What life is like for people using this service:

The registered manager had completed audits on the home to support quality checks, however for some areas, these had not identified where improvements needed to be made. This was in respect to medicines management, some risks and some areas of the home to maintain hygiene standards.

Medicines were not always managed safely. The stock was not correct to reflect some people’s prescribed needs and the storage conditions had not been recognised as being incorrect to keep medicines at the correct temperature. There was sufficient staff to support people, however some people were not always monitored in line with their risk assessments to ensure their safety.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in their care plans. The care plans were being developed to provide more information about people and their care needs.

People enjoyed the atmosphere of the home. The registered manager had a visual presence and staff felt supported by them and the provider. Staff had received training to support their role and received supervision to continue this support.

People had good health care support from professionals. When people were unwell, staff had raised the concern and taken action with health professionals to address their health care needs.

Staff followed guidance provided to manage people's nutrition and pressure care.

Staff were aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care. People felt well cared for by staff who treated them with respect and dignity.

There was a range of activities on offer and staff encouraged people to participate in things of interest to the individual. The registered manager was looking how they could develop this area further.

The environment had been considered to support people living with dementia. There was signage to support people to orientate the building and encourage their independence.

The registered manager worked in partnership with health and care professionals and the local community. They had displayed the latest rating at the home and on the website. When required notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

More information is in the detailed findings below.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance and the environment. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: Good (report published July 2016)

About the service: Claydon Lodge is a care home that provides personal care for up to 45 people, some of whom are living with dementia. At the time of the inspection 34 people lived at the service. Most people lived there permanently, and some people spent short periods there to provide respite to their main carers. The home was established over two floors with a range of communal areas on each floor. These included dining spaces, an activities room and smaller lounge spaces.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found that improvements had been made to the environment and people’s health care needs. However, we also identified some areas which required Improvement.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection was unannounced and took place on 25 February 2016.

Claydon Lodge provides accommodation and personal care for up to 45 older adults, including people who may be living with dementia. At the time of our visit, there were 36 people living in the home. There was a registered manager at this service. 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.

At our last inspection in August 2014, people were not always protected from receiving unsafe care. This was because there were not always sufficient staff and the home was not always kept clean and hygienic. Following that inspection, the provider told us what action they were going to take. At this inspection we found that the required improvements had been made to ensure sufficient staffing and they had mostly been made to establish safe systems of cleanliness and hygiene at the service. Further minor improvements required were assured by the manager through their revised management checks and related action plan for this. This showed that equipment and systems improvements help to protect people from any risk of infection through cross contamination.

People felt safe in the home and they were protected from the risk of harm and abuse. The provider’s arrangements for staff recruitment and deployment at the service helped to ensure people’s safety in care.

Robust needs assessment and care planning approaches helped to mitigate risks to people’s safety associated with their health conditions, equipment used for their care and their medicines.

Staff were trained and supported to understand and deliver their role and responsibilities for people’s care. People received effective care from staff who monitored their care and nutritional needs associated with their health conditions.

People were supported to access external health professionals when they needed to and staff followed health professionals’ instructions for people’s care when required. Shared health plans helped to promote a consistent and co-ordinated approach to people’s care and their related wishes and choices when they moved between services.

Staff followed the Mental Capacity Act 2005 (MCA). People’s consent or appropriate authorisation was obtained for their care when required, which helped to ensure their rights and best interests.

Staff were kind and caring and understood the importance of ensuring people’s rights and choices in care. People were treated with respect by staff who promoted their dignity, privacy, choice and independence. People and their relatives were appropriately involved and informed in the care provided.

Staff understood peoples’ communicate needs but did not always supported people to participate in home life or engage in activities in a way that was personalised and meaningful to them. Staff were usually visible and they often responded promptly when people needed assistance, although this was not consistently achieved.

Relevant adaptations and adjustments were not consistently considered in relation to people’s diverse needs associated with their dementia and sensory care requirements.

People and relatives were confident to raise concerns about their care or make any complaints but the provider’s complaints procedure did not fully inform them how to do this. Complaints received by the registered manager were investigated, handled appropriately and used to inform care and service improvements.

The service was well managed and people using the service, relatives and visiting professionals were confident of this. The provider kept us informed and took appropriate action for any important events that happened at the service.

The quality and safety of people’s care, was regularly

Claydon Lodge Care Home is a care home for up to 45 older people. Some of the people who live there have dementia. There were 32 people using the service on the day of our visit. We spoke with four people who used the service, four staff, six relatives and two visiting health professionals. We also spoke to the registered manager who was in daily charge of the service and met the provider. During our inspection we wanted to understand people’s experience of the service they were using. We did this by spending time sitting and talking with people, observing the way staff responded to them, reading care records about their care and speaking with staff about people’s needs.

Our inspection was unannounced and in response to concerns raised. This included concerns about care, meal time arrangements and the management of complaints. We visited the service on 11 August 2014. During our inspection we also checked whether improvements had been made since the time of our last inspection visit on 6 March 2014 during which shortfalls had been identified in relation to how people’s nutritional needs were being met and record keeping.

