The inspection took place on the 28 March 2017 and was unannounced.

Autumn Lodge - Hove provides personal care and accommodation for up to 36 people. On the day of our inspection there were 36 older people at the service, some who were living with dementia. The service is spread over three floors with a passenger lift, communal lounge/dining room and conservatory leading to the garden.

At the last inspection on 21 November 2014, the service was rated Good. At this inspection we found the service remained Good.

People and relatives told us they felt the service was safe. One person told us, “I feel protected”. A relative said, “Yes, it feels safe”. People remained protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine safely when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. A relative said, “I would say they are well trained. We were here when there was an emergency and they dealt with it very well”.

People remained encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People and relatives also said they felt listened to and any concerns or issues they raised were addressed.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. One person told us, “The food is freshly cooked, I like his cream of potatoes. I always ask for extra portions”.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. One member of staff told us, “There are weekly meetings for staff to talk with the manager. We get supervision, it updates our progress and is very useful”.

The service had a relaxed and homely feel. Everyone we spoke with spoke highly of the caring and respectful attitude of a consistent staff team which we observed throughout the inspection. A relative told us, “[My relative] has done very well and been helped by the staff”.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People, staff and relatives found the management team approachable and professional. A relative said, “[The manager] has been excellent”.

The inspection was carried out on 21 November 2014 and was unannounced. Autumn Lodge provides personal care and accommodation for up to 35 older people in 23 single rooms and five double rooms. There was also an en-suite flat available for couples. At the time of our visit the home was running to maximum occupancy. The home was sensitively converted from three Victorian houses to create the present singe structure. This is the provider/owner’s sole care home. They provide person centred care, specialising in supporting people living with dementia.

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.

We saw there were enough staff to spend time with people and support them in ways that encouraged their independence and made them feel safe.

One person told us, “There are enough staff on duty during the day and at night. I feel safe and happy here. I don’t want to live anywhere else”. A visitor to the home said, “There are always staff around. It’s a lovely environment. I never know where I will find my friend when I visit as there’s always something going on.”

Staff understood how to recognise abuse and to report their concerns. There were policies and procedures in place for managing risk. Risk assessments were centred around the needs of the person to be as independent as possible.

Medicines were stored and administered safely. Staff were trained in the administration of medicines and kept relevant records that were accurate and fit for purpose.

People’s care, treatment and support needs were clearly identified in their plans of care. They included people’s choices and preferences. Staff knew people well and understood their likes and dislikes. They treated people with kindness and respect. People were positive about the staff support and care they received. They said that staff looked after people well and that staff were friendly and helpful.

We heard the low hum of conversation and laughter between people, staff and visitors and saw how meal times were a pleasant dining experience. People were supported to have a balanced and nutritious diet by staff that were patient and sensitive. People required different levels of support with eating their meal and everyone that required assistance received it in a timely and appropriate way.

People and their visitors commented on the way that attention was paid to people’s personal appearance and celebrating milestone events. One visitor told us, “[My relative] always looks nice. It’s been important to her for her whole life and staff recognise that and help her maintain her appearance.” Another person said, “It was [My relative’s] birthday not so long ago and they prepared a homemade birthday cake to celebrate. A small but welcome touch”.

People were able to spend time in quiet areas when they chose to. We saw some people could make their own way out to an outdoor aviary while others were accompanied to observe and interact with the birds and animals. The various smaller lounges provided cosier, quieter areas for people to spend time away from the busier lounge. During our visit, some people chose to remain in their bedroom and staff checked on their wellbeing in a discreet manner.

We heard that the provider was very supportive of new activity based initiatives for all people and was good at resourcing the commitment. The home’s full range of activities were being carried out daily. The manager commented, “It’s very seldom we have a gap during the days when we don’t have an entertainer in.”

Staff had appropriate training and experience to support people. Training was up to date and staff had the opportunity to receive further or refresher training, such as in safeguarding and understanding dementia, specific to the needs of the people they provided care for. We saw how the manager was very visible ‘on the floor’ and had an open door approach to supporting staff.

Staff understood the aims of the home, their roles, were motivated and had confidence in the provider/owner and manager’s leadership of the home. There was good communication between staff and everyone helped each other.

During our visit we spoke with two people who used the service. We also spoke with seven members of staff. These were the registered manager, home manager, care deputy, care assistant, administration assistant, housekeeper and maintenance. We also looked at meeting minutes and surveys to help us understand the views of the people who used the service.

The people we spoke with told us they felt safe living at Autumn Lodge. One person who used the service told us “I like my bedroom and we now have a piano I can play”. Another person told us ”I feel settled and safe, the staff are very caring here”.

Staff we spoke with felt the home always had a family atmosphere and they worked well as a team. One member of staff told us “I am so happy working here and always supported by my manager”. Another member of staff told us ”I love my job, it feels we are one big family and our residents get the best care”.

We looked at six care plans, five staff records and observed levels of staff throughout the day. We saw the service had enough experienced and skilled staff to meet people’s needs.

As part of our inspection we spoke with the visitors of four people who lived at the home, the registered provider, the management team, a deputy manager, a senior care worker and two care workers. We also looked at the care records for five people who lived in the home and observed care workers supporting people.

Care workers were aware of their responsibilities in relation to obtaining consent from the people who were living in the home when delivering care. Care records seen documented whether or not people living in the home had the capacity to give consent to care.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. It was clear that people's assessed needs had been met. The relatives of the people who lived in the home, spoke very highly of the care workers and the quality of the support they had provided.

One relative told us “I am extremely happy. This place is very welcoming".

Another relative told us. “I have no concerns”.

People were protected from the risks of inadequate nutrition and dehydration. The food provided was well presented and seen to be of a good quality.

Appropriate arrangements were in place in relation to obtaining, storing, administering handling and recording medicines.

There were effective recruitment and selection processes in place.

Staff records and other records relevant to the management of the services were accurate and fit for purpose.

People and their visitors told us that they enjoyed living at the home and that staff were patient, caring and kind. They told us they were never rushed and that there was enough staff on duty to support them when needed.

People told us the food was good and that they could choose and alternative if they did not want the food on offer at meal times. People and their relatives and visitors told us they enjoyed the entertainment and activities on offer at the home.

We spoke with three people’s visitors who spoke highly of the home. They told us that visitors are always welcomed and that their relatives were happy and well cared for.

Staff members we spoke to told us that they were happy working in the home, that the team worked well together and that they had received the training and support they needed to meet individual’s care needs.