The inspection took place on 04 October 2016 and was unannounced. This was a comprehensive inspection.

Broadwater Lodge is a residential home providing support to older people, many of whom are living with dementia. The home is registered to provide care for up to 67 people. At the time of our inspection there were 63 people living at the home.

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.

There was an exceptionally inclusive atmosphere in the home. People told us that staff knew them well and they felt involved in how the home was run. We observed excellent examples of good caring interactions between people and staff during our inspection.

Staff treated people with the upmost dignity and there was a respect between people and staff that created a warm and caring environment. People’s privacy was protected by sensitive and compassionate staff.

The home environment was engaging and tailored to people living with dementia. Communal areas were decorated in ways that were meaningful to people and was designed to invoke their memories. The home contained a pub, nail bar, an old fashioned sweet shop and a 1940s kitchen environment that was greatly valued by the people who lived there.

Care plans were very person centred, containing information on how people wanted their needs met along with what was important to them. Staff found innovative ways to meet the needs of people living with dementia who were less able to express what was important to them. People’s records were kept up to date with detailed assessments when people were admitted to the home and regular reviews.

Accidents and incidents were being reported where appropriate. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence. Policies and procedures were in place to keep people safe in the event of emergencies.

There were sufficient staff present to safely meet people’s needs. Staff had undergone checks to ensure that they were of good character to be working with people. Staff had appropriate training and support to meet the needs of people living at the home.

People’s legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). Correct procedures were followed when depriving people of their liberty. Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve outcomes for people.

People’s medicines were stored and administered safely and staff worked alongside healthcare professionals to ensure that people’s health needs were met.

People told us that they enjoyed the food and we saw evidence of people being provided with choice and also being consulted on food during meetings and reviews.

Staff felt very well supported by the registered manager. Systems were in place to ensure care at the home was of a good quality. People’s feedback was regularly sought and complaints were responded to appropriately.

The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, the staff who supported them and from looking at records.

If you wish to see the detailed evidence supporting our summary please read our full report.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Is the service safe?

People were protected from the risk of inappropriate or unsafe care. This was because the provider had effective systems in place to assess, plan, review and monitor the care and support provided to people who used the service. In addition procedures were in place to identify, assess and manage risks to the health, safety and welfare of people and care workers in relation to activities and incidents.

Relatives of people who used the service were confident about people’s safety being maintained by the provider. One relative told us “X wanted to be somewhere safer than at home and they felt safe here." People told us they felt safe in the service. One person said, “I am safe here they look after me and I can do what I want."

Care workers were familiar with and had been trained to understand the service plan called ‘dealing with emergencies’ which included guidance on maintaining the health safety and welfare of people in the event of an emergency. This included evacuation and fire procedures.

Is the service effective?

People’s care needs were assessed with them and their relative or representative when appropriate. We noted that care plans had been regularly reviewed and reflected peoples care, support and health needs and wishes.

All staff had received training to meet the needs of the people who use the service. Examples of training included infection control, the safeguarding of vulnerable adults (SOVA), safe moving and handling, the Mental Capacity Act 2005 and fire safety.

We spoke with seven people and four relatives of people who used the service. They were complimentary about the care they received. One person we spoke with said, “The staff here are lovely, kind and caring." Another person said, "They always help me and there is plenty to do." A relative said, "They look after X really well and they always look well cared for." It was clear from our observations that the registered manager and the care workers had a good understanding of people’s care, health and social needs and were committed to providing quality care.

All of the people who used the service were registered with a G.P practice and we saw that health was included in the care plans. We spoke with a G.P who was visiting and they said, "The care here is very good. The staff know all about people and they respond well and follow our advice." One relative that we spoke with told us, “The care here is very good and they call the doctor when X is unwell." Another relative said, "X has been better since they moved to the home and their health has improved."

Is the service caring?

People were supported by kind and supportive staff. We witnessed numerous interactions between people and staff and without exception support was provided in a caring way that promoted people’s independence and upheld their dignity.

