About the service:

Flanshaw Lodge is a residential care home that was providing personal care to 22 people living with dementia aged 65 and over at the time of the inspection.

• People were happy living at Flanshaw Lodge.

• Staff were caring and compassionate, and treated people with respect. People were given choices and were supported to make decisions about their daily lives.

• People received personalised care and this was reflected in how well staff knew their individual needs. People were meaningfully engaged in activities appropriate for their interests and needs and staff used everyday opportunities to engage people in conversation.

• Staff were recruited safely and there were enough staff to meet people’s needs. Staff training and supervision was regular so staff felt supported in their roles.

• Staff understood individual risks to people and knew the safeguarding processes to follow to ensure people were safe.

• People liked the meals and they enjoyed a variety of food and drinks. People’s health care needs were well managed and they received their medicines when they needed them.

• The home was clean and well maintained, with a refurbishment plan which ensured the premises were in a good state of repair and décor.

• A complaints procedure was displayed. Complaints and concerns were dealt with appropriately.

• The registered manager was committed to providing person centred care and there were regular audits and quality checks to ensure the service ran well.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 8 March 2018). At this inspection, the provider had made sufficient improvements to improve the rating to Good.

Why we inspected: This was a planned inspection to check this service had improved.

For more details, please see the full report, which is on the CQC website at www.cqc.org.uk .

The inspection took place on 28 December 2017. There were 24 people living in the service at the time of the inspection. We previously inspected the service on 15 September 2015 and gave a rating of good. At this inspection we found there were some areas in need of improvement and we identified a breach in regulation 12. This was because risk assessments and control measures for managing risks were not robustly completed or reviewed.

Flanshaw Lodge is a care home for people living with a diagnosis of dementia. There is a registered manager in post who has been running the service for a number of years. 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.

Staff understood how to keep people safe, although not all individual risk assessments were thoroughly completed in people's care records.

Systems and processes were in place for managing medicines although improvements were needed in some areas of recording and auditing.

Accidents and incidents were appropriately recorded, analysed and safeguarded where appropriate.

Staff were suitably trained and supported to carry out their work and they were confident and competent in their role.

There was good support for people's nutrition and hydration and people enjoyed their meals. Staff linked appropriately with other professionals as required and there was effective communication to support people's needs.

Staff had a good rapport with people and engaged in kind and compassionate interaction. Staff responded well to meet people's needs and they involved people in their care and support. People and their relatives said they felt well cared for.

There was a homely and friendly atmosphere in which staff understood people's individual needs well.

Care records required some improvement as there were gaps and a lack of consistency in recording of people’s care and support.

There was very visible leadership through managers’ presence, and clear direction for staff; managers were involved in people's care and knew the needs of the service well. Audits were in place although not always completed effectively to identify areas to improve.

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

We spoke with four staff, the assistant manager, service manager and five people who lived in the home. We also spoke with one relative.

We saw staff were attentive to people's needs.We saw people were well cared for and their individual needs were met in a friendly, homely environment. We saw positive relationships between people and staff, which supported people's well-being, rights and wishes.

People made positive comments such as:

"I have no grumbles"

"What you see is what you get, we're alright here"

"We sing and dance and all sorts"

We found there were enough staff to meet people's needs and to provide care that enhanced their everyday experiences. We were told there were temporary changes to management and we saw the home continued to be well run.

We looked at quality assurance systems and found there were regular audits made to ensure the quality of the service.

We saw records were up to date, well maintained, easily accessible to those who needed them and confidentially filed to ensure people's rights were protected.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs they were not able to tell us their experiences. We observed staff interaction with the people who used the service, we spoke with their relatives, we spoke with staff and we looked at care plans.

We spoke with some of the people who used the service. One person told us “I like living here.” Another person told us that “staff look after me.”

We spoke to the cook and they told us that people were able to choose their meals from a menu. One person told us that “the food is lovely and there is plenty of it.”

We saw that staff received training in safeguarding and there was a corporate safeguarding and whistle blowing policy in place to support staff.

We looked at the care plans of four people who used the service. We saw that they were tailored to meet the needs of the individual. We saw that when a risk had been identified, an action plan had been put into place.

The staff we spoke with told us they enjoyed working in the home. Other staff told us they were able to sit down and “chit chat” with the people who used the service. We saw that interaction between the staff and the people who used the service was friendly and respectful. One of the people who used the service told us they felt they were “treated with respect” by the staff.

We spoke with one person who is living at the home. Because of communication difficulties, we were unable to communicate with other people who lived there. However, we did observe peoples’ behaviour and the way that staff cared and supported them.

The person spoken with said they understood their care and the support they need. They told us that they are encouraged to make their own decisions about their daily lifestyles and said, “We have a lot of freedom and can do what we want”. The person also explained that staff talk to them about their care and keep their relatives informed about any changes.

Another comment was “Staff are very good with everyone. The meals are good quality and we have lots of different food choices. I enjoy the bingo, dominoes and other activities. My family visit and are encouraged to be involved in my care and support.”

The person spoken with said they have never had any concerns during their time at the home. They commented “Staff are very good and kind. They are soon here if I need anything. If I wasn’t happy about something I would tell them.”

We carried out this inspection on 16 and 18 September 2015. The inspection was unannounced.

The service provides accommodation for up to 26 older people, all of whom are living with dementia. On the day of our visit there were 19 people living at the home. Accommodation at the home was provided in single bedrooms set over two floors.

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 told us that they felt safe and well cared for in Flanshaw Lodge and we found there was a homely, friendly atmosphere.

Staffing levels were supportive of people’s needs and staff had a good understanding of safety in the home.

Staff were working in line with the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.

Care was person-centred; staff treated people with kindness and demonstrated high levels of respect and dignity for people. Staff were mindful that this was people’s home, rather than staff’s workplace.

Best practice was encouraged and staff were supported well through supervision.

Opportunities for formal staff training were not always available, although managers were creative in finding other ways for staff to develop their skills and knowledge.

People had access to meaningful activities and staff understood each person’s individual preferences and interests, although these were not always recorded on the care plans.

Procedures were in place to manage concerns, complaints and compliments about the service.

Processes were effectively in place for monitoring the quality of the provision.

We did not identify any breaches in regulation.