The inspection took place on 20 and 21 March 2018 and was unannounced, which meant the provider did not know we would be visiting. At the last inspection in January 2016 the provider had not ensured that people were protected against the risks associated with unsafe and unsuitable premises. These issues were breaches of regulation 15 (premises and equipment).

Following the inspection, the provider sent us a detailed action plan to explain how they would address these concerns. At this inspection the provider had made improvements which meant they were no longer in breach of the regulations.

Lowgate is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Lowgate provides accommodation on ground floor level for up to 42 people with residential and nursing care needs. People had a range of health care needs, including those living with dementia. At the time of the inspection, there were 40 people living at the service.

The service had a registered manager. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

The provider had submitted statutory notifications and had displayed its inspection rating in the service and on its website as legally required. The registered manager was held in high regard by people, relatives, staff and healthcare professionals whom we spoke with.

People told us they felt safe as did their relatives. Staff had received safeguarding adults training and told us they would have no hesitation in reporting any concerns. Where concerns had arisen, these had been addressed, which included disciplinary action towards staff when necessary.

Medicines were generally managed well with people receiving their medicines on time by trained staff. Some issues we found during the inspection were addressed straight away by the registered manager.

There was enough staff on duty at the service at all times. There were suitable recruitment procedures in place. Checks were taken before staff started in their role at the service. We have made a recommendation regarding the review of the Disclosure and Barring Service procedures in line with good practice.

Staff had received a full induction, a range of appropriate training and felt fully supported in their work at the service.

Before people moved into the service they had their needs assessed to ensure the provider could meet them. Once people moved into the service, full and detailed person centred care plans were prepared with important information recorded about people to support staff in assisting them.

Risk was identified and assessed to minimise harm to people. Where accidents or incidents had occurred, these were fully recorded and monitored for any trends forming.

Suitable checks were made on the premises and the equipment to ensure they were safe, this included all of the utilities and the building itself. Emergency contingency plans were in place in case of emergencies and the provider had recently completed a fire risk assessment to minimise risk to people even further.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Good quality nutritious food and suitable refreshments were available to people. Support was offered to maintain dignity and respect to those who could not fully manage themselves. This included, for example, help with meals, personal care and mobility.

People told us staff showed them kindness and were caring and

The unannounced inspection took place on 20 and 25 January 2016. We last inspected Lowgate Care Home in May 2014. At that inspection we found the service was meeting all the regulations that we inspected.

Lowgate Care Home provides residential and nursing care for up to 42 people, some of whom are living with dementia. At the time of our inspection there were 37 people living at the service.

The service had 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.

We found some shortfalls in the upkeep of the building and the premises. We found areas that needed to be updated, particularly in line with best practice with regards to people living with dementia and items of furnishing in need of replacement.

Medicines were safely managed and staff were knowledgeable and suitably trained. We did find areas where improvements needed to be made and we discussed this with the registered manager and have made recommendations.

People told us they felt safe in the home. Staff had received safeguarding training and were able to describe how they would respond if they had any concerns.

Accidents and incidents were recorded and monitored and risks had been assessed. Actions had been completed to reduce the likelihood of risks occurring.

We found staff were suitably trained and received supervision and appraisal from their line manager or registered manager. There were enough staff to meet people’s needs and staff were able to respond to people quickly. Safe recruitment procedures had been followed to ensure staff were suitable to work with vulnerable people.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.

Staff at the service supported people well with nutritional and hydration needs. People were happy with these arrangements and told us they received a variety of food tailored to their dietary needs to ensure these needs were met and maintained.

People told us staff look after them well. Staff spoke with people in a caring and kind manner and treated them as individuals with respect and dignity. People’s care needs were detailed, recorded and reviewed by staff with input from the person, their families or healthcare professionals.

People had choices in their day to day living and were able to participate in a wide range of activities. Staff encouraged and supported everyone to maintain social links. People and their relatives told us they knew how to complain and any issues had been dealt with quickly.

We found suitable checks and audits were in place and these were completed by the registered manager and the provider. These were completed regularly to monitor the quality of the service. The registered manager had sent us notifications of incidents in line with their registration.

Staff felt supported in a team that worked together for the benefit of people living at the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to premises and equipment. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we spoke with three people and five relatives and looked at the care records for four people. One relative said, “Staff are marvellous, they have the patience of a saint. They have humour too, it’s brilliant, and they go well above their duties.” Another said, “Staff know everyone really well, even the relatives, they are really good with the people who live here.”

People and staff told us that consent was gained before care was delivered.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and we found that people looked clean and well cared for.

We saw the building was well maintained and designed to be accessible to all people.

There were enough qualified, skilled and experienced staff to meet people’s needs.

There was an effective complaints system available and a clear way of identifying complaints. We found that comments and complaints people made were documented and responded to appropriately.

People told us what it was like to live at this home and described how they were treated well by staff and their involvement in making choices about their care. People and their relatives told us they had confidence in the service: comments included, “It is a lovely place to live", "The food is great", "I am in everyday and the place is spotless", "Staff are always helpful and available whenever you need them" and "I have no complaints at all."

People said they could receive medical and specialist attention when they needed it. People said they were helped to fulfil their social needs within the home and community. People we spoke with said, "I find there are things to do and I am enjoying myself" and "I feel lucky to be here and the staff are just wonderful."

People told us their home was clean, comfortable and warm. They said, "I have everything I need around me." We found the home to be clean and well maintained but a shower room was in need of refurbishment. People and their relatives said staff were kind and caring and seemed to be well trained. People confirmed they were given the opportunity to comment on the service, change routine or raise complaints. They said their visitors were made to feel welcome and information sharing was good.

At the time of the inspection there were 37 people living at the home. Due to their health conditions and complex needs not all people were able to share their views about the service they received. During our visit we spoke with 6 people who used the service and observed their experiences. We spoke with the operations manager, two nursing staff, four care staff and two relatives of people who used the service.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five 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?

This is a summary of what we have found.

Is the service safe?

The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw risk assessments had been completed for people who were assessed as being at risk of falls. These risk assessments were held with the care plans of people who used the service and had been read by all members of staff.

We saw there was a system in place for the safe handling of medication.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No applications have needed to be submitted at the service. We saw policies and procedures were in place and all staff had received training in the Mental Capacity Act 2005 (MCA) and DoLS.

Is the service effective?

People were treated with respect and dignity. People who used the service were asked about the support they received and if they understood their rights. They were given the information they needed to make an informed decision about their care.

Is the service caring?

People's preferences, interests and needs were recorded and staff were able to give

examples of these when we spoke with them.

People's health and care needs were assessed with them and they were involved in this process.

People we spoke with were positive about the care they received from the service.

Comments included, "I have everything I need” and “I am looked after well here”.

Is the service responsive?

There was an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and ensured care delivery was adapted to meet their needs.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff demonstrated they knew how to identify and report abuse. They told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service or their representative.