This inspection took place on 28 and 29 March and was unannounced. There were no concerns at the last inspection of February 2016. Cleeve Lodge provides accommodation and personal care for up to 33 people. At the time of our visit there were 27 people living at the service.

At our last inspection, we rated the service Good. At this inspection, we found evidence continued to support this rating and in addition, we found the service had improved to outstanding in some areas.

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.

We were introduced to people throughout our visits and they welcomed us. People were relaxed, comfortable and confident in their home. The feedback we received from people was extremely positive throughout. Those people who used the service expressed great satisfaction and spoke highly of all staff and services provided. One person wrote to the registered manager recently and said, “You have an amazing team of workers that made a difference to my parent’s quality of life”.

Staff involved in this inspection demonstrated a genuine passion for the roles they performed and their individual responsibilities. Visions and plans for the future were understood and shared across the staff team. They embraced new initiatives with the support of the provider, registered manager and colleagues. They continued to look at the needs of people who used the service and ways to improve these so people felt able to make positive changes.

People experienced a lifestyle that met their individual expectations, capacity and preferences. There was a strong sense of empowering people wherever possible and providing facilities where independence would be encouraged and celebrated. People’s health, well-being and safety were paramount.

The registered manager listened to people and staff to ensure there were enough staff on duty to meet people's needs. They demonstrated their responsibilities in recognising changing circumstances within the service and used a risk based approach to help ensure the staffing levels and skill mix was effective.

Staff had the knowledge and skills they needed to carry out their roles effectively. They enjoyed attending training sessions and sharing what they had learnt with colleagues. There was an emphasis on teamwork and unison amongst the staff at all levels. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice. The ‘residents’ annual surveys consistently reflected how much they enjoyed the quality of food, the variety and the constant access to beverages and snacks through the day.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having capacity, records showed that their advocates or families and healthcare professionals were involved in making decisions.

Staff had an excellent awareness of individuals' needs and treated people in a warm, loving and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and personalised.

Regular monitoring and reviews meant that referrals had been made to appropriate health and social care

We were greeted by staff in a friendly, professional manner. We were assisted by the manager and senior carer during the day. They were helpful and knowledgeable about people in the home, policies, procedures and systems that helped ensure the effective smooth running of the service.

We spoke with people individually during our visit and we observed an arts session in the morning. The artist visited the home weekly and taught people how to paint with watercolours. This gave us the opportunity to get to know about people, the staff and their views.

There was a constant interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company. We were introduced to people throughout the day and they welcomed us to their home. They talked freely with staff in front of us and people were confident and assertive in their surroundings.

People were enjoying time in the lounges, conservatory and spending private time in their rooms. Two people were celebrating birthdays and we saw a cake tier stand with homemade decorated cupcakes that people were going to have with afternoon tea.

We spoke with two relatives who were visiting their relative. They felt that the home had done their "very best" for their relative. They told us “The admission and settling in period was good and they quickly became accustomed to the staff who are all very kind. The care staff are friendly and show affection. Our relative has grown fond of them all”.

People told us what it was like to live at the 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 practising professional.

People were complimentary about the home and the food. One person told us, “It’s a wonderful home, everyone is so kind, I couldn’t be treated better anywhere else” and another said, “Everyone’s so kind, you get what you want…plenty of baths!” People told us that there was always a choice of food available.

During the day we spent at Cleeve Lodge we saw a regular flow of visitors coming and going. Relatives told us,” My aunt has picked up a lot (improved in health) since being here, as she was very low in mood previously”.

We found that there were sufficient qualified and experienced staff available to meet people’s needs. We observed care and support being delivered in a kind and respectful way.

People told us, “There is plenty to do here” and, “Everyone is friendly”, “The staff are marvellous, anything you ask for you get”.

Records of people’s needs were up to date and accurate. These records contained information about people’s preferences, care, nutritional and health needs.

We spoke with 10 people who use the service, five members of staff and one visiting professional. People we spoke with told us a number of positive comments about the service and we saw lots of cards and letters complimenting the staff on their care. Examples of comments made included, “we cannot thank you enough for the love and care you have shown”; “The staff certainly do chat to me and they are very respectful and kind.” “You can go to any of them and they listen and help”; “It’s a lovely home, you couldn’t be treated better at The Ritz”; and “it has a lovely friendly atmosphere”.

We found that people are being helped to understand decisions about the care and treatment they are given. When people appear to have reduced mental capacity this is currently assessed informally and referral made to the GP when formal assessment needed.

We found that staff were approachable and people were encouraged and supported to make their views known to the registered manager and staff.

People we spoke with told us they had access to a range of health care professionals including GP, dentist, chiropodist and opticians. Care plans we saw were person centred and contained clear and comprehensive information about individuals and their needs, to guide and enable staff to provide the support and care they needed. Information was current and seen to have been reviewed and updated regularly with the individual person using the service.

We saw people being supported by staff to meet their needs in a caring and person centred manner, which was both timely and effective. We observed staff sitting and listening to people attentively. The responses seen were warm and respectful and showed staff had a good knowledge of the individual's personality, history and preferences. We saw people who use the service enjoying reading their books, or watching television, and three ladies had a manicure during the course of our visit.

We found that people are cared for by a staff team who are properly trained and supervised, to make sure they are competent to meet the varied care needs of people who use the service.

We found that the home is run in an inclusive way and there are systems in place to seek the views of people who use the service.

This inspection took place on 8 and 12 May 2015 and was unannounced. The previous inspection of Cleeve Lodge Care Home was on 20 September 2013. There were no breaches of the legal requirements at that time. Cleeve Lodge Care Home is registered to provide accommodation and personal care for up to 33 older people (although the provider limited this to 30 by using shared rooms for single occupancy). At the time of the inspection there were 26 people in residence.

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.

People were safe. All staff received safeguarding adults training and were knowledgeable about safeguarding issues. When concerns had been raised they had reported events to the local authority and CQC. Their recruitment policy ensured that unsuitable workers were not employed because pre-employment checks were robust.

A range of risk assessments were undertaken for each person and appropriate management plans were in place where needed. The premises were satisfactorily maintained and there were plans in place for refurbishment works. All maintenance checks were regularly undertaken.

The staffing numbers on duty were continually monitored to make sure they were appropriate and that each person’s care and support needs could be met. Staff confirmed that the staffing numbers were appropriate.

Staff completed a programme of mandatory training to enable them to carry out their roles and responsibilities. New staff had an induction training programme and there was a programme of refresher training for staff. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People were supported to make their own choices and decisions where possible. Where people lacked the capacity to make decisions, assessments were recorded of best interest decisions. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards.

People were provided with sufficient food and drink. There were measures in place to reduce or eliminate the risk of malnutrition or dehydration. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so. People were administered their medicines as prescribed by their GP.

The staff team had good friendly relationships with the people they were looking after. People were able to participate in a range of different activities.

There was a staffing structure in place and junior staff were supported by senior staff and the registered manager. Daily team meetings and regular staff meetings ensured that all staff were kept up to date with any changes in people’s needs and any events that had occurred or were due to take place.

Care records were kept for each person. These were well written and detailed, which ensured that people would receive the care and support they needed. Accurate records were kept of the care and support provided. People were involved in having a say how they were looked after and were encouraged to raise any concerns they may have.

There was a regular programme of audits in place to check on the quality and safety of the service. The responsibility of these checks were shared between the senior staff. The provider visited the service on a monthly basis and also checked on the quality and safety.