This inspection took place on 6 and 7 November 2018 and was unannounced on day one and announced on day two. This was the first inspection of the service under this new provider legal entity. Nesfield Lodge 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.

Nesfield Lodge accommodates 44 people across two floors. Both floors specialised in providing care to people living with dementia. At the time of our inspection, there were 40 people living in Nesfield Lodge.

At the time of our inspection there was a registered manager in post at the service. 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.

People told us they felt safe living at Nesfield Lodge. Staff understood when and how they would raise any concerns if they suspected abuse was taking place. The registered manager kept a log of all safeguarding investigations and recorded what action had, or needed to be taken, to keep people safe from abuse.

There was enough staff to safely care and support people. The registered manager regularly reviewed this, to ensure staffing levels continued to be appropriate. Staff were recruited safely and appropriate employment checks had been undertaken before staff began working at the service to ensure they were of suitable character to work with vulnerable adults.

People’s individual needs were risk assessed and staff had the right information to support people safely when using equipment such as hoists and walking aids.

The provider had policies and procedures in place to prevent the potential spread of infection. Staff followed good infection control practises in their work. We looked in people’s bedrooms and found that these were clean and tidy.

People’s medicines were managed safely and people and their relatives confirmed this when we spoke with them. We looked at six medication administration records (MARs) and found the stock of medication held for each of these was correct.

Fire safety equipment was in place and serviced regularly. Arrangements were in place to safely evacuate people from the premises in cases of emergency.

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.

People told us they enjoyed the food. The menus showed an extensive choice of meals which included specialist dietary options, including vegetarian meals. People ate at their own pace and were supported by staff in a patient and relaxed manner.

People were supported to access healthcare professionals. We spoke with a visiting health care professional who told us the number of referrals to the on-call doctor had reduced since they had begun working in close partnership with the service.

Staff received regular supervision and annual appraisals. The registered manager also provided group supervision to staff.

We received positive feedback from people and their relatives about the kind and caring nature of the staff. Visiting times for relatives were unrestricted and the registered manager encouraged people to invite guests to celebrate special occasions with them.

Staff respected people’s privacy and they told us how they promote people’s dignity when proving personal care, by closing doors and curtains and by approaching people discreetly and sensitively.

People were supported to be as independent as possible and staff encouraged people to make their own decisions wherever they could. We heard staff asking people what