Sonia Lodge is a residential care home for 28 people with dementia. At the time of the inspection there were 24 people living at Sonia Lodge in one adapted building.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

Sonia Lodge continued to provide good quality care. The kind and supportive culture was clear to see. People were engaged in different activities and there was a sense of mutual respect between people and staff. People greeted staff with warmth and staff told us about people and their backgrounds with fondness and sensitivity.

People were protected from harm and abuse. Risks continued to be assessed and lessened to provide people with the least restrictive and best possible quality of life. Staff continued to be recruited safely and there continued to be an appropriate level of trained staff to meet the needs of people living at Sonia Lodge. Staff told us that they felt supported and listened to informally and through supervisions and appraisals. Medicines continued to be stored and given to people safely. Staff had appropriate training and the registered manager conducted spot checks to ensure staff were safe to give people medicines. Protocols and checks ensured that people continued to be protected from the spread of infection.

The care and support provided to people continued to be person-centred and in line with best practice guidance. The registered manager attended local forums and learnt from visiting professionals. People and their families were given the time and support to be involved in all aspects of their care. Regular reviews ensured people were given the support they needed to meet their changing needs. Training continued to be tailored to take into account peoples individual and changing needs. Staff were knowledgeable of peoples dietary and hydration requirements and appropriate referrals were made to professionals when required.

People always had alternative options for meals and staff sought people’s ideas when creating the menus. When people were unwell, staff responded quickly and contacted the relevant professionals. Policies and procedures were in place to support a consistent level of care when people went to hospital or visited health professionals. The premises continued to meet the needs of people living at Sonia Lodge, rooms were personalised to peoples taste and people had access to different areas to relax or socialise in. 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 supported this practice.

The registered manager sought feedback from staff, relatives, health professionals and people using the service and an accessible complaints procedure was available. Regular checks and audits were carried out to ensure issues were identified and resolved. Complaints, compliments, feedback, errors and incidents were recorded and these were collected and analysed by the registered manager to identify if lessons could be learnt.

People were asked about their end of life preferences and their personal information was kept securely. Staff continued to respect people's privacy, dignity and confidentiality.

Further information is in the detailed findings below.

The inspection visit was carried out on 16 March 2016, was unannounced and carried out by two inspectors.

Sonia Lodge provides care for up to 28 older people some of whom may be living with dementia. People also had sensory, communication and mobility needs. On the day of the inspection there were 26 people living at the service.

The service is located in Walmer near Deal. On the ground floor there is one large communal lounge, a dining room/second small lounge and a conservatory that is also used as a dining area. Bedrooms are located on the ground and first floors. A passenger lift is available for access to the upper floor. There is a secure garden at the rear of the premises.

The service 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.

People felt safe in the service. Staff understood how to protect people from the risk of abuse and the action they needed to take to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns and were confident appropriate action would be taken. The registered manager responded appropriately when concerns were raised. They had undertaken investigations and taken action. The registered manager followed clear staff disciplinary procedures when they identified unsafe practice. Visiting professionals told us that people were cared for in a way that ensured their safety and promoted their independence.

Before people decided to move into the service their support needs were assessed by the registered manager to make sure the service would be able to offer them the care that they needed. People indicated that they were satisfied and happy with the care and support they received. People received care that was personalised. Peoples care plans contained the information and guidance so staff knew how to care and support in the way people preferred. The registered manager said that they were planning on re-writing all the care plans to make them more person –centred.

People had an allocated key worker. Key workers were members of staff who took a key role in co-ordinating a person’s care and support and promoted continuity of support between the staff team. The service was planned around people’s individual preferences and care needs.

Staff understood people’s specific needs and had good relationships with them. Most of the time people were settled, happy and contented. Throughout the inspection people were treated with dignity and kindness. People’s privacy was respected and they were able to make choices about their day to day lives. Staff were respectful and caring when they were supporting people. People were comfortable and at ease with the staff. Staff encouraged and involved people in conversation as they went about their duties, smiling and chatting to people as they went by. When people became anxious staff took time to sit and talk with them until they became settled. When people could not communicate verbally staff anticipated or interpreted what they wanted and responded quickly. People were involved in activities which they enjoyed. Staff said they would like there to be more activities for people. The registered manager had just appointed a person to carry out more activities and was waiting for their safety checks to be completed.

Staff were familiar with people’s life stories and were very knowledgeable about people’s likes, dislikes, preferences and care needs. They approached people using a calm, friendly manner which people responded to positively. Staff asked people if they were happy to do something before they took any action. They explained to people what they were going to

Our inspection team was made up of one inspector; we spoke with people who used the service, the registered manager, care staff and relatives. We also observed staff supporting people with their daily activities. We asked our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Below is a summary of what we found.

Is the service safe?

The service was safe. Practices in the service generally protected people using the service, staff and visitors from the risk of harm.

Safeguarding procedures were in place and staff understood how to safeguard the people they supported. People told us that they felt safe living at Fassaroe House. One person said, ‘The staff always tell me what they are going to do. They explain everything. I trust them’.

