Carmel Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is located on the outskirts of Poynton, near Macclesfield, in Cheshire. The home has accommodation for up to 36 people. All bedrooms have ensuite toilets. There are also two lounges, two dining rooms and a conservatory leading into an enclosed garden available for residents and visitors. The home is situated within a short walking distance of the shops and local amenities. It provides residential and respite services for people with dementia.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good. The service met all the relevant fundamental standards.

People and their relatives we spoke with were all positive about the care they received and approach of the staff within the home.

There were systems and processes in place to ensure that people who lived in the home were safeguarded from abuse and staff were aware of how to report any concerns. Risks to people were effectively recorded and subject to regular reviews and there were clear instructions for staff to try to minimise risks to people without unnecessary restrictions. Staff were safely recruited and deployed in sufficient numbers to meet the needs of the people living in the home. Medicines were managed and administered safely.

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. Staff were trained and supported to give them the skills and knowledge to meet the needs of the people and assist them to maintain good standards of health and nutrition. People had access to other health professionals and staff maintained good relationships with other health professionals.

We observed that staff knew people well and respected their dignity. Staff promoted independence as far as possible and everyone spoke positively about the staff and manager.

People’s care plans were person centred and contained details about the person, their history, preferences and how they wanted to be supported. These were regularly reviewed and contained any necessary advice from other professionals. There was a complaints procedure in place and people were clear who to speak to if they wanted to raise any issues.

People, their relatives and staff spoke positively about the management of the home and the approachability and responsiveness of the manager. The service had a clear vision to provide person centred care. Quality assurance systems were robust and considered a wide range of service provision. We saw where issues were identified they were subject to an action plan and issues were resolved in a timely manner.

Further information is in the detailed findings below.

This inspection took place on 5 December 2015 and was unannounced. Carmel Lodge Care Home is located on the outskirts of Poynton, near Macclesfield, in Cheshire. It provides personal care and accommodation and respite care for older people with dementia. The service is owned by Maria Mallaband Limited. The home is purpose built and has 36 bedrooms. At the time of our visit there were 33 people living at the home. All bedrooms have ensuite toilets. There are also three lounges, two dining rooms and a conservatory leading into an enclosed garden accessible to residents and visitors. The home is situated close to local amenities. There is a large accessible car park provided for visitors.

The home had 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 and associated regulations about how the service is run.

People living at the home, relatives and staff were very positive about Carmel Lodge, especially about the activities on offer and the management of the service.

We observed how staff spoke and interacted with people and found that people were supported with dignity and respect.

We found the staff had a good understanding of supporting people when they lacked capacity, including the requirements of the Deprivation of Liberty Safeguards. Staff took appropriate actions to fully support people who lacked capacity to make decisions for themselves.

We found care plans to be detailed and focused on the individual. They contained guidance to enable staff to know how to support each person’s needs and requests. Staff had a good understanding and knowledge of each person’s preferences and individual care needs.

We noted the service had a complaints procedure and people were confident that they could express their opinions and discuss any issues with senior staff.

The service operated safe recruitment of staff and ensured that staff employed were suitable to work with people living at Carmel Lodge. Appropriate pre-employment checks were carried out and application forms were robust to enable the management of the home to have adequate information before employing staff.

Staff received regular supervision and training to assist them in their job roles and in their personal development. The provider offered training to all staff to ensure they fully understood people’s needs, including the needs of those people living at Carmel Lodge who had been diagnosed with dementia.

Various audits at the home were carried out on a regular basis by the manager, regional manager and the provider’s own quality assurance personnel to help ensure that appropriate standards were maintained throughout the home.

We visited Carmel Lodge Care Home because at our last inspection we had concerns about the arrangements for those people who used the service and who did not have mental capacity. During this inspection we looked at care records and talked to staff. We spent time in different parts of the home and talked to some of the people who were living there. We found that Carmel Lodge Care Home had implemented the action plan they had provided to us in order to address our concerns following our last inspection.

When we visited Carmel Lodge Care Home we talked to six of the people who use the service. We also spoke to two relatives of people who use the service to find out their impressions and experiences of the care provided. We spoke to six members of staff who came from direct care as well as other settings. We also spoke to the manager and deputy manager.

