The inspection was carried out on 11 and 12 December 2018. The first day of our inspection was unannounced while the second day was announced.

Sonya Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Sonya Lodge is a service that provides accommodation and personal care for up to 37 older people with dementia. At the time of the inspection, 34 people were living at the service; who were living with a range of health and support needs. These included; diabetes, epilepsy and dementia. The service had very large communal lounges/dining rooms available on the ground floor; with armchairs and TVs for people and a separate, quieter lounge, where people could entertain their visitors.

At the last Care Quality Commission (CQC) inspection on 17 October 2017, the service was rated as Good. At this inspection, we found the service Requires Improvement.

The service has 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.

The provider did not follow safe recruitment practice. New staff started working without a DBS check.

Although effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service, these had not been rigorously followed. Records were not always accurate, complete and consistent.

People were safe at Sonya Lodge. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe.

Medicines were managed safely and people received them as prescribed.

There were appropriate numbers of trained staff to meet people’s needs and keep people safe.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff showed they were caring. They treated people with dignity and respect and ensured people's privacy was maintained particularly when being supported with their personal care needs.

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.

There were activities located around the service for people to engage with independently and each dining room table was set up for people to be engaged in a different activity.

Staff received regular training and supervision to help them meet people's needs effectively.

The registered manager ensured the complaints procedure was made available if people wished to make a complaint. Regular checks and reviews of the service continued to be made to ensure people experienced good quality safe care and support.

The registered manager provided good leadership. They checked staff were focussed on people experiencing good quality care and support.

People and staff were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that people wanted.

We found two breaches of the Health and Social

We carried out this inspection on the 10 and 11 May 2016, it was unannounced.

Sonya Lodge is a service that provides accommodation and personal care for up to 37 older people with dementia. At the time of the inspection, 34 people were living at the service.

The service had a registered manager. 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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

People were protected against the risk of abuse. Relatives told us they felt people were safe. Staff had been trained and recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

Staff were recruited using procedures designed to protect people from unsuitable staff. The registered manager had ensured that they employed enough staff to meet people’s assessed needs. Staff were available throughout the day, and responded quickly to people’s requests for help. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by the registered manager and felt able to raise any concerns they had or to make suggestions to improve the service for people.

Staff were trained to meet people’s needs. They met with management and discussed their work performance at one to one meetings and during annual appraisal, so they were supported to carry out their roles.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Staff contacted other health and social care professionals for support and advice.

Medicines were managed, stored, disposed of and administered safely. People received their medicines when they needed them and as prescribed.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

We observed staff that were friendly and compassionate. Staff delivered care and support calmly and confidently. People were encouraged to get involved in how their care was planned and delivered. Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. People demonstrated that they were happy at the service by smiling and chatting with staff who were supporting them. Staff interacted well with people, and supported them when they needed it.

People were supported to eat and drink enough to maintain their health and wellbeing. People were provided with a diet that met their needs and wishes. Staff ensured people had access to food, snacks and drinks during the day and at night. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served.

Staff encouraged people to undertake activities. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

If people complained they were listened to and the registered manager made changes or suggested solutions that people were happy with. Relatives knew how to raise any concerns and

The inspection was conducted by one inspector over the course of six hours. We spoke with the registered manager, four care workers, the activities coordinator, the cook, four people who lived in the service and six of their relatives. We looked at six sets of records for people who used the service, three personnel files, the service's satisfaction surveys, activities programme and policies and procedures.

When we inspected in February 2014, we found the service was non compliant with regulations about consent and care and welfare. The service has provided us with an action plan within the requested time frame. We carried out this inspection to check that this action plan had been implemented and that the situation had been remedied.

During this inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to residential care homes. We spoke with the manager and they demonstrated their knowledge of the procedures to follow if an application needed to be made to deprive a person of their liberty. We saw evidence that all staff had been trained in DoLS, in the principles of the Mental Capacity Act 2005 (MCA) and in the safeguarding of vulnerable adults. We found that people's mental capacity was assessed and best interest meetings were held according to legal requirements. We found that risk assessments with clear action plans were in place to ensure people remained safe. Measures to manage foreseeable emergencies were in place and the people who lived in the service had personal evacuation plans.

Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. A relative of a person who used the service said, "All the staff are really understanding about how to care for people with dementia". We saw that the delivery of care was in line with people's care plans and assessed needs. Care plans, risk assessments and handovers reflected people’s current needs. Changes in care plans were effectively communicated to staff. Staff‘s mandatory training was up-to-date and they received additional training when requested.

Is the service caring?

We found that the people who stayed in Sonya Lodge residential home were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. Requests for assistance were responded to promptly. We saw that staff showed kindness and patience when they supported people at mealtimes or during activities. A relative of a person who used the service told us, "This is such a caring home, we could not fault the care that is provided". Two people who lived in the service said, “The workers always check that I agree with anything” and “This is my home, I like it here”. A staff member said, “We respect people's decisions, and they can change their mind about anything at all, we ensure that they give consent and we respect any refusal”.

Is the service responsive?

People's needs had been assessed before they moved into the service and their support plans were reviewed regularly to reflect any change in their needs. We saw that people's records included their life history, preferences and wishes for the future. People were able to choose what they preferred to eat. Requests that were made during residents meetings or expressed in satisfaction surveys were followed through and responsive action was taken. Additional training for staff included dementia, mental health awareness, equality and diversity and palliative care. This ensured that staff were knowledgeable about people’s specific needs and were able to respond to them.

Is the service well-led?

The manager operated a system of quality assurance and completed audits to identify how to improve the service. Additionally, an operations manager carried compliance checks and improvement plans. When audits identified the need for an improvement, this was implemented. People and their relatives or representatives and staff were consulted about how the service was run. Annual survey questionnaires were carried out and their results were analysed. A staff member told us, "This is a great place to work in, the manager’s door is always open and they always follow through any concern we have”. The manager ensured advanced training on mental capacity and dementia care was available. The action plan addressing improvements concerning consent, care and welfare had been effectively monitored and implemented.

We found that before people received any care or treatment, they were not asked for their consent and the provider could not show that they had acted in accordance with their wishes.

We found people did not experience care, treatment and support that met their needs and protected their rights.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found the provider had an effective system to regularly assess and monitor the quality of service that people receive.

People we spoke to told us they liked living at the home. Comments included “I am happy here today as the first day I came to live here” and “I love it here”.

People we spoke to also told us they were looked after at the home. Comments included “The staff here are lovely”.

You can see our judgements on the front page of this report.

This inspection was to follow up on the findings from our previous inspection of 28 August 2013 to ensure that appropriate action had been taken by the provider to address our concerns. We asked the provider to send us a report of the changes they would make to comply with the standards they were not meeting.

We found that people who used the service were cared for by suitably qualified staff able to meet their care and support their needs. The provider had taken action by implementing a formal induction training programme for all new staff.

This inspection was to follow up on the findings from our previous inspection of 9 May 2013 to ensure that appropriate action had been taken by the provider to address our concerns.

We asked the provider to send us a report of the changes they would make to comply with the standards they were not meeting.

We found that the provider had taken action to ensure that staff had received appropriate training in safeguarding.

We found that people who used the service were not always cared for by suitably qualified staff able to meet their care and support their needs. The provider was unable to demonstrate that a formal induction process for staff has been implemented.

This inspection was to follow up on the findings from our previous inspection of 13 February 2013 to ensure that appropriate action had been taken by the provider to address our concerns. We asked the provider to send us a report of the changes they would make to comply with the standards they were not meeting.

We found people received care, treatment and support that met their needs and protected their rights.

We found that the provider had taken action in carrying ensuring all staff had received the appropriate training in safeguarding.

We found people who used the service were protected from the risk of abuse, because

the provider had taken reasonable steps to identify the possibility of abuse and prevent

abuse from happening.

The provider demonstrated that people were cared for in a clean, hygienic environment.

The provider was able to demonstrate that staff were provided with on-going training. However, the provider was unable to demonstrate that staff were supported by regular supervisions and yearly appraisals.

We also carried out a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. We looked at the home’s complaints system and found that the provider had an effective complaints system available.

We found that people were treated with respect and dignity.

We found people received care, treatment and support that met their needs and protected their rights.

We found people who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The provider was not able to show and evidence that people were cared for in a clean, hygienic environment.

The provider was not able to demonstrate that staff were provided with on-going support and training and that people who used the service were cared for by suitably qualified staff able to meet their care and support their needs.

We asked the deputy manager for the contact details of peoples relatives but did not receive them by the time of writing this report, so could not include their comments on this occasion.