Feltwell Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Feltwell Lodge is one of three care homes in Norfolk run by Hanley Care Homes. It is located in the small Norfolk village of Feltwell and accommodates up to 45 people; in one adapted Victorian building with a purpose built extension. There were 34 people accommodated at the time of our inspection.

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 a 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 last comprehensive inspection of 7 and 8 June 2016, we rated the service ‘Good’. At this inspection we found the service was now rated Requires Improvement

Care records provided insufficient guidance for staff in providing safe care and in supporting people’s wellbeing. We found improvements were needed in staff’s understanding of dementia care to enable them to support people in providing care that was effective and person centred. This included staff’s knowledge in managing high levels of anxiety and associated behaviour and supporting people to have access to meaningful stimulus, tailored to their level of dementia. We have made a recommendation about staff training on the subject of dementia, and to explore relevant guidance on best practice to enhance people’s wellbeing through meaningful occupation.

Provider governance systems needed further development in order for them to provide an accurate overview of the service to inform an ongoing plan for improvement, enable proper monitoring and review, or enhance the quality of the service. This would complete the quality monitoring cycle and demonstrate the quality of the service was continually improving and developing to provide good outcomes for people.

Staff treated people with kindness and compassion and respected their privacy and dignity. Positive relationships had developed between people and staff. The home encouraged and supported people to maintain relationships that were important to them.

The provider had properly trained and prepared their staff in understanding the requirements of the Mental Capacity Act in general, and (where relevant) the specific requirements of the DoLS. Staff supported people to have maximum choice and control of their lives and supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Management carried out assessments of capacity for people who were unable to give their consent or contribute to the decisions made about their care and support plan. Systems were in place to seek best interest decisions through the appropriate channels, with the appropriate healthcare professionals.

The culture of the service is positive, open and transparent, with good leadership.

The inspection took place on 07 and 08 June 2016 and was unannounced.

The home is registered to provide accommodation with personal care for up to 37 people older people. There were 29 single rooms and four double rooms. On the day of our visit there were 37 people living at the home, some of whom were living with dementia.

There was a registered manager at the service, who was permanently based onsite. 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 felt safe living at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm of it they needed to report any suspected abuse.

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and regularly reviewed. Where someone was identified as being at risk actions were identified on how to reduce the risk and referrals were made to relevant health care professionals.

There were sufficient staff numbers on duty to keep people safe and to meet people’s needs. Safe staff recruitment procedures were in place which ensured only those staff suitable to the role were in post.

Policies and procedures were in place to provide staff with the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely by trained staff.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the MCA and DoLS. Staff sought consent from people regarding their care. Appropriate referrals where in place, along with best interest decision meetings and consent from relatives where appropriate for people assessed as lacking capacity to make specific decisions.

Staff worked well with people living with dementia and had received appropriate training to deal with all elements of providing care services.

People health care needs were assessed, monitored and recorded and referrals for assessment and treatment were made. Where people had healthcare appointments they were supported by staff to attend these.

Staff were caring, knew people well, and supported people in a dignified and respectful way. Staff acknowledged people's privacy. People felt that staff were understanding of their needs and provided support during periods of distress. Staff had positive working relationships with people.

Care was provided to people based on their individual needs and was person-centred. People and their relatives were fully involved in the assessment of their needs and in care planning to meet those needs. Staff had a good knowledge of people's changing needs and action was taken to review care needs.

Staff listened and acted on what people said and there were opportunities for people to contribute to how the service was organised. People knew how to raise any concerns. The views of people, relatives, health and social care professionals were sought as part a quality assurance process.

Quality assurance systems were in place to regularly review the quality of the service that was provided. The management team demonstrated good leadership.

People's standard of health and welfare was maintained and their care needs were regularly reviewed. Risks to people who lived in the home were identified with an appropriate plan of care developed. This meant that staff had access to detailed care records to ensure that they provided people with safe care and support. A person who used the service told us that, “I’m happy here and cared for. I feel safe.” A relative who we spoke with also told us that, “Staff are very kind and I would recommend (Feltwell Lodge)”.

People were protected from the risk of dehydration and poor nutrition because nutritional needs were assessed ensuring that any such risks were identified and eliminated.

There were adequate staffing levels in place to ensure the safety and well-being of people who lived at the home.

We found that the provider managed people's health and safety risks effectively through care records. This was because we found evidence which demonstrated to us that the provider maintained and reviewed personalised care records for people who used the service.

During our inspection of 20 February 2013 we examined evidence which demonstrated to us that people, or their families and relatives, had given consent to the care and support provided by staff members at Feltwell Lodge. We saw that families of people using services at the home were regularly consulted about their relatives care.

People’s care needs were regularly reviewed and we saw that risks to people were identified with an appropriate plan of care developed. This gave detailed guidance to staff about how to provide appropriate care and support to people living at Feltwell Lodge.

We saw that appropriate arrangements were in place to ensure the correct prescribing, storage and dispensing of people's medication.

We found that appropriate checks were undertaken before staff started working at Feltwell Lodge. Records examined demonstrated to us that people were cared for or supported by suitably qualified staff.

We saw that people were made aware of how to make a complaint if they wanted to. Although no complaints had been made during the last 12 months, systems were in place to ensure that any complaints made would be dealt with appropriately.

We were told that the staff promoted people's dignity and treated them with respect and sensitivity. One person told us they were satisfied with their daily routine in the home and said they good choice in their daily lives.

All of the people we spoke with during our inspection were happy with the service they received at Feltwell Lodge. People told us that staff understood their individual needs. People told us they enjoyed the food, although it was a bit repetitive.

We heard positive comments about the staff team. People said they felt safe living in the home and that they were treated well. They were confident that any complaints or issues would be dealt with by the managers.