About the service:

Carlisle Lodge is a care home that provides nursing and personal care for people over 65 and accommodates up to 19 people in an adapted building. At the time of the inspection there were 14 people accommodated who had a range of complex health care needs and some people were also living with a dementia.

People’s experience of using this service:

The service met characteristics of ‘Good’ in most areas.

•Since the previous inspection, significant improvements had been implemented to ensure the requirements of the Mental Capacity Act 2005 were being met. Quality systems had been improved to effectively monitor these requirements along with health and safety matters in the service. However, we found further improvements to the quality systems were needed to ensure suitable training programmes and records were maintained in relation to all staff training.

•The outcomes for people living at Carlisle Lodge were personalised care provided by caring and supportive staff. People lived in a safe, comfortable and homely care home. One person said, “They look after me and it’s warm and comfortable, I feel very safe here.” The emphasis was on a relaxed but a professional environment.

•Staff knew how to keep people safe. They responded to any risks and took measures to reduce these. Staff had a good understanding of how to identify and respond to any suspicion or allegation of abuse. Medicines were handled safely with people receiving their prescribed medicines in a timely fashion.

•Staff knew people really well. They had a good understanding of each person's needs and choices. People’s individuality was embraced with people’s past life’s and beliefs being recognised. Any restriction to people’s liberty were made in the least restrictive way possible to ensure people’s safety. These had been considered in line with the MCA 2005.

•The food provided was individually tailored to people’s needs and preferences. There was a strong emphasis on providing what people wanted and enjoyed. One person said, “The food is very good. We have an excellent cook and she makes the effort to find out what people like, she sees me every day. At first, I found the meals were too much for me, so they have been made smaller. I only have to ask for anything. They come around with drinks but I can ask for different drinks at any time.”

•Staff had a good relationship with people and interaction was positive and friendly. Activities and entertainment were person centred and ensured each person had the opportunity for social interaction.

•Staff worked closely with health and social care professionals to secure the best outcomes for people’s health and well-being. Visiting professionals told us staff responded to their input in a positive way and worked with them for people’s benefit.

•The registered manager supported staff development and learning. New ways of working were explored and appropriate training was given to ensure staff had the appropriate skills to look after people.

•The registered manager led by example in providing person centred care. She interacted positively with everyone at the service and ensured that relative and visitors felt welcomed and included. Staff felt appreciated and well supported. Complaints were recorded and responded to in an open and transparent way and there was a culture of learning from accidents, incidents and any feedback received.

Rating at last inspection: Requires Improvement (report published 8 March 2018).

Why we inspected: We previously inspected Carlisle Lodge in February 2018. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements. They provided us with an action plan. We inspected to follow up on the actions taken by the provider. At this inspection we found the provider was now meeting these legal requirements.

Follow up: We will continue to monitor intelligence we recei

We inspected Carlisle Lodge on 15 February 2018 and our visit was unannounced. Carlisle Lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Carlisle Lodge provides nursing and personal care and accommodates up to 19 people in one adapted building. At the time of the inspection there were 15 people living at the service. People were living with a range of complex health care needs and some people had a degree of memory loss associated with their age and physical health conditions. Most people required help and support from two members of staff in relation to their mobility and personal care needs. Accommodation was provided over four floors with a passenger lift that provided level access to all parts of the service.

There was a registered manager at the home. 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 registered manager was also the provider of the service.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLs) which applies to care homes. Robust systems were not in place to identify if people were unlawfully deprived of their liberty. Improvements were also needed to ensure the service was also consistently meeting the requirements of the Mental Capacity Act 2005. The system to ensure registered nurses held registration with the Nursing and Midwifery Council was not robust. Quality assurance systems were in place but these had not identified some areas that needed to be improved. We made a recommendation about this.

There was a calm and relaxed atmosphere in the service throughout the day of the inspection visit. We observed people had an excellent relationship with staff and staff interacted with people in a caring and respectful manner. The visions and values of the service were embedded into practice and both staff and people described the key strength of the service as its homely atmosphere.

Staff knew people really well. They had a good understanding of each person's needs and choices. They could tell us about people's personal histories including their spiritual and cultural wishes. Each person was treated as an individual and their choices were respected and upheld. Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People spoke highly of the food provided and the registered manager recognised the importance of meals as a highlight of people’s days. Health care was accessible for people and appointments were made for regular check-ups as needed.

There were enough staff available to ensure people received continuous, attentive and discreet care and support. Staff had time they needed to respond to people's choices as well as meeting their care and support needs in a way that suited the person. Staff had received the training they needed to support people and deliver care in a way that responded to people's changing needs.

There was an open and friendly culture at the service. The registered manager was well thought of by people, relatives and staff. She worked hard to include people and staff in decisions about the service, and was committed to improving and developing the service. Recruitment checks were carried out to ensure suitable staff were employed to work at the service. Staff were supported by a system of induction,