Relatives confirmed the caring approach taken towards them and their relatives. One relative said, “The staff are so kind, they always make me welcome and I can talk to them at any time." Another relative said, "They are lovely and caring, they always keep in touch and tell us about how X is."

In conversation with one care worker they told us, “I love working with the staff and the people here." Another care worker said, "The manager told me, well done for being so happy around the residents."

There were systems in place to ensure people who used the service and their relatives could provide feedback to the provider about the quality of the service they received. People and their relatives were confident that when concerns were raised these had been addressed.

Is the service responsive?

The service had a number of effective formal systems in place to monitor care quality including the care plan review process, the accident and incident recording process and complaints and comments. Activities and the food were also assessed for effectiveness and satisfaction levels. We saw evidence that the service had made changes in response to people's feedback.

Staff meetings were held to discuss care issues and related matters. The provider regularly sought feedback from relatives. The registered manager told us, “We communicate with people’s families regularly and if there are any problems we deal with them straight away. We send out surveys and look at the results as well as any complaints or compliments we receive.”

One relative that we spoke with told us, “Communication with the staff and manager is very good. They let me know about things and they always respond quickly when I contact them with a problem”.

Is the service well-led?

The registered manager demonstrated a thorough knowledge of their role. During our inspection they were accessible to people and care workers and expressed genuine interest in the activities that were undertaken. We observed the registered manager speaking with people kindly and in a way that demonstrated they knew people well. For example using people's interests or family history to engage in conversations that meant something to that person. We also heard the registered manager speaking quietly to relatives and listening to them. There was a pleasant homely feeling at this service and we saw people responding to care workers and others by smiling, joking and interacting.

Quality monitoring procedures were effective and care workers presented as caring and dedicated.

The majority of the people at Broadwater Lodge had dementia and were unable able to tell us about their experiences in a meaningful way. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

People who could express a view told us the staff were ok. One said "Oh yes the staff are good, but they are always so busy." Another person said "I like the staff here, they are lovely. Relatives and friends of people spoken with on the day told us the care provided at the home was good and their relatives were well looked after. People received safe and coordinated care, where more than one provider was involved, or they were moved between services. People were treated respectfully and their views were taken in to account by staff. Staff understood the signs of abuse and were confident about raising their concerns with the appropriate people.

People's health and welfare needs were met by sufficient numbers of appropriate staff. There was a complaints procedure and process in place and people were supported to make a complaint if they wished. People who could express a view told us if they were not happy with their care they would tell someone.

We last inspected this service on the 13 August 2012 and found the provider was not meeting the essential standards of quality and safety for Respecting and Involving people who use services, Cleanliness and infection control and Assessing and monitoring the quality of service provision. The provider sent us their action plan which addressed how and by when they would become compliant with the required standards.

This inspection on the 2 January 2013 was for the purpose of following up on whether the provider had achieved compliance with these essential standards.

The majority of the people at Broadwater Lodge had dementia and were unable able to tell us about their experiences. To help us to understand the experiences of people have we used our SOFI (Short Observational Framework for Inspection) tool.

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences. We spent time on each of the units observing care and found that people had positive experiences.

A number of the people at Broadwater Lodge had dementia and were unable able to tell us about their experiences. To help us to understand the experiences of people have we used our SOFI (Short Observational Framework for Inspection) tool.

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences. We spent a considerable amount of time observing care and found that some people had positive experiences, whilst others did not.

During the course of the inspection we spoke with people who use the service and relatives who were visiting the home.

Those people who could express a view told us that the service was ‘wonderful’ and ‘excellent’ and that the staff ‘look after us well’ whilst others told us that overall they were satisfied with the care provided.

One person told us that due to the number and mix of people it was more difficult to find people with whom to have a conversation.

Representatives told us that staff ‘look after them well’ and that although ‘the building is tired’ there was a ‘feeling of care’ and that staff were ‘kind and considerate’. Overall, representatives told us they had a good level of satisfaction with the service provided.

Some people and their representatives told us "The unpleasant smell is off putting".