Avery Lodge is registered to provide accommodation and personal care for 67 people. It can accommodate older people, people who live with dementia and people who have a physical disability. The accommodation is provided on three floors. The ground floor is called Balmoral Suite where five older people can live. The first floor is called Kensington Suite where 31 people can live. The second floor is called Sandringham Suite where 31 people who live with dementia can be accommodated. At the time of our inspection visit there were 64 people living in the service. Nearly all of them were older people most of whom lived with dementia.

The service was run by a company that was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 19 January 2015 the service was rated Good.

At this inspection we found the service remained Good.

This inspection was unannounced and was carried out on 3 May 2017.

Care staff knew how to keep people safe from the risk of abuse. Although people had been helped to avoid preventable accidents some parts of Sandringham Suite had not been well cleaned and did not have a fresh atmosphere. Medicines were safely managed and there were enough staff on duty. Background checks had been completed before new care staff had been appointed.

Care staff knew how to support people in the right way. People enjoyed their meals and had been helped to eat and drink enough. They had also been supported to obtain all of the healthcare assistance they needed.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People were treated with compassion and respect. Care staff recognised people’s right to privacy and promoted their dignity. Confidential information was kept private.

People had been given all of the care they needed and they had been supported in innovative ways to pursue their hobbies and interests. There was a system for quickly and fairly resolving complaints.

People had been consulted about the development of their home. Quality checks had been completed to ensure that people received safe care. Care staff were supported to speak out if they had any concerns and good team work was promoted. People had benefited from care staff acting upon good practice guidance.

Further information is in the detailed findings below.

Avery Lodge provides accommodation for up to 67 people who need personal care. The service provides care for older people. Some of the people live with dementia and need additional support to be involved in making decisions about the care they receive. The main accommodation is purpose built and divided into three self-contained floors or units. On the ground floor five people live in Balmoral and on the second floor 31 people live in Kensington. The top floor is called Sandringham and is reserved for 31 people who live with dementia. There is a passenger lift to assist people to move between the floors. Although people generally choose to stay on the floor where their bedroom is located, they can and do move between floors. For example, people on Sandringham often attend social functions held in one of the lounges on Balmoral.

There were 65 people living in the service at the time of our inspection.

This was an unannounced inspection carried out on 19 January 2015. There was 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 is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection the registered provider had asked the local authority to review all of the people living on Sandringham. This had been done to determine if they were being deprived of their liberty and so needed to have their rights protected.

We last inspected Avery Lodge in October 2013. At that inspection we found the service was meeting all the essential standards that we assessed.

People were not consistently helped to stay safe. Some of the arrangements to protect people from the risk of infection were not robust. However, staff knew how to recognise and report any concerns so that people were kept safe from harm and abuse. Staff helped people to avoid having accidents. People’s medicines were safely managed. There were enough staff on duty. Background checks had been completed before new staff were appointed.

Staff had been supported to assist people in the right way including people who lived with dementia and who could become distressed. People had been helped to eat and drink enough to stay well. Staff had ensured that people had received all of the healthcare assistance they needed. People’s rights were protected because the Mental Capacity Act 2005 Code of Practice and the Deprivation of Liberty Safeguards were followed when decisions were made on their behalf.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity.

People had received all of the care they needed including people who lived with dementia and who had special communication needs. People and their relatives had been consulted about the care they wanted to be provided. Staff knew the people they were supporting and the choices they had made about their care. People were supported to celebrate diversity by fulfilling their spiritual needs and embracing their cultural identities. People were offered the opportunity to pursue their interests and hobbies. There was a good system for handling and resolving complaints.

People had been consulted about the development of the service. The registered provider and registered manager had completed quality checks to make sure that people reliably received the care they needed in a safe setting. The service was run in an open and inclusive way that encouraged staff to speak out if they had any concerns. The service had developed links with the local community. People had benefited from staff being involved in a national initiative to develop good standards in caring for people who live with dementia.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with seven people who used the service and two relatives and asked them for their views. We also spoke with the cook, three care workers, three senior staff, the senior team leader and the acting manager. We also looked at some of the records held in the service including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found where people were able to they gave consent to their care and support. A person told us, “I feel I more or less decide what I want. I get my breakfast early, which is the way I like it.”

We found people were provided with a varied and nutritional diet. We saw one relative had just been to ask for, and given, a “goodie bag” of snacks as their relation was feeling a little under the weather.

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A person told us, “I have two tablets every morning, they (staff) keep these and give them to me. I have a cream I put on every day, I keep that.”

We found there were sufficient staff to meet people’s needs and the provider maintained records that were accurate and fit for purpose. A person who used the service told us, “There is always someone (staff member) around. If they can’t see to you straight away they will come back to you.”

People we spoke with said they felt they were helped to maintain their independence and had their privacy and dignity respected. One person said, “I think I keep my independence.” Someone else said, “Everyone tries to help each other.”

People said they had their care discussed with them and we saw that people or their relatives had signed care plans to show they were in agreement with them. One person told us their care was planned with them. They said, “There are care plans. I have seen them.”

One person told us there were two activity coordinators (known as the “pink ladies”) who were “determined to get you to do something!” and added “ I do some of the activities.” Another person told us, “Everything you want is here, nothing seems to be spared.”

We asked people if they felt safe in the home and they said they did. One person told us, “I feel quite safe, there is no unpleasantness or anything.” Another person said, “I feel doubly safe.”

People told us they thought the staff were all very good at their job and they were very patient. One person told us, “The staff are brilliant, they are kind and patient.” Another person said, “Nothing fazes them. Their patience never alters.”

People told us they were listened to and had a say in the running of the home. One person said, “We can express our views. There are monthly area meetings.” Another person told us, “You hear such stories about these places, this place is tops.”

People said that they were happy with the care and support they received and felt the home was a nice place to live. One person told us, “What more could they do for me, I am definitely very happy here.”

People who use the service we spoke with told us they feel safe in the home. One person said, “Everyone is so kind to me.”

People who use the service said they felt able to comment on things and we saw examples where people’s views had been acted upon. These included the presentation of food, purchasing additional equipment and improvements to the laundry service.