This inspection took place on 5 January 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Elm Lodge provides care and accommodation for up to 26 older people with a dementia type illness. On the day of our inspection there were 24 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Elm Lodge was last inspected by CQC on 28 November 2013 and was compliant with the regulations in force at that time.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Accidents and incidents were recorded and regular reviews took place to identify any trends and prevent future accidents from taking place, such as falls.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff were suitably trained and training was arranged for any due or overdue refresher training. Staff received supervisions and an annual appraisal.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Elm Lodge. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

People who used the service and family members were aware of how to make a complaint however there had been no formal complaints recorded at the service.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were consulted about the quality of the service. Family members told us the management were approachable and had an open door policy.

We have made a recommendation about recording the registered provider’s visits to the home.

We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs, which meant they were not able to tell us their experiences. However, those who spoke with us said, ‘I am comfortable,’ and ‘Dinner is very nice’.

We saw that staff asked people for their consent before they provided care and support, and people were asked where they wanted to sit in the lounge and dining room.

We examined four care plans and found they contained information about the people concerned. There was evidence that people and their representative, if appropriate, were involved in making decisions about the care provided.

We looked at the policies and procedures for medicine management and how the service ensured people were safe.

We reviewed the home’s recruitment procedures and found them to be effective.

A complaints policy was included in the home’s service user's guide, which was made available to people who used the service and their relatives.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people had complex needs which meant that they were not always able to tell us their experiences. We observed staff supporting people living in Elm Lodge, we looked at documents and spoke to visitors, the care staff, manager, deputy manager and provider.

We visited the home and spoke with nine people who used the service. People who spoke with us said they were comfortable and one person said, “The staff are lovely.” We observed that staff were respectful when offering support, and protected people’s dignity and privacy when providing personal care.

We spoke with two relatives and they told us the care workers looked after people very well. They said they were involved in decisions about the support provided, and they felt people who used the service were safe. One relative said, “They know what their needs are and how to look after them.”

We looked at three care plans. We found documentary evidence that care plans were developed in consultation with the people living in Elm Lodge and their relatives.

We spoke with three care workers and they said the management were very supportive. A training programme was in place, and staff told us they provided the care and support that people who used the service needed and wanted.

A quality monitoring system was in place to ensure that a good standard of support was offered by the service.