This inspection took place on 11 October 2018 and was unannounced.

Down Lodge Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Down Lodge Residential Care Home accommodates up to 16 older people in one adapted building. There were 15 people at the service at the time of inspection, some of whom were living 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.

The service had a registered manager in place at the time of our inspection. 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.

The registered manager was also the provider. They took a prominent role in the day to day running of the service. The registered manager had a good rapport with people, approaching them with kindness and humour. The registered manager understood their regulatory responsibilities and was experienced and knowledgeable in their role.

There was a calm, warm and friendly atmosphere in the home. There were sufficient numbers of suitably skilled and qualified staff in place. The provider had recruitment processes in place to identify suitable candidates for the role. Staff were well acquainted with people’s needs and were given the opportunity to spend meaningful time with people throughout the day.

People’s care plans reflected how they would like to receive care. The registered manager had developed these plans using information from people, relatives and healthcare professionals.

The provider had an electronic care planning and monitoring system in place. This system was used to effectively monitor people to help ensure changes to people’s health and wellbeing could be quickly assessed.

Staff received training which was relevant to their role. The registered manager monitored staff’s ongoing performance and there were systems in place to ensure staff understood their responsibilities and duties.

People were treated with dignity and respect. Staff understood people’s individual preferences and needs with care organised to help ensure these needs were met. When people received care at the end of their lives, they were given compassionate support which reflected their needs and preferences.

There were a range of activities which people could take part in and people were able to give feedback to the registered manager to suggest new things to do.

Staff understood the need to gain appropriate consent to care. 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.

The home was a clean, hygienic environment, which was suitable for people’s needs. The registered manager carried out a series of audits and checks to help maintain the safety of the environment and the quality of care.

Risks to people’s health were assessed and mitigated. The registered manager assessed people’s needs to help ensure appropriate plans of care were in place. People had access to healthcare services when required and the provider had established effective working partnerships with other stakeholders to promote people’s wellbeing. People fol

This inspection took place on 28 April 2016 and was unannounced.

Down Lodge Residential Care Home is a care home providing accommodation and personal care for up to 16 older people. At the time of the inspection there were 12 people living at the service. There was a registered manager in post who is also the provider. 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 at Down Lodge Residential Home and enjoyed living in a relaxed, calm and friendly environment. They were protected by staff who were knowledgeable with regard to safeguarding people and understood the procedures to follow if concerns arose.

People were cared for by staff who had undergone a thorough recruitment process and there were sufficient of them to meet people’s needs. Medicines were managed safely.

Risks to people’s well-being and the environment were assessed and managed. Risks were minimised while at the same time providing protection for people’s freedom and choice. The property was well maintained, clean and provided a safe environment for people.

People received effective care from a well trained staff team who received regular refresher training and had the opportunity to gain qualifications. Staff felt supported and had regular, individual meetings, team meetings and appraisals.

People’s right to make decisions was protected and staff understood their responsibilities regarding gaining consent and offering choice.

People were provided with nutritious, well prepared food which they enjoyed. When necessary, people’s nutrition and hydration were monitored. People had access to health professionals and appropriate advice and support was sought to maintain people’s health and well-being.

People told us their privacy and dignity was respected. Staff knew people well and understood their personal preferences. Interactions between people and staff were positive and examples of humour, compassion and kindness were observed during the inspection.

People were involved in their care. Reviews took place regularly and care plans were updated to reflect changes. Staff has access to up to date information regarding people at all times. People were encouraged to be independent. A programme of activities was available for people to take part in if they wished.

The quality of the service was monitored by the registered manager. Regular feedback was sought from people and their relatives and used to develop the service. People, relatives and staff spoke highly of the registered manager. They were confident in his leadership and there was a good team working spirit.

At the time of our inspection 13 people lived in the home. We spoke with five people, and one relative of someone who lived in the home. We also spoke with a district nurse who attended people during our visit, and three of the four care workers on duty during our inspection. We discussed care provision, and monitoring and operating systems, with the registered manager and deputy manager of the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found.

Is the service caring?

People were supported by care workers attentive to their needs. We observed staff spoke respectfully with people, and took time to chat with them. People told us they liked the staff who cared for them. One relative said “The staff are all very kind”.

