We carried out an unannounced inspection of Nutley Lodge Care Home 18 December 2017. Nutley 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. Nutley Lodge Care Home accommodates 27 people in one adapted building. At the time of the inspection 26 people were living at Nutley Lodge Care Home.

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. Two providers ran the service as a partnership with their families and had been in the industry for many years. The service was last inspected in August 2015 and was rated ‘good’ overall. Well led was rated as requires improvement as the service had not submitted a notification to CQC in a timely way. This had now been rectified and notifications of events were now sent according to legal requirements.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. One person said, “It’s so lovely here. I wouldn’t want to go anywhere else now.”

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, some of whom were living with dementia and unable to tell us directly about their experiences. They looked comfortable and happy to spend time in the large lounge and entrance hall or their rooms. The staff were preparing for Christmas and there was a large Christmas tree and decorations throughout the home.

People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or enjoyed a musical session with the provider’s wife playing the piano. Some people were living with dementia and people were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely whilst supervising from a discreet distance.

People were provided with good opportunities for activities, engagement and trips out. These were well thought out in an individual way and the providers with their families were very involved in day to day life at the home. People could choose to take part in activities if they wished and when some people preferred to stay in their rooms, staff checked them regularly, spending one to one time with them. One person said how the ‘girls’ [staff] were all lovely. They said, “I can do what I want. I like to read my newspaper in the morning then go down for lunch. They know what I like. There’s lots to do. I like it here.”

People and relatives said the home was a safe place for them to live. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with provider involvement and the service worked with the local authority safeguarding team. Relatives said they would speak with staff if they had any concerns and issues would be addressed and people seemed happy to go over to staff and indicate if they needed any assistance.

We spoke with five people during our visit and they were all very happy with the care they received. One person told us “I am looked after well here, I am very satisfied; this makes a big difference. We have a joke and people treat me respectfully. Staff give you as much time as they can; everyone is willing. In the circumstances I couldn’t be happier”. Another person said “When you get to my age you need someone to look out for you; it is all very nice here”.

We saw person centred comprehensive care plans that ensured that the needs of people were met. A relative we spoke with said “It is excellent care, absolutely superb.” They went on to say “Staff are always willing to go further, there are extra touches and we are welcome to visit any time. There are lots of varied activities; lots of people come in, this stimulation is important”. Another relative told us “Excellent care. When we looked round here it felt like home. I am very happy”.

Staff we spoke with were aware of the importance of safeguarding adults and what to do if they had concerns. One person we spoke with told us that they “felt safe”.

One member of staff told us that “new staff get a lot of supervision when they start and until they are confident” and all staff told us they had access to regular training. All care staff we spoke to told us they received excellent support from the manager. One member of staff said “the manager supports one hundred per cent; an excellent manager”.

There were 24 people living at the home at the time of the inspection. We spoke to six people living at the home and people’s relatives to get their views on the care provided.

Everyone we spoke to was complimentary about the home. One person told us "I’ve always been happy here". One relative commented on the “lovely atmosphere” and people told us they felt the care was “excellent”.

Everyone we asked told us staff asked their permission when caring for them and we observed people’s consent being consistently sought.

We observed care being delivered in line with people's individual care plans and people told us in particular about how they felt their emotional needs were well met. One person told us “if you’ve got a problem there’s always someone to talk to”.

We observed staff administering medicines competently and safely. One person told us “I don’t have to say ‘give me my meds’ because they do all that at the right times”.

People told us staff were "all so kind and caring", "very very helpful" and "excellent". Appropriate checks had been carried out prior to staff commencing employment.

There was a quality assurance system in place and people told us they felt their views were taken on board by staff. One person told us “anything we want we get it”. Another person told us “if there’s anything I don’t like I see (registered manager) and they put it right”.

The people we spoke to at Nutley Lodge were positive about the care and treatment they or their relatives had received. People said they felt involved in their care. People told us that the staff were respectful, and helpful and that they felt listened to.

