Vale Lodge is registered to provide accommodation for up to 20 people, some of whom are living with dementia and mental health needs and who require support with their personal care needs. On the day of the inspection 19 people were living at the service, one person was in hospital. Vale Lodge is a large property with accommodation over two floors. There is a communal lounge, a communal dining room and garden.

We carried out the previous comprehensive inspection on 22 November 2015, the overall rating was Good. At this inspection we found some areas of concern including: safe recruitment practices, the understanding of the MCA Code of Practice, the recording in care plans and ensuring quality assurance processes in all areas were robust to ensure high quality of care.

Risks associated with people’s care and living environment were effectively managed to ensure people’s freedom was promoted because staff knew people well and communication within the team was good. However, support plans required further detail regarding action staff should take if risks were identified for example weight loss.

People received care from staff who had undertaken training to be able to meet their unique needs. However, people’s human rights were not always protected because the code of practice in relation to the Mental Capacity Act 2005 (MCA) had not been followed.

The registered manager and provider wanted to ensure the right staff were employed, however, although external staff had recruitment checks to ensure they were safe to work with people, one family member had not.

The registered manager and provider were supported by a dedicated team. However, the governance processes in place had not identified the areas for improvement we found at the inspection. The management structure had not been able to sustain high quality in all areas.

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.

People and their relatives told us staff were very caring and kind. Staff demonstrated kindness and compassion for people through their conversations and interactions. Staff knew people well. People and relatives confirmed their privacy and dignity was promoted and they were actively involved in making choices and decisions about how they wanted to live their lives. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People and their relatives were welcome at the service and encouraged to be part of the care planning process and to attend or contribute to care reviews where possible. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans gave some personalised information but staff knew how people liked their care delivered, their favourite pastimes and their preferences.

There was a complaints policy, and incidents were learned from to ensure improvement. The registered manager and provider promoted the ethos of honesty and admitted when things had gone wrong.

People were supported by consistent staff to help meet their needs in the way they preferred. People’s independence was encouraged and staff helped people feel valued by engaging them in everyday tasks where they were able, for example laying the table and feeding the garden birds if they wished to. People enjoyed a variety of activities and trips to local areas.

People’s medicines were managed safely by trained and competent staff.

People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. People were supported to access

The inspection took place on the 22 November 2015 and was unannounced.

Vale Lodge is a residential care home and provides care and accommodation for up to 20 older people, some whom are living with dementia or have mental health needs. On the day of the inspection 19 people were using the service.

The service had 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.

During the inspection people and staff were calm and relaxed; the environment was clean and clutter free. There was a happy, peaceful atmosphere. Comments from people, relatives and health professionals were exceptionally positive.

People moved freely around the spacious home and enjoyed living in the home. Everyone we spoke with commented “people come first” and staff told us repeatedly “we’re here for them.”

Care records were personalised, of very high quality and focused on people’s needs and wishes and encouraged people to maintain their independence. Staff responded quickly to changes in people’s needs. People and those who mattered to them were involved in identifying their needs and how they would like to be supported. People’s preferences were sought and respected. Staff knew the intimate details of how people wanted to be cared for. People’s life histories, disabilities and abilities were taken into account, communicated and recorded, so staff provided consistent personalised care, treatment and support.

People told us they felt comfortable, safe and secure. People who were able to share their views told us they felt the home was safe

We saw staff were visible in the communal areas and responded instantly when people required assistance. Equipment to maintain people’s safety was visible, close to them and well maintained. Grab rails and call bells were used to support people’s safety and independence.

Staff were thoughtful and compassionate to people. People, relatives and professionals were exceptionally positive about the quality of care and support people received. Reviews from people, relatives and health care professionals were outstanding. Supportive, kind and respectful relationships had been built between people, family members, professionals and staff. Staff took pride in their roles and the small extra things they did made people feel special and showed they cared.

There was an open, transparent culture where learning and reflection was encouraged. The manager was organised and the service was well-run. People’s risks were monitored and managed well. Accidents and safeguarding concerns were managed promptly. There were effective quality assurance systems in place in all areas. Incidents related to people’s behaviour or well-being was appropriately recorded and analysed. Audits were conducted in all areas, action points noted and areas improved where needed. Staff received good supervision, annual appraisals and training. Research was used to promote best practice in dementia and end of life care.