Staff were aware when people required support, for example to walk between rooms or with their meals. Assistance was offered promptly. Staff knew people’s preferences and ensured these were met to promote people’s wellbeing.

Is the service responsive?

People’s care and support needs were assessed before they moved into the home, to ensure the home could meet these safely. Care plans were reviewed with people each month to ensure they were supported as they wished and required. When care needs changed we saw care plans were updated to ensure people continued to be cared for safely.

Staff interacted with health providers such as the GP, district nurse and pharmacist to ensure people’s good health was promoted. A district nurse attending one person during our visit told us care workers were “pro-active” to maintain people’s wellbeing.

Is the service safe?

We saw there were sufficient care workers to attend to people promptly when they required support. People told us they did not feel rushed by staff, and care workers said they felt they had time to provide quality care for people. We saw training was kept up to date to ensure staff maintained the skills they required to support people safely.

The home was well maintained. One person told us they thought “The home is very nice and bright”. Staff and people living in the home told us repairs were reported and addressed promptly. We saw measures were in place to keep people safe from unwanted visitors. Services and checks, such as legionella water tests and boiler servicing, ensured people were protected from potentially harmful risks.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. At the time of our inspection no one required Deprivation of Liberty Safeguards.

Is the service effective?

We saw people were included in monthly reviews of their care plan. This ensured their changing needs were understood and care workers met their current needs and wishes. People told us staff listened to their comments. One person told us “It’s a good home”.

We observed care workers liaised with the GP and pharmacist to ensure medications and treatment were changed to meet people’s health needs. Important health information, such as current medications and allergies, was stored for easy access should a person require an emergency transfer to hospital.

Is the service well led?

People were asked for their feedback on the quality of the service provided through an annual survey, resident meetings and monthly individual meetings with the deputy manager. They told us they felt staff listened to their comments. We saw the manager acted on people’s comments, for example with regards to menu preferences.

There were processes in place to monitor and audit care provision and safety in the home to ensure people, staff and visitors were protected from harm. Risks assessments were reviewed to ensure actions taken to mitigate risks were effective. Information was analysed to identify trends that indicated when further actions were required.

At an inspection on 16 July 2013 we found the provider did not ensure staff received appropriate supervision and appraisal. This meant people who use the service were potentially at risk of unsafe care and treatment, as staff were not supported appropriately to ensure their care provision was suitably reviewed.

At our inspection on 22 October 2013 we found the provider had recorded individual appraisal meetings held with staff. We saw notes from appraisals documented discussion between a senior member of staff and each care worker to note any issues, praise good working practice and consider personal development.

Staff had completed training to ensure they were suitably skilled to support people safely. We saw staff training was up to date, and refresher training was planned. Staff told us they were satisfied with the level of supervision and training provided.

We did not speak with people who use the service at this inspection, but we did discuss training, supervision and appraisal with two care workers and the registered manager.

At the time of our inspection the manager was on leave, and so not available. We met with the care supervisor, who carried out management duties in the manager’s absence.

We found staff were respectful to people, and the service involved people in decision-making. We spoke with five people who use the service. They told us staff treated them with dignity and respect. One relative said “All the staff are very caring. If I’m away I know X is well looked after.”

We looked at five care plans, and saw people had initial assessments and regular reviews to ensure their care needs were suitably supported. One person told us “It’s not regimented here. It’s the next best thing to being at home.”

We saw staff understood the need to protect vulnerable people from the risk of abuse, and were aware of the service’s safeguarding policy.

The service conducted an annual survey to assess whether people were satisfied with care and support provision. Monthly health and safety checks were conducted to identify and address potential hazards.

People were cared for by staff trained to deliver care and treatment safely and to an appropriate standard. The service held staff meetings and had an 'open door' policy for staff to raise concerns, but did not conduct regular recorded one to one supervision with staff. They did not hold individual appraisal meetings for staff to review or discuss their work practices or

learning and development needs. This meant staff were not appropriately supported or regularly assessed. People who use the service were not supported by staff appropriately monitored to ensure suitable care provision.