Cresta Lodge is a residential care home registered to provide support to 27 people, some of whom were living with dementia. At the time of inspection there were 22 people using the service.

At the last inspection on 17 and 20 July 2015 the service was rated Good overall. In effective the service was rated ‘requires improvement’ and was breaching Regulation 11 Need for Consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service provided us with an action plan stating how they intended to improve in this area. At this inspection we found that the necessary improvements had been made to comply with this regulation. The service was rated good in all five domains and maintained a rating of good overall.

The service was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) 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.

People’s relatives told us they felt their relative was safe living in the service and that staff made people feel safe. Risks to people were appropriately planned for and managed. Medicines were stored, managed and administered safely.

Checks were carried out to ensure that the environment and equipment remained safe. The service was clean and measures were in place to limit the risk of the spread of infection.

People’s relatives told us there were enough suitably knowledgeable staff to provide people with the care they required promptly. A health professional wrote to us and said they felt the staff were competent and well trained.

Staff had received appropriate training and support to carry out their role effectively. Staff received appropriate supervision which helped them develop in their role. People received appropriate support to maintain healthy nutrition and hydration.

People’s relatives told us staff were kind to people and respected their right to privacy. Relatives told us staff supported people to remain independent and our observations supported this.

Relatives told us they were encouraged to feed back on the service and participate in meetings to shape the future of the service.

People received personalised care that met their individual needs and preferences. People and their relatives were actively involved in the planning of their care. They were supported to access meaningful activities and follow their individual interests.

The home was decorated in a way which helped people living with dementia find their way to key areas such as the bathroom and their bedroom. There was an accessible garden available to people and ample sources of engagement available for people to access independently.

The registered manager and the providers created a culture of openness and transparency within the service. Staff told us that the managers and providers were visible and led by example. Our observations supported this. Relatives told us they knew how to complain and felt they would be listened to.

There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service. There were plans in place to develop the service and the knowledge and skills of the staff team. Plans were in place to continually update and refresh the decoration of the home in line with people’s preferences. People were being consulted about what activities and outings they would like in 2018.

The service worked well with other agencies such as Norfolk County Council to ensure they stayed up to date with the latest policies, procedures and best practice.

Further information is in the detailed findings below.

We spoke with people using the service and they told us that, "I doubt there is a better place than this." Another person said, "It's fine here. Staff are always about." A visitor described the service as, "Home from home."

We saw that, where they were able, people signed their care plan to show they had given their consent to receive the agreed care and treatment. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. The care plans showed us that the provider worked in co-operation with other health professionals so that people received the care and treatment prescribed for them.

We looked at the arrangements for looking after and administering medicines to people. We saw that the arrangements were safe and ensured that people received their medicines when they needed them and as they were prescribed. We saw that staff received training about this and were well supported to provide a safe and caring service to people. Recruitment processes ensured that only appropriate people who were suitably qualified were employed by the service.

There was a complaints process in place which was well known by people living at the home and their visitors. One person said, "I've nothing to complain about, but I would speak to staff if I did have." This told us that comments and complaints people made would be responded to appropriately

People spoke positively about the staff.

One person said, "They are very kind and thoughtful." They described staff as diligent. Another said staff looked after them, "One hundred percent with noughts on." A third person told us, "The care is good. Staff are very good. I can't fault them."

We were told that no one was made to do anything they didn't want to do.

This inspection took place on 17 and 20 July 2015 and was unannounced.

Cresta Lodge provides accommodation and care for up to 27 older people, some of whom may be living with dementia. At the time of this inspection 22 people were living in 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.

People’s consent was sought for day to day care and support tasks and staff acted in people’s best interests when they could not obtain this consent. However, mental capacity assessments had not been carried out when people’s capacity to make their own decisions was in doubt. Where more complex decisions were made the service was not acting in accordance with the regulations.

Staff understood their obligations in ensuring people were protected from the risk of abuse and knew what action to take if they had any concerns. People’s care was assessed to identify areas of risk to their wellbeing and plans were made to mitigate these risks as far as possible. The premises and equipment being used was under ongoing review to ensure it was safe for people. There were enough staff to support people effectively and people could be assured the arrangements in place to manage their medicines were robust.

Staff recruitment processes were thorough with the necessary checks being made. A comprehensive training programme was in place to support staff to deliver good care for people.

The service had a good working relationship with the GP who had confidence in the service and its staff. People were supported to access a wide range of health care professionals when required.

People had enough to eat and drink and those who required more or specialised support with their nutrition received it.

Staff were observant and caring, providing people with individual support based on people’s specific needs and preferences.

The home was well led and managed by the manager who was effectively supported by the providers. People living in the home, their relatives and staff were complimentary about the way the home was run and had confidence in the management team. Robust systems were in place to ensure that the standard of care people received was constantly under review.

You can see what action we told the provider to take at the back of the full version of the report.