People were encouraged to live active lives and were supported to participate in community life where possible. Activities and outings were meaningful and reflected people’s interests and individual hobbies. Photograph albums and noticeboards held memories of days out and parties. People enjoyed activities within the home such as visits from musicians and external outings to Dartmoor, the seaside and local places of interest.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for where possible. People were supported to maintain good health through regular visits with healthcare professionals, such as district nurses, GPs and mental health professionals. The home had an excellent reputation with health professionals for caring for people very well. A doctor had commented it would be the home they chose for their parents.

People, friends, relatives and staff were encouraged to be involved in meetings held at the home and helped drive continuous improvements. Feedback we reviewed was excellent from families and health professionals. There were no complaints but a policy was in place which ensured if there were complaints they would be investigated and responded to promptly. Listening to feedback helped ensure positive progress was made in the delivery of care and support provided by the home.

People and those who mattered to them told us the management team and staff were “lovely”, always listened and were approachable. People told us they did not have any current concerns but felt confident any feedback given to staff would be dealt with promptly and satisfactorily. Staff told us they also felt listened too, respected and cared for. Staff talked positively about their jobs, understood their roles and felt valued.

Staff understood their role with regards to ensuring people’s human rights and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff. All staff had undertaken training on safeguarding adults from abuse; they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

Staff received a comprehensive induction programme and the Care Certificate had been implemented within the home. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. Training was used to enhance staff skills and the care people received.

People’s end of life wishes were known and specific details sought and recorded about how people wished to be cared for in their final days. A “tree of life” held people’s special wishes for their last days. Staff were undertaking the local hospice end of life care programme and acted as “champions” in this area. Good working relationships with health professional’s ensured people’s last days were dignified.

We (the Care Quality Commission) carried out this inspection following information of concern being raised about the service.

We talked with seven people who lived at the home. They all told us that they were happy with the service provided. They told us “The staff are very good to me, they are very kind and always speak nicely to me” and “When I am not well they really look after me”. They told us there was sufficient activity to keep them busy and that they enjoyed the trips out each week.

We looked at the care provided and records relating to five people. Records relating to people’s care were detailed and personal to each person. The details included risk assessments and care plans and provided information for staff to meet people’s individual needs. We observed that people were settled, comfortable and appeared happy.

People told us that they felt safe. Staff were trained to recognise signs of abuse and knew what actions to take to keep people safe.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with three staff who told us there were enough staff on duty each day and that they had sufficient training in all areas to help them do their jobs well.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

There was also an effective system to regularly assess and monitor the quality of service that people receive.

We (The Care Quality Commission) conducted an unannounced visit to Vale Lodge Care Home on 19 July 2012 as part of a programme of scheduled inspections.

We met 14 people who use services, a relative; we spoke to two health care professionals, talked with the 4 staff and checked the provider’s records.

We looked at the care records of four people who use services. We met them, looked at records and asked staff about their care. The provider and newly appointed manager also provided information.

One person told us, “It’s all very good here”. We talked with most of the people who lived in the home but some people were not able to communicate verbally to us in a meaningful way.

We saw people’s privacy and dignity being respected and staff were being helpful. Comments from people who lived in the care home included,”Staff are good to us” and, ‘they feed you up well!”. “There is a choice of meals”.

One person told us, “We go on lots of trips in the mini bus”. People told us that if they had any concerns that they would speak to staff or the management and felt confident that appropriate action would be taken.

We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. We looked in detail at the care four people received. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them.

We saw that the staff had a good understanding of people’s individual needs and that they were kind and respectful. They took time to work at people’s own pace. Staff members are to be commenced on learning a second language to assist someone in the home whose first language is not English.

We observed people being supported to make decisions about their lives and be as independent as possible. We saw that people’s care records described their needs and how those needs were to be met. Several staff told us how any information about new admissions to the home would be communicated to them. One new admission to the home during our visit was made very welcome and staff provided excellent support and reassurance to this person showing they already had a detailed knowledge of their needs before admission.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home. We spoke with four staff members working during our visit. One newly employed staff member said, “It’s like a large family here”.