The inspection took place on 21 and 24 August 2018 and was unannounced.

The Warren Residential 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.

The Warren Residential Lodge is registered to provide accommodation for up to 31 people, including people living with dementia care needs. At the time of our inspection, there were 29 people living at the service. The service was arranged over one level, which was divided into different ‘zones’. Five bedrooms had en-suite facilities and there were four communal bathrooms in addition to three toilets. There were two lounges, one dining room and a garden area that people could easily access.

There was a registered manager 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.

The home was last inspected in July 2017 when it was rated as ‘Requires Improvement’ overall with a breach of Regulation 17 of the Health and Social Care Act 2008 relating to Good Governance. At this inspection we found that appropriate actions had been taken and therefore the service was no longer in breach of this regulation.

People felt safe living at The Warren Residential Lodge. Staff knew how to keep people safe and how to identify, prevent and report abuse. They engaged appropriately with the local safeguarding authority.

Individual and environmental risks to people were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

There were appropriate arrangements in place for the safe handling, storage and disposal of medicines.

Recruitment procedures were in place to ensure that suitable staff were employed by the service.

People received care and support from staff who were suitably qualified, skilled and knowledgeable to carry out their roles effectively.

New staff completed a comprehensive induction programme and all staff were suitably supported in their roles.

People praised the standard of care delivered and the quality of the meals. Dietary needs were met and people received appropriate support to eat and drink. People were supported to access healthcare services when needed and to attend hospital appointments.

People were cared for with kindness and compassion. Staff interacted with them in a positive way. They spoke about people warmly and demonstrated a detailed knowledge of them as individuals.

People were cared for with dignity and respect and were treated in a kind and caring way by staff. Staff know people well, encouraged people to remain as independent as possible and involved them in decisions about their care.

Staff protected people's privacy and responded promptly when people's needs or preferences changed. They involved people in the care planning process and kept family members up to date with any changes to their relative's needs.

People received personalised care and support that met their needs. Care plans provided staff with detailed information about how they should support people in an individualised way.

People had the opportunity to access to a range of suitable activities. There was an appropriate complaints procedure in place and people knew how to make a complaint.

People and their families felt the home was run well. The provider was actively involved in running the service and there was a clear management structure in place.

Staff were happy in their work and felt supported by the provider and the manager.

There was an open and transparent culture in the home. Relative

We carried out an unannounced inspection of this home on 28 June 2017. The home is registered to provide accommodation and personal care for up to 31 older people, some of whom live with dementia. Accommodation is arranged on one level and at the time of our inspection 25 people lived at the home.

A registered manager was 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.

Incidents and accidents which occurred in the home were recorded; however, there was no information on investigations completed following these incidents, any learning which came from these incidents or any patterns identified in these incidents. There was no information to show how this was shared with staff to prevent further recurrence in the home.

Whilst audits were completed in the service these were not always used effectively to inform improvements in the home.

People had access to activities although some people felt activities were limited and needed improving. People were supported to maintain their independence through activities outside the home such as attending day centres and independent trips to the local shops and church.

Risks associated with people’s care had been identified, and staff had a good understanding of these risks.

People received their medicines from staff that were appropriately trained and medicines were effectively managed and audited.

People said they felt safe at the home. They were able to talk openly and honestly with staff and were sure any concerns or issues they had would be dealt with effectively. Staff knew people well and felt confident people would speak with them to raise any concerns. The registered provider and staff had a good awareness of how to safeguard people from abuse.

There were sufficient staff to meet the needs of people. There was a very low turnover of staff and the stable staff group worked well together. With appropriate training and supervision processes in place, people were cared for by people who had the right skills and support to meet their needs. Staff recruitment processes were robust and the registered manager sought guidance on the checks needed for staff who had worked in the service for over five years.

Staff at the home had been guided by the principles of the Mental Capacity Act 2005 (MCA) when working with people who lacked capacity to make some decisions. Staff followed legislation designed to protect people’s rights and freedom.

The atmosphere in the home was warm, calm and very friendly. Staff knew people well and demonstrated a high regard for each person as an individual.

People received nutritious and well-presented meals in line with their needs and preferences.

People had access to external health and social care professionals for support and treatment as was required. Staff had good working relationships with other professionals including the local care home team, community nurses, social workers and GPs. Health and social care professionals said staff knew people well and provided safe and effective care for them.

People had their needs assessed on admission to the home. The information gathered informed care plans which were discussed and agreed with people and their families. A new system of care planning was being introduced to improve this documentation and support more frequent reviews of people’s care.

The registered manager promoted an open and honest culture within the home where people were encouraged to voice their opinions and have these addressed.

We found one breach of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.