This inspection took place over two days on 29 and 30 November 2016 and was unannounced. At our last inspection on 16 September 2014 2014 we found that the provider met all standards that we inspected.

Minchenden Lodge provides residential care and support for a maximum of 21 older people. Some of whom may be living with dementia.

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.

Staff had received training on medicines administration and people were supported to take their medicines safely. Medicines were accurately recorded on medicine administration (MAR) sheets.

People were involved in decisions about their care. Where people were unable to have input, best interests meetings and decisions were recorded. Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report it to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

There were individualised care plans written from the point of view of the people that were supported. Care plans were detailed and provided enough information for staff to support people. We saw that care plans were regularly reviewed and updated immediately if changes occurred.

Risk assessments gave staff detailed guidance and ensured that risks were mitigated against in the least restrictive way. Risk assessments were reviewed and updated regularly.

People and relatives said that they were treated with dignity and respect. Staff were able to give examples of how they ensured that they promoted dignity. People were encouraged to be as independent as possible.

There were activities provided for people both within the home and outside. People were also able to request activities if they wished. Activities were discussed during residents meetings.

People and relatives were involved in end of life care planning. People experiencing end of life care were treated with compassion and empathy.

Staff received regular, effective supervision and attended monthly team meetings.

Staff, people and relatives were positive about the culture of the home and the management.

Audits were carried out across the service on a regular basis that looked at things like, medicines management, health and safety and the quality of care. There was a complaints procedure as well as incident and accident reporting. Surveys were completed with people who use the service and their relatives. Where issues or concerns were identified, the manager used this as an opportunity for change to improve care for people.

A single inspector carried out this inspection. The focus of the inspection was to answer five key question; is the service safe, effective, caring, response and well-led?

As part of this inspection we spoke with eight people who lived at Minchenden Lodge. We also spoke with five members of staff and the district nurse who was visiting on the day of our visit. We reviewed records relating to the management of the home which included five plans, daily care records and records about how the home monitors its own performance and the quality of care.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed during the visit and what we saw in the records we looked at.

Is the service safe?

People were cared for in an attractive and pleasant environment that was suitable for purpose. Staff personnel records contained all the information required by the Health and Social Care Act 2008. This meant that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act and is concerned with people’s safety and well-being where they are not always able to make decisions for themselves. Arrangements had not been put in place to care for people under DoLS where necessary.

The home ensured people’s medical needs were met and worked well in partnership with other health professionals to support people living at the home appropriately.

Is the service effective?

People told us that they were happy with the care they received and felt their needs were met. One person said ‘I like it here. There is always something going on.’ A relative told us ‘My husband is well looked after. Staff take great care with him and he is happy.’ Another said ‘I would be happy to recommend this place.’

It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. We saw that steps were taken to maintain people’s independence and wellbeing.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. They were very supportive of people’s relatives many of whom were themselves elderly and frail. We saw that people were able to do things at their own pace and were not rushed. All the people we spoke to said that staff were kind and helpful.

Is the service responsive?

We saw that staff were responsive to the needs and wants of people living at the home. People were encouraged to make decisions about their own care wherever possible and the choices that people made were respected. We saw that support offered changed in line with people’s support needs in a timely way.

Is the service well lead?

The service was led by a manager who was very hands on with the care of people living at the home. The emphasis of the leadership was on providing a homely environment where people’s individuality was respected and promoted and family involvement encouraged.

Our inspection on the 03 October 2013 found that information about the complaints system was not brought to the attention of the people who use the service and their relatives. The provider wrote to us and told us that they would make sure that people and their relatives were aware of the complaints procedure, and that any complaints were addressed. We saw that copies of the complaint policy were now available for people and their relatives so that they would know how to make a complaint. People who use the service and their relatives told us that knew how to make a complaint. They were confident that any concerns they raised would be addressed. One person said, “they listen to what you say and deal with thing when you tell them.” The manager explained that she had introduced a way to record minor concerns that were raised verbally by people and their relatives. The manager told us that where issues were more serious they would be recorded as a formal complaint with the agreement of the complainant. People’s complaints were fully investigated and resolved, where possible, to their satisfaction.

We saw that people appeared to be happy and relaxed and one person we spoke with said “it’s lovely here – not institutional”. Appropriate arrangements were in place to ensure people’s valid consent to care and treatment was gained.

The provider had taken steps to provide care in an environment that is suitably designed and adequately maintained. People told us they liked their rooms and we saw they were well furnished and decorated.

Medicines were stored and managed appropriately, following immediate action taken the day after our inspection.

We saw that the home had an appropriate complaints policy and procedure. Whilst the manager told us they had not had any complaints, we found that people had not been made aware of the complaints system. The provider told us they intended to produce information for people about their policies and procedures, including complaints.

We spoke with 13 people who use the service and nine members of staff. We looked at four care plans and staff records. All people using the service were positive about the home. One person said, “A lovely atmosphere. The staff are wonderful and patient. We are lucky to live here.” Another person said, “We are lovingly cared for. There are lots of activities. The staff care is very good.”

Staff were equally positive. One member of staff said, “I love it.” Another said, “It’s a lovely place to work, compact and homely.” We observed positive and warm relations between staff and people using the service throughout our visit.

The people using the service told us that they felt safe and staff told us that they felt supported. We saw records confirming that staff had been provided with supervision and a range of training. The care plans provided detailed assessments and plans for meetings people's needs. Action had been taken to introduce a new care planning system based on good practice from the provider's other care services. Regular health and safety and quality checks had taken place and there was a plan to introduce relatives meetings.

Overall, the arrangements made to keep medicines safe were thorough although we found three gaps in recording and administration. This presented a risk to people’s health and wellbeing if they did not receive their medicine at the correct time.

On the day of the inspection there were twenty people using the service.

The home was warm, clean and had a relaxed and friendly atmosphere. There were four care staff on duty with a senior carer supervising. The registered manager was also on duty and in addition there were two domestics, two cooks and an activities worker.

People who use the service told us that staff were kind and respected their privacy.

They told us they could talk with the manager or staff about any issues in the home.

We observed staff supporting people in a friendly and professional way and saw that people were being offered choice with regard to menus, activities and care preferences.

People who use the service were positive about the care and treatment they received at the home. They confirmed that staff assisted them when they needed support with their care and that staff were very helpful. People told us they had good access to health care professionals such as doctors, district nurses, dentists and chiropodists.

People who use the service indicated to us that they felt safe at the home. They told us they had no concerns about their care but would speak with a relative or the staff if they needed to.

The service did not have a formal system in place to regularly identify, assess and manage risks relating to the health, welfare and safety of people using the service and others who may be at risk.