We Inspected Deer Lodge residential care home on 28 August 2018. The inspection was unannounced which means the provider was not told that we were inspecting.

At the previous inspection of February 2016, the provider was meeting all the standards and was rated “Good”. During this inspection we found that improvements needed to be made regarding the management of the service in order for it to be well-led.

Deer Lodge 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.

Deer Lodge provides accommodation and support with personal care for up to 14 older people, including people who are living with dementia. The home accommodates people over two floors, with common lounges and garden. At the time of inspection there were 12 people living in the home.

The service 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 2008 and associated Regulations about how the service is run.

At the time of inspection the registered manager was on holiday and the home was being managed by the deputy manager.

At the previous inspection in February 2016 the provider and registered manager had expressed their plans on how to improve the service. These plans included the addition of a deputy manager, modernising the record keeping processes and developing staff training to go beyond basic mandatory training, better alignment of staff personal skills and interests with both their own professional development and introducing new activities with people.

During this inspection we found that there had not been much development in these areas and that this lack of development had contributed to the service not being as well-led as it could be. The role of deputy manager had been established and was working well with regard to ensuring care plans and other documentation was well managed. However, there was no clear boundary between the role of the registered manager and the role of the deputy manager which impacted on the management and supervision of staff and the team working between the Provider, registered manager and deputy.

Staff training was again managed well, but had not moved beyond the basic mandatory training, and there was still work to be done regarding monitoring staff professional development and how any training had had a positive impact on the care of people.

The quality assurance checks by the provider were carried out monthly, but were mainly cursory checks on areas of safety and speaking with the registered manager regarding staffing matters. The quality assurance system did not discuss any plan for the future development of the service, whether they related to any feedback from people who used the service or relatives, or review whether they were in line with the required standards.

The home’s IT system was basic and did not enable the service to make use of IT for the benefit of staff or people living in the home.

Access to staff records was limited because of poor communication between the management team regarding the location of keys.

During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. You can see what action we told the provider to take at the back of the full version of the report.

People who lived at the home were protected from the risk of abuse happening to them. People told us they felt safe and well cared for at the service and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. People were familiar with the registered manager and depu

We carried out an inspection of Deer Lodge care home on 1 February 2016 The inspection was unannounced. At the previous inspection of 15 September 2014 the home had met all the standards.

Deer Lodge is a home for up to 14 older people, including people who have dementia. The home has 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 2008 and associated Regulations about how the service is run.

People who lived at the home were protected from the risk of abuse happening to them. People told us they felt safe and well cared for at the service and they would not be afraid to tell someone if they had any concerns about their safety or wellbeing. Risk management plans clearly identified what the risk was and provided staff with instructions about how they needed to manage the risk to ensure people received safe care and support whilst enabling them to remain as independent as possible.

There were enough staff on duty to care for people, With a minimum of two care staff per shift with one waking night staff and one sleeping in staff. Staff had been trained to use specialised equipment, such as hoists, safely.

People told us that they were happy with the care they received and felt their needs had been met. Staff were able to demonstrate good knowledge of people’s needs as they spoke about them and provided care in a safe and caring manner.

The provider had a clear Service User Guide which emphasised the rights of people to be treated with dignity, to have privacy and to be able to exercise choice. This was also reflected in the home’s policies and procedures and formed the basis for staff training.

The provider ensured that people’s independence and choice was promoted. People told us that they had been involved in making decisions and there was good communication between staff and themselves. They also confirmed that their consent was asked for before doing anything, such as going somewhere, or receiving medicines.

We saw that people’s health, nutrition, fluids and weight were regularly monitored. There were well established links with GP services offering a single point of access for people.

People told us that the staff were kind and caring towards them. People’s comments included; “Staff are very kind” and “I am very happy here”.

Care records were individual to each person and contained information about people’s life history, their likes and dislikes, cultural and religious preferences. Care records included details such as personal achievements, places visited and family relationships.

We listened to how staff spoke with people and found this was professional and relaxed, and included friendly chit-chat between staff and people who used the service. We saw how people who used the service responded positively to the interaction. Staff responded promptly when asked a question and took time to explain their actions.

People were able to get up and go to bed at a time that they preferred and were able to enjoy activities and interests that suited them. The home also supported people to maintain relationships with family, relatives and friends.

In order to listen to and learn from people’s experiences the home had an open door policy for relatives and friends as well as occasional meetings where relatives could attend and discuss issues affecting the home and the care provided to people.

The size of the home meant that staff could hold discussions with small groups of people and individuals on a daily basis. People were involved in discussions about their food, activities and how the home was run.

The provider maintained regular contact with the registered manager in order to regularly assess and monitor the quality of service that people received. People were very posi

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us that they felt very safe and happy at the home. One person told us, “The staff here are lovely and do everything they can to help you”. Another said, “They make sure you’re ok”.

During our visit we saw that people were protected from abuse and avoidable harm and that policies and procedures were in place to act on any concerns. We saw that staff had received training in Safeguarding, Moving and Handling and the safe administration of medicines. The provider had effective recruitment procedures which included checks made under the Disclosure and Barring Service (DBS).

We saw that the provider ensured that the administration of medicines was properly carried out and monitored. At the time of inspection an audit of medication procedures was taking place by an external pharmacist, and positive feedback was provided.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager informed us that they had received training and information on this subject and were in the process of reviewing people’s care needs and records to ensure they complied with the relevant legislation.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. One person told us, “The staff look after me really well. I get help when I need it and the food is good”.