We looked around the home and the gardens and spent time sitting with people in their lounges. We visited some people in their bedrooms. We also looked at care and other records.

We found that staff understood people’s right to make choices about the care that they received and that they treated people with respect and dignity. Staff related positively to people and provided personalised care wherever possible. We found that the provider operated effective recruitment procedures to ensure that staff were suitable to work in the home and that there was a complaints system in place.

During our inspection we found that staff had a good understanding of safeguarding and whistleblowing arrangements which are procedures which help to keep people safe. We were told that some of the people living in Carmel Lodge no longer had the capacity to make decisions for themselves but when we could not find evidence that the appropriate assessments had been undertaken to protect these people.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an “expert by experience” (people who have experience of using services and who can provide that perspective) and a practising professional. There were 35 people living at the home at the time of our visit. We spoke with four of these people and one family member visiting their relative. We also spoke to; the home manager, the deputy manager, one senior carer, three carers, the housekeeper, laundry staff and the chef on duty. Limited information was obtained from some of the people using the service due to their dementia care needs or communication difficulties. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Care staff, activity co-ordinators, catering and housekeeping staff were observed engaging with people in a respectful and courteous manner. People were comfortable in the presence of staff and interactions were friendly. There was a relaxed atmosphere throughout the day of our visit.

We saw people’s dignity was upheld at all times. For example, people were well dressed with tidy hair. We also observed people enjoying a good level of independence in terms of eating, drinking and moving around the home. Staff were observant and intervened if a person was struggling with eating their meal or if they needed help with moving around.

During our visit we spoke with four people who lived in the home. There were happy with the way they were treated. Comments they made included; “The staff are very good and they look after me well”, “I can’t complain about anything, “Everything is just right”, and “I’m happy here and my family are happy that I’m here.” All four said they could do what they wanted during the day and they could join in activities if they wanted. For example one person told us; “I can do what I like, really. That’s good, isn’t it?”

We observed people having their lunch and saw the food looked appetising, was well presented, hot and served with care. People had a choice and those who were not eating were offered a number of alternatives. A choice of hot and cold drinks was offered mid morning with lunch and mid afternoon.

Staff were observed supporting people with food and drink during lunchtime and during the day. The meal time was unrushed so that people could finish their meals. Staff would offer help if a person was not eating. In the downstairs dining room staff took turns to sit at the dining tables with people and eat the same meal with them. This facilitated close supervision to ensure all people ate and drank well and also enhanced their social experience.

The people we spoke to were happy with their food and drink and how their nutritional needs were met. Comments they made included; “You can’t fault them with drinks. They just keep coming.”, “I get all the food I want. It’s good food and it’s all fresh”, and “Sometimes I have a snack at night so I don’t get hungry. You can have a sandwich if you’re hungry.”

The four people we spoke to said there were always staff to meet their needs at any time of day or night. For example, one person said; “They’ve always got time for you.” Another said; “Some people need a lot of help so they’re always on the go.” All four felt that the staff were good at their jobs.

During our visit to the home we spoke with four people who live there. They told us told us they are happy living there, staff look after them well and help them when they need. They also said they are treated with respect and are able to do the things they want to do. For example, one person told us staff are friendly and polite. Another person told us she can get up and go to bed when she wants. They gave examples of the things they did during the day including reading, doing crosswords, going out to the local shops, having visitors, going to the hairdresser, helping in the garden and taking part in activities organised by the home’s activity coordinators. None had any concerns or complaints about their care. They all said they liked and enjoy eating the food provided by the home and they are offered alternatives if they do not like the choices available.

We also spoke with four relatives of people who live at the home. They told us their relatives are looked after well, staff are responsive to meeting their needs and support them in a sensitive and caring way. They said their relative’s choices are respected and staff always keep them informed of what has been happening to their relative between visits. Two relatives said they who were involved in planning how their relative’s needs were met by the home. The other two said they did not want to be involved in care planning but they were happy with how their relatives are being looked after.

They relatives also told us staff are caring, helpful and attentive and there is always enough staff available to meet their relative’s care and welfare needs. One told us how staff have supported their relative to help maintain their independence with aspects of their personal care. Another told us that staff had put on a wonderful party for their relative’s 100th birthday. Another said they had never seen anything that gave them any worries or concerns in relation to their relative’s care or anyone else living at the home.