They also told us that their privacy and dignity was respected and that they were encouraged to express preferences and choices about their care.

The relative of one person said, ‘I would recommend it (the home) to anyone, we are happy that mums happy’ and ‘Its homely and the staff really care’.

A relative whose parent had moved into the home a few weeks earlier told us that the staff, ‘were all wonderful’. They said that the staff and management had worked hard to support their relative to settle in happily since their arrival.

People we spoke to were always complimentary about the service provided by the care home. One person that spent most of their time in their room told us that the staff were friendly and caring and that they brought drinks and food to them regularly.

The home had a wide range of activities available to people that suited both their interests and abilities. People were being supported to keep mentally and physically active.

The staff team had a good knowledge of people's needs and were meeting these needs. The assessments, care plans and risk assessments were adequate to manage people’s care. However a new format for care planning was in the process of being introduced to improve care planning by moving to a person centred approach.

We saw that food and drinks were made available to people. People had choices of meals and mealtimes, and the food was of good quality.

On the day of our visit we found that the care home was clean and people confirmed to us that this was always the case.

We saw that people’s medication was being managed safely but that the quality of recording was not always fully completed.

We received mixed views about care from people residing at Nutley Lodge. Some people told us they were looked after well, the staff were kind, and they were happy with the care they received from the staff. One person told us that they had no choice about how often they could bathe. One person told us "I am the happiest I have been this year".

The inspection took place on the 18 and 19 August 2015 and was unannounced. We last inspected the service on 25 September 2013 and found no concerns.

Nutley Lodge provides residential care without nursing for up to 27 older people. Nursing care is provided by the community nursing team. People living at the service could be living with dementia and have a physical disability. On the day we visited, 26 people were registered at Nutley Lodge, but one person was in hospital.

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.

There was evidence of leadership and governance in place. Nutley Lodge was run by a partnership. Auditing by the registered manager and provider took place to ensure the quality of the service was maintained. People, relatives and staff said the registered managers were approachable. People and relatives were asked for their views of the service. Staff said they could contribute ideas about how they felt the service could be improved.

The service had not returned all the required notifications for when people experienced a serious injury while living at Nutley Lodge. This meant there was no external monitoring of serious injuries involving people living at the service. The registered manager reviewed the necessary regulation during the inspection and advised they would ensure any serious injury notifications were sent in the future.

People felt safe living at Nutley Lodge and spoke highly of the staff. People felt comfortable speaking to staff and the registered manager if they had any concerns or suggestions. Staff were knowledgeable about safeguarding people and what action to take if there was a concern. Both people and staff said any concerns would be taken seriously by the registered manager.

Staff treated people with kindness and respect. People’s dignity was protected at all times. Staff were observed treating people as individuals and ensuring their needs were met. People were in control of their care and of planning how their care needs were met. People were supported to plan for their end of life. Risk assessments were in place to reduce the risk of them coming to harm. People were involved in assessing their risks and how staff could support them. Relatives or their representatives were also fully involved.

People’s medicines were administered safely. Staff followed safe infection control policies and practices.

Staff were recruited safely and trained to meet people’s needs effectively, including those with specific care or support needs. Staff said they could ask for training and guidance was always available from senior staff and local health care professionals. All staff, regardless of their role, took extra training to meet people’s needs where they were living with dementia. The service had been awarded the Dementia Kite Mark again in 2015 to demonstrate their role in supporting people living with dementia.

People’s nutritional and health needs were met. People said staff responded to their needs quickly and ensured they saw health professionals when required. People said staff helped explain what healthcare professionals had said and supported them to make choices about what they wanted to happen.

Activities were provided to keep people mentally and physically stimulated. People’s personal histories were gathered to ensure activities were person centred. People’s faith needs were met.

People’s concerns and complaints were investigated and only closed once people were happy with the outcome.