We found that the provider had a clear Service User Guide which emphasised the rights of people to be treated with dignity, to have privacy and to be able to exercise choice. This was also reflected in the home’s policies and procedures and formed the basis for staff training.

We saw that the provider held comprehensive records on people which enabled staff to understand their health and social care needs. Records included care plans written from the individual’s perspective and in clear, plain English.

There was good communication and contact between the provider and other services such as social services, pharmacy and community health services. We saw that GPs and social services were included in quality questionnaires and that they had responded positively.

Residents meetings were held regularly, to which relatives were also invited. These had not been well attended since Christmas and the manager informed us that they were looking at how best to make these meetings more meaningful for people. A flexible visiting-hours arrangement was in place and the provider also held several events per year to which relatives and friends were invited.

The provider had a complaints policy which was accessible to everyone as well as a comments and feedback process.

Is the service caring?

People we spoke with told us they were very happy with the level of care they received and the attitude of the staff team. One person told us: “I find the staff very nice and they are always smiling and friendly”.

During our visit we saw that staff involved people in conversations and activities and treated people with compassion, kindness, dignity and respect. People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this to be the case.

We observed staff working at the home and spoke to staff. One carer described the home as a “family”. Another described their work positively by telling us that “it is a small home and so you get to know everyone and know what they need and know what they are interested in”.

Is the service responsive?

People we spoke with told us they were satisfied with how the staff responded to any queries or issues. One person told us: “I have never had any problems myself, but if I needed anything I would just ask and they would sort it out”. We observed staff responding quickly to people who wished to walk in the garden or to go to another part of the home.

We saw that people’s needs had been assessed before they moved into the home. Records confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

People we spoke to were happy with the way the service was managed. One person told us: “The manager is lovely. Fantastic. She is always ready to say hello and talk to”. Staff we spoke with also told us they felt supported in their work, through training and supervision.

We saw that the provider had made arrangements to carry out quality audits of the service as well as questionnaires for people, their relatives and other professionals. the results were used to help the provider plan for the future care of people.

We carried out this responsive inspection as a result of receiving information that concerned us regarding the way the provider treated people and supported them in making choices when people's personal circumstances changed. One of the examples we looked at was when people could no longer afford to fund themselves independently.

We found that the provider's own policy on contracts had not been followed in that there was no evidence of the fees being based on a needs assessment or that annual reviews of the person's needs had been carried out each year in accordance with the provider's policy.

Care records demonstrated that people had been asked about their likes and dislikes on admission to the home. These included preferences regarding food and drink, in addition to health, religious or cultural requirements. People confirmed that they were asked about the personal care and support that they wanted, and that this was respected and implemented.

We found that there were times when the provider did not do as much as they could to engage fully with other agencies, such as social services teams, when difficulties arose with funding. We found that the provider could have delegated the investigation and resolution of complaints to someone who was in a position to resolve it locally and meet with social services.

People we spoke with told us they felt very comfortable at Deer Lodge and that the care staff treated them in a friendly and respectful manner. Views from non-residents were also positive, with people describing how helpful the staff and manager were in caring for relatives.

During the inspection we saw that people were supported in a caring manner and that care staff were aware of each individual's support needs.

Staff we spoke with confirmed that they had received Safeguarding training and were aware of the different types of abuse that could happen to people and the procedures to follow. One member of staff told us that even if there were any concerns that procedures may not be followed they would know how to contact outside authorities.

Staff confirmed that they had undertaken a range of mandatory training including National Vocational Qualification level 2 or 3 in care, training in food hygiene, safeguarding adults, medication administration, health and safety, first aid, moving and handling, fire safety, end of life care, and dementia. Samples of staff records that we inspected showed this to be the case.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive and to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People told us what it was like to live in 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 Care Quality Commission (CQC) inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective.

On the day of the inspection there were fourteen people living at the home (no vacancies). We spoke to or spent time with all of them. We also spoke to five staff members, and looked at six people’s care records. We also 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. At Deer Lodge there were a number of people who had dementia or found it difficult to communicate.

People spoke highly of the support provided to them within the home. One person noted “I’m extremely well looked after here.” We saw many examples of staff supporting people in a friendly and professional way that respected their dignity.

People told us that they liked the food served in the home. One person told us “when the weather is fine we have our lunch or tea in the garden and this makes living here very enjoyable.”

People living at the home indicated that there were sufficient staff to meet people’s needs effectively.

People told us that they felt safe at the home, and the home had effective systems in place to ensure that people were protected from abuse.

We met everyone who was living at Deer Lodge at the time of our visit. People told us that they were happy there. They said that the staff treated them with kindness, the food was good and that they were well cared for. Some people told us that they would like more things to do.

We inspected the home in September 2011. We visited the home again in January 2012 to see if improvements had been made since our last visit. We had told the service that they needed to make improvements in a number of areas. We saw that they had improved the health and safety and infection control at the home. There had been improvements to activity provision, although some people felt that their individual social needs were not always being met. We saw that people were treated with dignity and respect.

People who live at the home told us that they liked it and that the staff were kind and caring. They said that the food was good. One person told us that, ‘it is nice to have things done for us’.

We saw that people’s personal care needs were well met, but they were not always getting a personalised service which met their individual needs. We saw that some parts of the environment were not safe and this may mean people are at risk.