Manor Lodge is a care home that provides accommodation and personal care for sixteen older people some of whom are living with dementia. The home has a communal lounge/dining room and well-maintained enclosed garden. People’s bedrooms are single occupancy and located over two floors. A passenger lift enables people with mobility needs to access the first floor. There were sixteen people using the service including one person who was in hospital at the time of the inspection.

At our last inspection we rated the service good. At this inspection on the 15 March 2018 we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

Arrangements were in place to keep people safe. Staff knew how to identify abuse and understood the safeguarding procedures they needed to follow to protect people from abuse.

Risks to people's health and well-being were identified, assessed and managed as part of their plan of care and support. Staff understood their responsibilities to deliver safe care and to report to the manager all concerns to do with people’s safety and any poor practise from staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff gained people's consent before providing personal care.

Medicines management systems were in place to ensure people’s medicines were stored and administered safely. People’s dietary needs and preferences were understood and supported by the service.

People received personalised care and staff were responsive to people’s needs. People's care plans included details about people’s individual preferences and information staff required to provide people with the care and support they needed in the way that they wanted. Care plans were reviewed regularly and were updated when people's needs changed.

Staff had a caring approach to their work and understood the importance of treating people with dignity and protecting people's privacy. People’s confidentiality was maintained.

People had the opportunity to take part in a range of activities. Staffing levels and skill mix provided people with the assistance and care that they needed. Appropriate recruitment procedures were in place to ensure that only suitable staff were employed to provide care.

Staff received the training and support that they needed carry out their roles and responsibilities including providing people with individualised care.

People and their relatives knew how to make a complaint and were confident their concerns would be addressed appropriately by the service.

There were systems in place to assess, monitor and improve the quality of the services provided for people. Improvements to the service and people’s care were made when needed.

People’s healthcare needs were assessed. The service worked with healthcare and social care agencies to ensure people’s needs and preferences were met.

We have made two recommendations. One about improving the access of the building for people using the service and visitors who have mobility needs, and another about developing the adaptation, design and decoration of premises to ensure that the environment always meets the needs of people using the service who were living with dementia.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on15 March 2016 at which a breach of legal requirements was found. This was because the provider did not always ensure the proper and safe management of medicines.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook an unannounced focused inspection on the 18 August 2016 to check they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Manor Lodge on our website at www.cqc.org.uk

Manor Lodge provides accommodation and personal care for up to 16 older people some of whom have dementia. There were 16 people living at the home at the time of our inspection.

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 [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.

At our focused inspection on the18 August 2016, we found that the provider had followed their plan and legal requirements had been met. The provider had taken action to address our concerns about some aspects of the way medicines were managed by the service. The provider had made improvements to the storage of medicines. They had also carried out medicines competency assessments of staff who administered medicines and provided staff with additional medicines training.

This unannounced inspection of Manor Lodge took place on the 15 March 2016. At our last inspection on 5 March 2014 the service met the regulations inspected.

Manor Lodge is registered to provide accommodation and personal care for 16 people. The home provides care for older people some of whom have dementia. The home is owned and managed by R.M.D. Enterprises Limited. On the day of our visit there were 16 people living in the home. Public transport and a range of shops are located within walking distance.

People informed us they were satisfied with the care and services provided and told us staff were kind. We saw people were treated with respect and staff engaged with people in a friendly and courteous manner. Throughout our visit we observed caring and supportive relationships between staff and people using the service. People’s privacy and dignity were respected.

People received the medicines they were prescribed. However we found there were aspects of the storage and management of medicines where improvements were needed.

There were procedures for safeguarding people. Staff knew how to safeguard the people they supported and cared for. Arrangements were in place to make sure sufficient numbers of skilled staff were deployed at all times. People’s individual needs and risks were identified and managed as part of their plan of care and support to minimise the likelihood of harm.

Care plans were personalised and reflected people’s current needs. They contained the information staff needed to provide people with the care and support they wanted and required. People had the opportunity to participate in some activities of their choice.

People were encouraged and supported to make decisions for themselves whenever possible and their independence was maintained and promoted. People were supported to maintain links with their family and friends.

People were supported to maintain good health and their well-being was promoted. They had access to appropriate healthcare services that monitored their health and provided people with appropriate support, treatment and specialist advice when needed.

