About the service:

Boulevard Lodge is a small residential care home that provides care for up to 9 people age 65 and over. On the day of inspection there were 7 people using the service.

People’s experience of using this service:

People received care that was person-centred. One person told us, "I don’t have any complaints, if I did I would tell someone. I would recommend this home to other people, so far so good. Staff are kind and speak nicely, they are always polite, they knock on the door before entering. I feel safe here and have no worries."

Systems and processes were in place to keep people safe. Equipment checks were made, and risk assessments were carried out. Medicines were administered safely. Safe staff recruitment processes were followed. Staff received induction, training and supervisions to provide safe care.

People were supported with their nutritional needs and with meal options. Staff respected people’s privacy and encouraged people to be independent. People and staff told us they felt supported and listened to. Staff spoke to the people using the service in a respectful manner. People told us they were happy living at the service.

People were provided with information on how to make a complaint. We saw from the complaints log that past complaints were dealt with appropriately.

The registered manager was approachable. We were told the provider visits the service weekly and is supportive. Audits were in place to monitor the quality of the service.

Rating at last inspection: Good (report published 5 August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained Good overall with Requires Improvement for Effective.

Follow-up: We will continue to monitor the service through the information we receive until we return as part of the inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on 11 and 13 July 2016 and was unannounced.

Boulevard Lodge is registered to provide accommodation and personal care without nursing for up to nine persons who may be living with dementia. There were nine people living in the service at the time of our inspection.

There was a manager in post who was in the process of registering with the Care Quality Commission (CQC) . A registered manager is a person who has registered with the CQC 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’s care and support was provided in a way that ensured their safety and welfare. Staff knew how to protect people from the risk of harm. They had been trained and had access to guidance and information to support them with the process. Risks to people’s health and safety had been assessed and the service had care plans and risk assessments in place to ensure people were cared for safely. People needs were met by sufficient numbers of well trained and supported staff who had been safely recruited. People received their medication as prescribed. There were safe systems in place for receiving, administering and disposing of medication and staff had been trained and were competent to administer it.

The manager and staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and had made appropriate applications when needed. People had sufficient amounts to eat and drink to meet their individual needs. Their healthcare needs were monitored and staff sought advice and guidance from healthcare professionals when needed.

Staff knew the people they cared for well and treated them with compassion and kindness. They ensured that people were treated with dignity and respect and that they always had the privacy they needed. People expressed their views and opinions and they participated in the pastimes and hobbies of their choosing. Family and friends could visit people at the time of their choosing and were always made to feel welcome. Where people did not have family and friends to support them to have a voice, they had access to advocacy services. An advocate supports a person to have an independent voice and enables them to express their views when they are unable to do so for themselves.

People’s needs had been fully assessed and their care plans provided staff with the information needed to meet their needs and ensure their safety and well-being. People were confident that their concerns or complaints were listened to and acted upon. There was an effective quality monitoring system in place to assess and monitor the service and to drive improvements.

This inspection took place on 11 May 2015.

Boulevard Lodge provides care and accommodation without nursing for up to nine people who may be living with dementia. The service also provides respite (short term) breaks in addition to permanent stays. There were eight people living in the service on the day of our inspection.

The registered manager left the service in October 2014. A manager was appointed in December 2014 but has not yet applied to be registered. They were being supported in their role by a consultant and the consultant’s representative. 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’s needs had not assessed before they moved into the service. Although the care plans contained some good information to inform staff of how to care for people safely, improvements were needed to ensure that staff fully understood how to meet people’s needs.

Although a quality assurance process had been developed improvements were needed to ensure that systems and processes were consistently implemented to ensure that standards are maintained.

People felt safe and secure and the staff had a good understanding of how to protect them from the risk of abuse. Staff had been trained and had access to guidance and information to support them with the process.

Risks to people’s health and safety had been assessed and the service had made plans for how they were to be managed. This ensured that people were cared for safely.

People received their medication as prescribed. There were safe systems in place for receiving, administering and disposing of medicines.