The registered manager did the staff rotas, they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded when required.

Each person had a care plan detailing their support and care needs. We saw that there was guidance for staff to follow to reduce risks and implement strategies to make sure people were as safe as possible

Is the service well-led?

The service was well- led. There was a clear management structure in place. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was improving. A relative told us, “The standard of care has improved considerably over the past few months. There is of course still room for improvement”.

Is the service effective?

The service was effective. People told us that they were happy with the care that had been delivered and that their care needs were met. One person we spoke with told us, “They are all very pleasant, I get everything I need”. We saw that staff were attentive to people using the service and responded promptly when needed.

People’s health and care needs were assessed with them, and they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Staff received the training and support that they needed to carry out their roles effectively and safely.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People were given care and support by staff in a way that suited them best.

Is the service responsive?

The service was responsive. People and their relatives knew how to make a complaint if they were unhappy. They told us if they had any concerns they would speak to the registered manager or the provider. They were confident that their complaint would be taken seriously and acted on. We looked at a complaint that had been received by the service and how they had dealt with it. We found that the responses had been open, thorough, and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

People's care was reviewed regularly and any changes to their care and support needs were identified and the relevant changes to their care and support was implemented.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Our inspection of 16 October 2013 found that suitable arrangements were not in place to ensure the dignity, privacy and independence of people using the service. People were not treated by the service with consideration and respect.

At this time we issued a warning notice to the provider. In response to the notice and other compliance actions the provider agreed to stop taking admissions to the service and had developed an action plan demonstrating how they planned to become compliant with the regulations.

A new manager had been recruited and had been working at the service for a month.

At this inspection we looked at the outcome area where the warning notice was issued.

We spoke with people and also observed the interactions between people and staff.

There were 21 people using the service at the time of our inspection, two people were receiving treatment in hospital.

We observed how people reacted and responded to see if people indicated they were happy, bored, discontented, angry or sad. Everyone we spoke with expressed that they were happy living at Fassaroe House.

We found that people's privacy, dignity and independence were respected. There was engagement and conversation with the people being assisted by staff, especially at mealtimes. When people asked for help they were responded to quickly. People told us that their independence was prompted and they were supported to do as much as possible for themselves. People had choices about what they could do and where they could sit.

At the time of our inspection there were 26 people receiving a service from Fassaroe House.

We found that people’s privacy, dignity and independence was not respected. There was little engagement and conversation with the people being assisted by staff, especially at mealtimes. People were at times ignored when they asked for help. People told us that they had lost their independence. Peoples choices were limited about what they could do and where they could sit.

The service had not taken action to ensure each person's care was safe and met their needs. Care was not consistently planned and delivered in response to people's changing needs. This meant that people may not be receiving the care and support that they needed.

People told us that at times they did not feel safe at the service. They said they were frightened to be in their bedrooms. The service had not taken the appropriate action to report some incidents of abuse. This meant that people could not be sure they would be fully protected from all types of abuse.

There was enough staff on duty to meet support and meet people's needs. However they did not have the competencies and skills to care for people in the way that suited them best.

Staff were receiving guidance from the provider, however not all staff had received the necessary training to undertake their roles effectively and safely. Staff competencies to undertake their roles was not monitored.

We were able to talk with some people but not everyone was able to tell us about their lifestyle and how they preferred to be supported and cared for. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spent some time with people and observed their lifestyle and interactions with the staff and other visitors. We observed how people reacted and responded to see if people indicated they were happy, bored, discontented, angry or sad.

People told us that they had the care and support they needed to remain well and healthy. One person told us that the staff were taking them to a hospital appointment. They said that the staff always went with them if they have to attend any appointments. Everyone we spoke to said positive things about the staff like, “They are kind and patient.” and "They always tell me what is going to happen”. The staff speak to me nicely, nothing is too much trouble for them.”

People said they liked living at the home and they were involved in decisions about their care and support.

People and their relatives told us that they thought that there was enough staff on duty. They told us they did not have to wait long if they wanted anything.

People and visitors told us that they had been asked by the staff if they were happy and had the opportunity to voice their opinions about the care being provided.

We made an unannounced visit to the service and spoke to people who use the service the manager and to staff members.

Not all the people at Fassaroe House were able to talk to us directly to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

Other people were able to talk with us and tell about their experiences at the home.

The people we spoke with gave us positive feedback about the service.

People told us that they were treated with respect by the staff that supported them and that their privacy was maintained.

People said they felt listened to and supported to make decisions about their care. They said that they received the health and personal care they needed and that they were comfortable.

People said that they felt safe at the home and any concerns they had would be listened to and acted on.

They said their views were taken seriously by the staff and they could openly discuss any concerns they had.

We spoke with four members of staff. They were able to tell us about how they made sure everyone got the care and support that they needed and how they kept people safe. Staff explained what they would do if they did have any concerns.