Garden Lodge is a ‘care home’. People in care homes receive accommodation and personal care as a 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.

Garden Lodge accommodates 10 people in one adapted building. At the time of our unannounced inspection there were 9 older people, some of whom were living with dementia, living at the service.

This inspection took place on the 8 January 2018 and was unannounced. At the last comprehensive inspection on 11 December 2015 we rated the service as good. At this inspection the service remains rated as good.

Why the service is rated good.

The Care Quality Commission (CQC) records showed that the service had a registered manager. However, they were unavailable during this 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.

Staff demonstrated to us an understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff demonstrated their knowledge about how to report poor care practice and suspicions of harm. However, not all staff could demonstrate their understanding of what would be a safeguarding concern. Information and guidance about how to report concerns, together with relevant contact telephone numbers were displayed as a prompt for staff to refer to. Pre-employment checks were in place to ensure that new staff were considered suitable to work with the people they were supporting.

People were assisted to take their medication as prescribed. Processes were in place and followed by staff to make sure that infection control was maintained and the risk of cross contamination was reduced as far as practicable.

The service had building adaptations in place to help people with limited mobility. This meant that people could access all of the communal areas and garden.

Staff supported people’s individual needs in a kind, patient and respectful way. People’s privacy and dignity was promoted and maintained by the staff members assisting them.

People and their relatives were given the opportunity to be involved in the setting up and review of their individual support and care plans. Staff encouraged people to take part in activities and maintain their interests. People’s friends and family were encouraged by staff to visit the service and were made to feel very welcome.

People were supported by staff and external health care professionals, when required, at the end of their life to have a comfortable and as dignified a death as possible.

People had individualised care and support plans in place which recorded their needs. These plans informed and prompted staff on how a person would like their care and support to be given, in line with external health care professional advice. Individual risks to people were identified and monitored by staff. Plans were put into place to minimise people’s risks as far as practicable to allow them to live as independent and safe a life as possible.

People were supported by staff to have enough to eat and drink. People were assisted to access a range of external health care professionals and were supported by staff to maintain their health and well-being.

Staff were trained to be able to provide care which met people’s individual needs. The standard of staff members’ work performance was reviewed by the registered manager through supervisions, spot checks and appraisals. This meant that the registered manager monitored and supported staff through regula

Garden Lodge is a care home that provides accommodation and personal care to up to 10 older people, some living with dementia. It is not registered to provide nursing care. There were nine people living at the home at the time of this visit. There are internal and external communal areas, including a lounge/dining area, and a garden for people and their visitors to use. The home is made up of two floors which can be accessed by stairs. All bedrooms are on the ground floor with an upstairs room used as an office. Two bedrooms are en suite with hand wash basins in the other seven rooms. There was a communal bathroom and communal toilet for people to use.

There was a registered manager in place during this 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 Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Where people had been assessed as lacking capacity to make day-to-day decisions, applications had been made to the local authorising agencies. Staff demonstrated to us that they respected people’s choices about how they wished to be supported. Staff were able to demonstrate a sufficient understanding of MCA and DoLS to ensure that people would not have their freedom restricted in an unlawful manner.

Plans were put in place to minimise people’s identified risks, to enable people to live as independent and safe a life as possible. Arrangements were in place to ensure that people were supported with their prescribed medication. Medication was managed and stored safely. However, an accurate record of people’s ‘as required’ medication was not always kept.

People, when it was needed, were assisted to access and were referred to where appropriate a range of external health care professionals. People were supported to maintain their health. Staff assisted people to maintain their links with the local community to promote social inclusion. People’s friends and families were encouraged to visit the home and were made to feel welcome. People’s nutritional needs were met.

People who used the service were supported by staff in a kind and respectful way. Care and support plans prompted staff on any individual assistance a person may have required as guidance. Records were in place to monitor people’s assessed care and support needs.

People and their relatives were able to raise any suggestions or concerns that they had with the registered manager and staff and they felt listened to.

Staff understood their responsibility to report any poor care practice. There were pre-employment safety checks in place to ensure that all new staff were deemed suitable to work with the people they supported. There was an adequate number of staff to provide people with safe care and support.

Staff were trained to provide care which met people’s individual care and support needs. The standard of staff members’ work performance was reviewed through supervisions, appraisals and competency checks. This was to ensure that staff were competent and confident to deliver people’s support and care.

The registered manager sought feedback about the quality of the service provided from people, their relatives and visiting stakeholders. Staff meetings took place and staff were encouraged to raise any suggestions or concerns that they may have had. Quality monitoring processes to identify areas of improvement required within the service were formally documented with action required recorded.

During our inspection we gathered evidence to help us answer our five questions: 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 kind and attentive staff. We observed how staff members treated people within Garden Lodge and saw that this was done in a kind, encouraging and attentive way.

We saw evidence that people using the service, external healthcare professionals and visitors to the home were asked to complete a satisfaction questionnaire. Where suggestions were raised, these were addressed.

Is the service responsive?

People and relatives of people living at the home told us that the provider had an ‘open door’ policy. This meant that they could raise any suggestions or concerns with the provider and were confident that these concerns would be listened to.

Is the service safe?

People we spoke with told us they or their relative felt safe. Risk assessments regarding people’s individual activities were carried out and measures were in place to minimise these risks.

The home had policies in place in relation to the mental capacity act 2005 and deprivation of liberty safeguards although the provider told us that no applications had needed to be submitted.

The home and décor were maintained to an adequate standard. A relative told us that the, “Décor of the home is OK; bedroom is always clean and tidy”.

Is the service effective?

Our observations found that members of staff knew people’s individual health and well-being needs.

Relatives we spoke with told us that they were able to see their relatives at any time because visiting times were flexible.

Is the service well led?

Quality monitoring systems were in place so that people were listened to and were safe from the risk of unsafe and inappropriate support and care.

The service worked with external social and healthcare professionals to make sure that people received the care and support they needed and in a joined up way.

Records showed us that staff were trained to deliver safe care and support. However, the provider could not demonstrate to us that all staff who had worked at the home for over one year had an appraisal.

All of the five people with whom we spoke gave us positive feedback about the service. One of them said, ”I get on well with the staff because they’re so kind. It’s friendly here like a home should be”. A relative said, “I’m very pleased with the care my mother gets in the home and I like the way staff are kind and helpful to her”.

We saw that people had been given accurate information about the fees they would have to pay. Records showed that people had been correctly charged for the facilities and services they had received.

People said or showed us that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

We found that there were reliable arrangements to ensure that people received the medication that had been prescribed for them.

Records showed that security checks had been completed on staff to help ensure that only suitable and trustworthy people were employed in the service.

Documents showed that there was a system for dealing with complaints in a fair and effective way.

People said that staff members were polite, kind and respectful. They confirmed that their privacy and dignity was respected. They stated they were involved in reviewing their care plan and were supported to make decisions regarding their immediate care needs and wishes.

We found that staff members were gentle and listened to people. They supported people to remain as independent as possible and care records provided clear information about meeting the needs people could not meet themselves.

People we spoke with said that staff members were always available and that they did not have to wait for assistance. There were adequate staffing levels and staff members were appropriately trained.

People said that they felt safe and that they were happy living at Garden Lodge. They confirmed they would be able to raise concerns with the manager and stated that they felt sure action would be taken. Staff members had a good understanding of their role in reporting abuse, what to look for and how to support people if this happened.

There were systems in place to regularly check and monitor the way the service was run.