The manager had a good knowledge of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and they had made applications appropriately when needed. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals.

People were supported to have sufficient amounts of food and drink to meet their needs. There was a system in place to deal with any complaints or concerns.

Staff were kind and caring and treated people respectfully. People participated in a range of activities that met their needs. People were made to feel welcome and were able to receive visitors at a time of their choosing. Staff ensured that people’s privacy and dignity was maintained at all times.

Boulevard Lodge was registered with CQC in December 2012 but was not providing a service until 17 February 2014. On the day of our inspection there were three people living there permanently and five people staying on a respite (short term) basis. We spoke with six of the eight people who used the service and four of their visiting relatives. We also spoke with the manager and two members of the staff team. We looked at four people's care records, four staff files and the complaints and quality checks.

We thought about what we found and asked the questions that we always ask; Is the service safe, effective, caring, responsive and well-led?

This is a summary of what we found:

Is the service safe?

When we arrived at the service we were asked to sign the visitor's book and our identity was checked. This meant that people were protected from unwanted visitors such as others who posed a risk to their safety.

The manager had carried out regular safety checks to ensure that systems, practices and the building itself were safe for people who used the service.

People told us that they felt safe living in Boulevard Lodge. One person said, “It is a really good service, I feel happy and safe here, the staff make sure that my call bell is near me at all times, day and night.” Another person said, “I am very happy and I know how to raise any concerns or complaints and feel that the manager and staff would deal with them properly.”

Staff had received training in safeguarding vulnerable adults from abuse (SOVA), the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant that staff had been given the information that they needed to ensure that people were cared for safely. Health and safety checks had been carried out and issues had been dealt with appropriately. This showed that the service was safe.

Is the service effective?

People told us that they felt that the service met their needs. One person who used the service said, “The staff are always very quick to attend to me when I call for them.” Another person said, “This is a lovely service, I am really comfortable, the food is excellent and staff are friendly and quick to respond to me when I ask for something.”

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. The care records were well written and had been reviewed and updated monthly. This meant that staff had up to date information about how to meet people's needs.

Is the service caring?

Staff’s interaction with people who used the service was good. They spoke with people respectfully and supported them in a kind and caring way. Staff had a good knowledge of people’s likes and dislikes. People told us that all of the staff treated them well. One person said, “The staff are kind and caring, nothing is too much trouble for them, they are there when I need them and are sensitive to my needs.” “One of the carers is a lovely male and he asked if I would prefer a female member of staff to assist me with my personal care. I thought that was really considerate and shows how caring he was.”

People told us that the staff treated them respectfully. People’s preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes. This showed that people were cared for by kind and caring staff.

Is the service responsive?

People told us that they had enough to do. One person said, “I like to watch my television, I like my own space and don’t join in much but I will do so occasionally when I feel like it, staff always offer and encourage me to join in and they support me when I want to.” Another person said, “The staff spend a lot of time discussing things with me, they make sure that I keep up to date with what is going on in the world, we look at the newspaper together.” People told us that staff were quick to respond to their needs.

People were supported to see other professionals such as a general practitioner, community dentist, chiropodist, optician, and district nurse. This showed that people’s general health care needs were met and that the service responded to people’s changing needs.

Is the service well-led?

There was a good quality assurance system in place. People had been asked for their views and opinions on a daily basis. People told us that they received a good quality service. One person said, “I get lovely home cooked food, the staff are all very nice and are kind and friendly towards me.” Another said, “I am very pleased with the service and am very comfortable and happy with my room.” A visiting relative told us, “I visit a lot of homes in my business and I can honestly say that this one is excellent, it is the best service by far. My relative is very happy here and is doing well.”

People who used the service and their relatives told us that the staff and manager asked them for their opinions on the quality of the service. The manager told us that the first formal meeting was scheduled for June 2014. The complaints procedure was clear and it showed clear timescales of when complaints would be responded to. People told us that they knew how to complain. This showed that there was an effective quality assurance system in place and that the service was well-led.