People were provided with food and refreshments which met their preferences and dietary needs. However, the menu did not indicate that people had choice during some meals.

Staff were appropriately recruited, trained and supported to provide people with individualised care and support. Staff told us they enjoyed working in the home and received the support and training they needed to carry out their roles and responsibilities.

Staff understood the legal requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They knew about the systems in place for making decisions in people’s best interest when they were unable to make one or more decisions about their care and/or other aspects of their lives.

People had opportunities to feedback about the service. There were systems in place to regularly assess, monitor and improve the quality of the services provided for people.

We found one breach of the new Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection on the 7th November 2013 we found concerns with four essential standards that we inspected. The provider supplied us with action plans to address the concerns. We carried out an unannounced inspection on the 5th March 2014 to check for compliance with the compliance actions and with the enforcement action taken in the form of a warning notice.

During this inspection we found that the provider had taken proper steps to demonstrate compliance in all the areas where there had been concerns. These areas included Care and welfare, Management of medicines, Supporting workers and Assessing and monitoring the quality of service provision.

We spoke with six people who used the service, four visitors, four care staff, the registered manager and an owner of the care home. People who used the service told us that they were happy living in the home. They said the staff were kind and treated them well. Comments from people included “its fine here,” “The food is good,” and “The staff are very nice.”

Relatives of people who used the service spoke highly of the care provided by the home and made positive comments about the registered manager. Comments from relatives of people who used the service included “Nothing is too much trouble for the staff and the manager,” “They are all very kind,” “Staff are very good at what they do,” “They are very kind and positive,” “I feel involved and listened to,” and “I have recommended the place to several people."

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Written procedures that guided practice had not been amended to reflect up-to-date information. Staff were not provided with suitable information to protect service users against risks of receiving inappropriate or unsafe care.

Staff were able to describe their responsibilities in recognising potential abuse and reporting safeguarding concerns. Some relevant training had been provided and information about safeguarding was included in the induction programme for new staff.

People were not protected against the risks associated with medicines. Medicines were not kept securely. Up-to-date published information about medicines was not made available to staff. This meant people were at risk of receiving unsafe or ineffective medicines.

Not all staff received appropriate training, professional development, supervision and appraisal. Staff could not demonstrate their continued ability to meet required standards, or that training was planned and based on the needs of people using the service.

There were some systems in place to seek the views of people using the service, relatives, and staff. There were no clinical, or quality audits carried out to ensure that risks were identified and managed.

People we spoke with told us they were happy with the home and the care they received. People said "I like it here" and "without caring I wouldn't be able to do anything". We found that staff were able to meet the individual needs of the people who use the service.

We also spoke with the relatives of people who use the service who were equally happy. One comment was, "I can relax 100%. The care here is fantastic". Another relative said, "all staff are nice. I've never seen anyone who isn't smiling". We spoke with one relative who stated that the home had helped her mother to walk again.

The staff we spoke with had been working at the service for many years. They had undertaken additional training courses to improve their skills and qualifications. Staff said "it's a good working atmosphere. We work like a team".

The service had person centred care plans in place and encouraged people to be independent. Dignity and privacy was respected and the home provided a safe environment. Although there were regular reviews of care plans and daily record sheets filled in for each person, the policies were several years old.

People told us they were very happy living in the service. They said that the staff were “kind, patient and caring” and looked after them well. They confirmed that staff came quickly if they used the call bell and that if they spent time in their bedrooms, staff always checked on them to ensure they were safe. People told us the manager was approachable and they felt able to talk with her if they had a concern or complaint.

People and their relatives told us that the service was clean and free from odours and they were satisfied with the environmental facilities available.

People and their relatives said that activities were arranged and people had the choice to take part in them. People confirmed that they were supported and encouraged to be independent. People said “If I want to spend time alone I can or if I choose to be with the other people then I do”.

People said they knew what medicines they were taking and they were aware of their side effects.

People and their relatives spoke positively about the meals and people said they were asked what they wanted to eat.

Care professionals spoke favourably about the service with comments including, “I have always found staff very willing to communicate” and another commented “we have generally found Manor Lodge responds quickly to our requests”. Other comments included, the service acts promptly to refer people for advice and treatment and staff seem well informed about the condition of the people and “show a caring commitment”.