been taken to help prevent the fall from happening again.

There was a supervision schedule in place, and all staff had received up to date supervisions and most had undergone an annual appraisal, any due were booked in to take place. All newly appointed staff were enrolled on the Care Certificate. Records showed that all staff training was in date.

We saw some example of where people lacked capacity, the appropriate best interest processes had been followed. The service was working in accordance with the Mental Capacity and DoLS (Deprivation of Liberty) and associated legislation. We saw that where people could consent to decisions regarding their care and support this had been documented.

Staff were able to give us examples of how they preserved dignity and privacy when providing care. People we spoke with were complimentary about the staff, the registered manager and the service in general. People told us they liked the staff who supported them.

Complaints were well managed and documented in accordance with the provider’s complaints policy. The complaints policy contained contact details for the local authorities and commissioning groups.

Staff we spoke with demonstrated that they knew the people they supported well, and enjoyed the relationships they had built with people. Care plans contained information about people’s likes, dislikes, preferences, backgrounds and personalities.

Action plans were drawn up when areas of improvement were identified. Staff meetings and resident meetings took place. Regular audits were taking place for different aspects of service delivery. Quality assuranc

Lostock Grove is a large detached house which can accommodate up to 25 older people who require support with their personal care. Accommodation is provided over two floors. There are both single and shared bedrooms and all have en-suite toilets. A stair lift provides access to the first floor. There are two communal lounges and a separate dining room. A ramp to the front entrance, with car parking available, allows easy access for people with limited mobility.

The last inspection of the service took place on 31 March 2014. During this inspection the service was found to be compliant with the one regulation assessed.

This inspection took place on 22 September 2015 and was unannounced.

We were assisted throughout the inspection by the long term 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.

During this inspection we spoke with people who used the service, their friends and relatives and a number of community professionals who had involvement with the service. The feedback we received was extremely positive. People expressed confidence in the service and felt staff provided safe and effective care. People were complimentary about the caring approach of staff and spoke highly of the way the service was managed.

We found that the arrangements for the safe management of people’s medicines were not always effective. We identified some concerns about medicines management and found the service was non compliant with the associated regulation.

We found the registered manager was aware of the requirement to protect the rights of people who

did not have capacity to consent to some aspects of their care and we were able to confirm that the correct processes were followed in these circumstances. However, information about people’s capacity and action taken to safeguard their rights was not always clearly recorded on their care plans.

People’s care needs were carefully assessed and any risks to their safety or wellbeing were identified. Staff had a good understanding of people’s needs and how they wanted their care to be provided.

People were supported to access health care and staff and the registered manager were proactive in ensuring any health care concerns were referred promptly to the relevant community professionals. The staff and registered manager worked positively with external agencies to help ensure people received the care they needed.

Staff were fully aware of their responsibility to safeguard people from abuse and were confident to report any concerns to the registered manager.

People received their care from well trained and well supported staff. Staff were carefully recruited to help ensure they had the suitable skills and character to carry out their role.

People described care workers in ways such as, ‘kind’, ‘caring’ and ‘helpful’. People told us they were treated with respect and that their privacy and dignity was consistently promoted.

People who used the service were enabled to make decisions about their care and express their views and opinions. People felt their opinions were valued and we saw a number of examples where the registered manager had taken action as a result of feedback received.

People were enabled to raise complaints and when they did so the registered manager ensured they were responded to appropriately. The registered manager also ensured that any learning from complaints or adverse incidents such as accidents, was identified and shared with the staff team.

There were processes in place to enable the registered manager and provider to monitor safety and quality across the service. Where areas for improvement were identified, action was taken to address them.

All the people we spoke with described a positive culture within which they felt able to raise concerns and express their views and opinions. People also expressed confidence in the registered manager to act on any concerns appropriately and take people’s views into account.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicines management. The action we have asked the provider to take is detailed at the end of this report.

On our arrival at the home we saw that a number of residents were busy making some decorations for Halloween with the staff. We noted that the interaction between residents and carers was very pleasant and everyone seemed to be enjoying the activity.

We talked with a number of residents who all spoke very positively about life at the home and expressed satisfaction with the service they received. People’s comments included:

‘’I definitely can’t grumble. The staff are nice and the food is very nice!’’

‘’I like it here! If I didn’t, I wouldn’t keep coming!’’

‘’Let me write your report! I will give them ten out of ten for everything!’’

Staff that we spoke with were also very positive about the home. One carer told us, ‘’Everyone gets on really well here. The staff all get on and the residents do as well. There are some lovely friendship groups with the residents.’’

We spoke with a student and some volunteers. Again, the feedback was very positive. The student told us, ‘’I have learned a lot about how to interact with people. They are very good at that here.’’ One of the volunteers commented, ‘’I come because I like this home. People are treated very well and the staff are nice to the residents. That’s why I like it.’’

People told us:

"It's absolutely fine...My room is lovely...I'm getting on very well and I'm well settled."

"I'm quite happy...No complaints."

"It's smashing...The staff give me lots of encouragement."

"I like all the staff. We have a good laugh."

A visiting relative told us: "This place is wonderful!"

We found that the provider had well trained staff who ensured that consent to care and treatment was gained from people who used the service. Staff at the home were well supported to carry out their role and there was a good team ethos amongst the staff and management.

The provider took a person centred approach to assessing people's needs and delivering care, which promoted the health and welfare of each individual. We saw that the care that was delivered for people was of a high standard and people were satisfied with the care and support they received.

The registered manager had good systems in place for monitoring and assessing the quality of care that was provided. However, some of the issues highlighted by these measures had not been satisfactorily resolved. We found that the standard of cleanliness and the condition of the premises were below the appropriate standards.

People said they were given an informed choice to enter the home and were treated with privacy and dignity.

People were allowed sufficient choices to help them retain some independence.

People who used the service thought they were consulted about their care to ensure their wishes were taken into account.

People who used the service felt safe and were confident any concern would be listened to.

People who used the service thought staff were kind, attentive and in sufficient numbers to meet their needs.

People who used the service, staff and a family member thought they were listened to and supported to help maximise their contentment.