Hankham Lodge Residential Care Home provides accommodation and support for up to 20 older people who require assistance with daily living due to physical frailty and health needs, such as diabetes. There were 20 people living at the home during the inspection, some were living with memory loss and mild dementia and others needed support to move around the home safely. The home is a converted older building with bedrooms on two floors and there is a passenger lift that enables people to access all parts of the home.

The registered manager, although on maternity leave at the time of the inspection, continued to oversee the service and staff said they were available for advice and support if needed. The registered manager was one of the home’s two providers; the other provider was available during the inspection and informed us they had been managing the home since August 2016 and had send in a notification to inform us of this, but was not yet registered. 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.

This inspection took place on the 10 and 13 April 2017 and was unannounced.

At our inspection on 8 and 16 December 2015 we found the provider was not meeting the regulations with regard to record keeping and the quality monitoring system was not always effective; as it did not enable the provider to identify where quality and safety were being compromised. At this inspection we found improvements had been made and the provider met the regulation.

However, we found that additional work was needed to ensure the improvements were embedded into practice. For example, the quality assurance and monitoring system had been reviewed and a number of audits had been completed. However, the system had not identified areas of concern that we found during the inspection, such as gaps in the care plans.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The management and staff had attended training and had an understanding of their responsibilities with regard to Deprivation of Liberty Safeguards (DoLS). The provider had followed current guidance by contacting the local authority for DoLS assessments when required.

Relevant training was provided; staff were supported to understand people’s needs and develop the skills to provide the support people wanted. Staff had attended training and had an understanding of the Mental Capacity Act 2005 and, people who did not have capacity to make some decisions were supported to make choices about all aspects of their day to day lives. People chose where they spent their time, in their own rooms or the communal areas. They were very positive about the food and told us activities were available for them to join in if they wanted to. Staff were kind and caring and treated people with respect.

Staff had attended safeguarding training; safeguarding and whistleblowing policies were in place and staff demonstrated an understanding of abuse and how to protect people. The atmosphere in the home was calm and people said they were very comfortable living there and felt safe and well cared for.

There were systems in place for the management of medicines. Staff had attended training and completed records as they gave people their medicines.

The recruitment process was robust, it ensured only suitable people worked at the home and there were enough staff working in the home to provide the support people wanted.

Complaints procedures were in place. The provider encouraged people, relatives and staff to be involved in decisions about how they improved the service and, people and staff were positive about the management of the h

There were 20 people living at Hankham Lodge Residential Care Home at the time of this inspection visit.

We spoke to four people who used the service in depth, one visitor, and two staff working in the home. We spoke with the registered manager and the provider. We spent time with people using the service and observed interaction they had with each other and with the staff.

We saw staff asked for people's consent before they provided any care or treatment. People told us they were never made to do anything and they were free to make choices about their life. One person told us, “I like to have my meals in my own room, and this is respected.” People told us that they received good care and were well treated.

We reviewed the premises and saw that the home was well maintained with safety issues taken into account.

We reviewed the recruitment practice and associated documentation. We found the home followed robust recruitment processes for the recruitment of new staff.

We looked at a number of records and found that these had been managed and completed in a consistent manner.

We spoke with seven people living in the home at the time of the inspection. They all said that they were very satisfied with the care that they received from staff.

A person told us that staff were all friendly and helpful. ‘’Staff are fantastic. If I need them, I use my call bell and they come really quickly‘’.

We spoke with one relative. She told us that staff were generally very helpful and friendly. However, she had concerns about some of the care that her mother received, and the way a complaint she made last year had been dealt with.

This was largely a positive inspection. People living in the home stated that they were highly satisfied with the care they were provided with. A relative expressed satisfaction with the staff of the service. However, she thought that personal care could sometimes be better: that hot water always needed to be available for washing and that complaints needed to be handled in a more positive way.

The main issues we identified were to ensure that care fully meet people's needs, fire precautions were always fully in place, that hot water was always available to people and staff, and that complaints are always positively handled, in line with the stated complaints procedure of the home.

Hankham Lodge Residential Care Home is registered to provide accommodation for up to 20 older people with care needs associated with age. The needs of people varied, some people were mainly independent others had low physical and health needs and others had a mild dementia and memory loss. The care home provided some respite care and can meet more complex care needs with the support of community nurses which has included end of life care. A small day care provision was also provided.

At the time of this inspection 19 people were living at the home.

This inspection took place on 8 and 16 December 2015 and was unannounced.

The service had a registered manager in place who was although was on maternity leave continued to have an overview of the service provision. The registered manager was also one of the registered partners/owners of the service. 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 emphasised how happy they were to be living at Hankham Lodge Residential Care Home and liked the homely feel of the service. One person said “I feel like part of the family now and they know my family too.” Another told “I don’t think there’s anywhere better.”

Despite having positive feedback from people on the safety and management of the service. We found areas that could impact on people’s safety and care.

The recruitment practice followed did not always ensure the required checks had been completed for all staff before they worked unsupervised. Possible safeguarding risks were not assessed openly in the home to ensure they could be monitored in a sensitive and confidential way.

The management arrangements had not ensured staff had maintained suitable documentation and systems to ensure effective and safe care was always delivered. Auditing and quality monitoring systems were not always effective and did not demonstrate people’s views were taken into account and responded to.

Feedback received from people their relatives and visiting health professionals through the inspection process was positive about the care, the approach of the staff and atmosphere in the home.

People told us they felt they were safe and well cared for at Hankham Lodge Residential Care Home. Medicines were stored, administered and disposed of safely by staff who were suitably trained.

Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. People had access to health care professionals when needed.

There was a variety of activity and opportunity for interaction taking place in the service. This took account of people’s preferences and choice. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with the registered manager and owner of the service. On call arrangements were in place to provide suitable staffing and management cover.

People were complementary about the food and the choices available. People needed minimal support with eating and staff were positive in their approach to promoting people’s independence.

People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

There was an open culture at the home that supported a friendly and homely environment that both people and staff enjoyed.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.