The inspection took place on 23 and 24 October 2018 and was unannounced. At our last inspection in November 2015 the service was rated as good overall. One area requiring improvement was in the reporting of incidents, which the provider has since addressed.

As a result of this inspection we have made one requirement. This is where we have identified a statutory breach of regulations. The breach in regulation requires the provider to make sure the service complies with legislation designed to protect people’s rights, in this case the requirements of the Mental Capacity Act 2005.

Valley 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 service provides accommodation and personal care and support to a maximum of 47 older people, including those who are living with dementia, in one adapted building. There were 31 people using the service at the time of our inspection.

The service has 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.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; however, the policies and systems in the service had not always supported this practice and legislation designed to protect people’s rights had not been followed.

There was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences.

There were systems and processes in place to protect people from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns. Risks to people were individually assessed and action taken to minimise the likelihood of harm.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training.

Safe recruitment practices were followed and appropriate checks had been undertaken, which made sure only suitable staff were employed to care for people in the home. There were sufficient numbers of experienced staff to meet people’s needs.

Staff received an induction and on-going training to support them to meet the needs of people using the service.

People received regular and on-going health checks and support to attend appointments. They were supported to eat and drink enough to meet their needs and to make informed choices about what they ate.

The service was responsive to people’s needs and staff listened to what they said. Staff were prompt to raise issues about people’s health and people were referred to health professionals when needed. People could be confident that any concerns or complaints they raised would be dealt with.

The provider and registered manager were promoting an open, empowering and inclusive culture within the service. There were a range of systems in place to assess and monitor the quality and safety of the service.

There were 21 people using the service at the time of this inspection. The manager told us that all had been assessed as having some degree of dementia. We spoke with seven people who use the service, two visitors, four staff, the manager and deputy manager, a hairdresser and a chiropodist. We looked at the care and support records of five people who used the service and observed the care and support provided in communal areas.

We found that the service assessed, planned and delivered care for people with dementia in a considered and responsive way. They cooperated effectively with other providers to ensure that the safety and welfare of people was protected when their health care needs changed or when they moved between different services. The service was well led and continually assessed the quality of the care provided.

We observed that staff promoted an inclusive and supportive environment. A person living in the home told us “The care staff always make time to talk to me. There was something I was worried about; the staff told me they are here to help”. Another person said “The main thing is I feel safe here; they have taken away the worry from me”. A visitor remarked “This is a lovely home and the staff have so much patience and respect for the residents”.

During this inspection we spoke with four people who used the service, with four staff and with the manager. People were happy with the service provided and we saw that staff interacted well with people in their care and talked positively about their work.

People were, as far as they were able to do so, involved in making decisions about their care and support.

People's needs were continually assessed and care was delivered in line with their care plans. There were policies and procedures in place to ensure that the safety and suitability of the premises was maintained, these were understood and followed by staff.

Staff were well supported by management and were provided with appropriate training to help them understand and meet the needs of the people who use the service.

There was an effective system in place to deal appropriately with comments and complaints made by people, or persons acting on their behalf. People living at the home had been given information about procedures to make comments and complaints and staff were trained to listen and act appropriately.

People told us they are happy living at the home. They receive the care and support thy need in a way they prefer because staff listen to their wishes and involve them in care planning processes. They told us there was always sufficient staff available to provide then with the care and support the need. They commented that the home arranges for them to see health care professionals such as General Practitioners (GP’s) and Community Nurses when they need to.

People confirmed that they are able to influence the running of the home in a variety of methods that include formal meetings with staff, general discussions and care plan reviews.

They told us they enjoy the meals provided at the home. There was always sufficient food a drink available to meet their requirements.

People told us the home is always clean and tidy. The home is kept warm at all times and provides a homely environment for them to live in.

People told us that if they have any problems or concerns they can talk to staff about it and the problem will always be resolved. Relatives of people using the service also told us that any concerns raised with the home would be resolved promptly.

This inspection was unannounced and took place on 23 November 2015. It was carried out by two inspectors. A further visit by two inspectors took place on 25 November 2015 to complete the inspection.

The previous inspection took place in February 2014 when we found the service complied with all essential standards of quality and care we reviewed.

Valley Lodge is a care home without nursing which can provide care support and accommodation for up to 30 people. At the time of our visit 24 people were living there, most of whom were living with dementia.

The service had recently extended to provide accommodation for up to 47 people. The owner had applied to CQC to vary their registration in this respect and following our visit this was agreed.

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 said they felt safe and said they received a consistently good standard of care and support. Staff had a good understanding of how to protect people from avoidable harm such as from potential abuse. Some incidents of potential abuse should have been reported to Hampshire County Council under local safeguarding protocols and to CQC, but had not been. Risks to people’s health or wellbeing was assessed and actions were taken to minimise them. Staff recruitment processes were robust and staff were employed in sufficient numbers to meet peoples’ needs. Where staff assisted people with their medicines this was managed consistently and safely.

There was appropriate training and support to ensure staff could effectively meet people’s needs and preferences. People were always asked to give consent to their care and support. Staff ensured they acted in people’s best interest when they lacked capacity to consent to aspects of their care and support, although the assessment of this could at times be made clearer for some specific decisions. People’s health care needs were discussed with them and staff liaised effectively with health care professionals on people’s behalf.

Staff had developed trusting relationships with people who used the service and they cared about their wellbeing. Staff were kind and caring. They responded quickly to people’s distress. Staff communicated effectively using their knowledge about people’s background and interests to engage people’s interest.

The building had recently undergone substantial building works to accommodate an additional 17 people. Whilst this was being completed, everyone’s bedrooms and bathroom facilities, where possible, were also upgraded. Fixtures and fittings installed throughout the building had been carefully considered to assist people to remain as independent as possible.

People’s care needs were assessed and their preferences recorded and understood by staff. People’s plans of care provided staff with further relevant and up to date information to help them to support people appropriately. There were some activities provided, which were flexible to suit people’s wishes and preferences. There was a robust complaints procedure and changes had been made to improve the service as a result of comments made.

The service had a positive culture Managers and senior staff were available for guidance and support. Quality assurance arrangements were robust.