The evidence we collected helped us to answer five key questions.

Below is a summary of what we found.

Is the service safe?

People who spoke with us confirmed they received their medications as prescribed and no concerns were expressed relating to medications management.

Procedures for dealing with emergencies were in place and staff were able to describe how they would act.

The control and prevention of infection was not managed well as staff did not always follow the provider’s policies and procedures that were in place. We found the sluice area of the home to be in need of cleaning. In this area we also found hand washing and drying facilities for staff to be inadequate to reduce the spread of infection.

We found there were times when staff were not available to support people in a timely manner. The provider used a staffing tool to help them to decide the staffing levels needed for the home, however this did not include the deployment of staff throughout the shift, to include the busiest periods.

We found records were maintained to support people’s care needs. They were stored securely and remained confidential.

Is the service effective?

People told us they enjoyed their meals at the home and the arrangements around meal times suited their preferences. They told us they liked having privacy at meal times with no visitors allowed during this time.

Is the service caring?

One person told us, “Care is okay, I am well looked after here.”

We found people were involved in most decisions about their care and support.

Staff on duty were seen to be kind and caring.

Is the service responsive?

People’s care records included guidance for staff to help and support people in the way they preferred to be assisted.

A visitor confirmed that staff were helpful because when their relative needed medical help or advice staff contacted them and dealt with the situation.

Is the service well led?

People and visitors told us when the visiting times at the home were changed they had not been asked for their agreement. They had not been included in the decision making process.

The registered manager was in daily charge of the service. People at the home were supported by a staff team who knew how to care for them.

At the time of the inspection the home was being managed by a manager who wasn't registered with us. They stated, "I have my application to submit I am just waiting for my police check".

There were 25 people living at Claydon Lodge at the time of our inspection. We spoke with six people using the service and three staff. Some people were not able to tell us of their experiences so we observed interactions and how they were supported by staff throughout the inspection. People we spoke with told us, "They (the staff) have been very kind". Care records reflected the needs of people, they contained information about people's personal, health and welfare needs. Although we noted records were not always accurate, complete or secured safely.

The menus showed that people were afforded a choice of meal at every mealtime, but menus weren't easily accessible to people and we observed they were not informed of the choice options available at the two mealtimes we observed. Food quality was reported to vary, we did not see evidence of people's involvement in making decisions about food choices.

Medication was usually appropriately managed, stored and administered in line with accepted practice. The provider may find it useful to note some improvements in this area would ensure safer practice.

There was a complaints procedure in place. The acting manager was able to demonstrate how any complaint was recorded, investigated and resolved.

At our last inspection in September 2012, we found although people were generally happy with the care they received at Claydon Lodge that their care files were not always adequately detailed and accurate.

We also found that the provider did not operate systems that fully protected people against infection, and was not always obtaining appropriate consent for people's care.

We went to Claydon Lodge on 16 January 2013 to check that the improvements we asked for had been made. People we spoke with were happy with their care and one person said, "The staff are always very nice."

We found that consent was being sought from people for their care, and where people did not have the capacity to consent, appropriate arrangements were in place in for decisions to be made on their behalf.

We also found that improvements had been made to care planning systems at the home and that care files had been reviewed. We saw from their care files that information about people’s needs was now detailed and accurate.

We saw that the home was clean and also that measures had been taken to reduce the risk to people from infection.

People we spoke with were generally content with the service. One family member told us, "I think people are safe here".

We found that training and supervision was largely satisfactory to enable staff to meet people’s needs at Claydon Lodge.

There were care planning files in place, though they were not always adequately detailed and accurate. We also found that Claydon Lodge did not operate systems that fully protected people against infection, and was not always obtaining appropriate consent for people's care.

People confirmed they felt safe and secure whilst using the service. One relative told us they had "no qualms" about the service and said staff were "really good".

People told us they were pleased with the service they received and relatives also told us they were satisfied with the way their relative was cared for. One relative described the staff as “brilliant” and told us the care was “spot on” and another said staff were “very caring”.

People told us they enjoyed the food and one person said they received "what they like" for meals.

Everyone we spoke with was satisfied with the standards of the care service. People told us that they 'liked the place', that it was 'very very good' and that staff were 'likeable' and 'helpful'. One person said ' I feel safe' and another that 'it's good here'. A relative told us that staff were 'very nice' and that they 'do try'.

People enjoyed their food. One person said the food was 'lovely' and another that they were 'fine'. One person said they wanted more activities and said they were 'bored stiff'.

A visitng professionals told us that they had 'no concerns' about the care. They told us that the service responded well to professional advice and guidance.

People told us the premises were odour free and tidy and that they were 'clean' .

People liked using the service and told us that they received the help they needed, even though there was sometimes a shortage of staff. People told us that staff were “very good” and “they look after us very well”.