Hengrove Lodge is a residential care home registered to provide accommodation and personal care for up to 15 older people. At the time of the inspection the service was looking after 15 people but one person was in the process of moving to an alternative care home.

The inspection was unannounced. At the last inspection in January 2016 the service was rated as Good. At this inspection we have found the service to be exceptionally caring and to have maintained a good rating.

Why the service is rated Good

There was a long-term registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 service people received was safe. The staff team had received training in safeguarding adults and knew what to do if concerns were raised regarding the people they looked after. Any risks to people’s health and welfare were well managed. Staff recruitment procedures were robust and pre-employment checks ensured that only suitable staff were employed. The management of medicines followed safe working procedures and clear records were maintained. The premises were clean, tidy and fresh smelling. No infection control issues were identified.

The service people received was effective. The assessment and care planning processes followed ensured people’s care and support was person centred and met their individual needs. Staff were well trained. New staff had to complete an induction training programme and there was an on-going mandatory training programme for the rest of the staff team. The staff team had the right skills, knowledge and experience to deliver effective care and support. Mandatory training included Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The staff team worked within the principles of the legislation.

People were provided with sufficient food and drink. Each person was able to have a say about the meals that were served and were offered an alternative if they wanted something else to eat. The staff team supported people to access other health and social care services as required.

People were looked after by staff who were exceptionally caring. The feedback we received from people and their relatives was overwhelmingly complimentary. Their comments included, “Everyone is so good to me. The staff are so helpful and caring”, “I cannot fault a thing, my life is very good and I wish I had moved in years ago”, “This is an exceptionally caring home. When I was looking for a place for Mum I visited others. The welcome I received when I visited here was what made the difference” and “This home was recommended to me by a healthcare professional. It has exceeded the family’s expectations and we are fully confident that Mum is extremely well looked after”. Health care professionals said, “People are very well looked after here and the home is a nice place to visit” and “People receive a person centred service. This is a very homely home and the staff are all very caring”.

The service people received was responsive to their individual needs. Each person received a person centred service. They were supported to have a meaningful and fulfilling life with the ability to participate in the activities they liked. A range of different activities were arranged including visits by external entertainers and stay and play sessions with toddlers from a local children’s centre.

The service was well led. The registered manager provided good leadership and management for the staff team. The staff team were committed to providing people with a good quality and safe service and many o

We undertook an unannounced inspection of Hengrove Lodge on Wednesday 13 January 2016. When the service was last inspected during April 2014 no breaches of the legal requirements were identified.

Hengrove Lodge provides accommodation for people who require personal care to a maximum of 15 people. At the time of our inspection 15 people were living at the service.

A registered manager was in post at the time of 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.

People at the service told us they felt safe and a person’s relative said they never needed to worry about the person living at the service. We saw the service had undertaken an assessment of people’s individual needs and had recorded risk management guidance where appropriate.

There were sufficient staff on duty to meet people’s assessed needs and recruitment procedures were robust to reduce the risk of unsuitable staff being employed at the service. The provider had ensured staff had received training to allow them to identify and report actual or suspected abuse if required.

The service was clean and there were policies and procedures in place to reduce the risk of cross infection. People received their medicines when they needed them and equipment was regularly maintained to ensure it was safe to use.

People and their relatives said staff provided effective care. Where required, people were supported to access healthcare professionals to ensure their healthcare needs were met. The registered manager told us they had a good relationship with relevant GPs.

The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. The registered manager had implemented an effective system to ensure any conditions attached to DoLS were met. Staff were aware of how the Mental Capacity Act 2005 impacted on their role and demonstrated how they applied the principles of the Act in their role.

People received support with their nutrition and hydration. Staff said they were provided with regular training, supervision and appraisal. We reviewed records that supported this. The provider had an induction process aligned to the new care certificate.

Positive comments were received about the caring nature of the staff. The services compliments log also contained positive views from people. People’s relatives were welcomed at the service and felt the registered manager and staff communicated well with them. People were spoken with respectfully by staff. Staff understood the health and social needs of the people they cared for. People were supported by the service at the end of their life in accordance with their wishes.

People said staff responded to their needs. There were systems to ensure staff communicated key information about people to each other to ensure people’s needs were met. Care records contained personalised historical information about people and staff showed knowledge of this information. People had the opportunity to participate in activities and a complaints process was in operation. We made observations during the inspection of staff being responsive to people’s needs.

People and their relatives knew the management structure within the service. Staff were positive about the support they received from the services management and their colleagues. Staff spoke of a positive team environment.

The registered manager had been given regional and national recognition of their management and leadership achievements. There were methods to communicate with people and staff and people were asked for their views. There were systems that monitored the quality of service provided.

We set out to answer our five questions during our inspection; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

At the time of our inspection there were 12 people living permanently in the home and two people were staying for a short stay. We observed the care being provided to people in the communal areas of the home and examined the care documentation and supporting records. We spoke with six people that used the service who were able to tell us of their experiences and we spoke with four members of staff to gain their understanding of how they met the needs of people living in the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is it safe?

Staffing was maintained at safe levels. During our inspection people’s needs were responded to in a timely manner. Staff received training which included dementia training. This was because some people living in Hengrove Lodge were living with a form of dementia. This meant staff were trained to support people through their dementia journey.

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff had a good understanding of who they needed to contact should they have any concerns around people’s welfare. Two people that lived in the home told us they felt safe and told us if they had any concerns they would tell the manager. People who used the service were cared for by staff who knew how to protect them from the risk of abuse.

We spoke with staff who explained what whistle blowing at work was and knew the procedures that were in place. They told us it meant to report to someone in authority if they suspected malpractice and or abuse at work that could compromise people’s safety. We saw a copy of the whistle blowing procedure was up to date with the contact information of who staff could report concerns to.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). The registered manager confirmed no one currently living in the home was subject to such an application. However relevant staff had been trained to understand when an application may be required and the registered manager told us about times when they had sought advice in the past from the Dols team. This meant that people were safeguarded from abuse.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. We saw that incidents and accidents were regularly audited by the manager. This reduced the risks to people and helped the service to continually improve people’s safety.

Is it caring?

People were supported by sensitive and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. We spent time in the communal lounges observing interactions between staff and people that used the service. The observations we made demonstrated staff supported people in a calm unhurried manner, using communication methods conducive with their individual assessed needs. Staff sat with people playing dominoes and doing puzzles. People were consulted before staff undertook their care routines. This was confirmed by people that we spoke with.

People who lived in Hengrove Lodge that we spoke with told us they felt safe and happy living in the home. People’s comments included: “I have never been happier; we have a game of dominoes often”. “I do lots with my day, I enjoy sewing and knitting”. “Staff are nice”. “We do what we want to do to be honest”. “I get up and go to bed when I like”.

People’s preferences, interests, likes and dislikes had been recorded that supported their individual needs.

Is it effective?

We found people’s health and care needs were assessed with them and reviewed regularly. Care plans provided guidance for staff to follow to ensure people’s individual specific needs were met. Care plans were reflective of people’s current level of need.

Specialist dietary, mobility and equipment needs had been identified in care plans where required. People told us their keyworker met with them on a monthly basis.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

There was an independent counselling service provided regularly within the home. This was provided by the provider on a six weekly basis. This meant that when required, people could access additional confidential support.

Is it responsive?

People's needs had been assessed before they moved into the service. The registered manager told us people met with their key workers monthly to discuss their care plans and relatives were involved as people required and agreed.

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. For example people's files held information and advice sought from the district nurse team in relation to their wound management care. Records demonstrated they visited on a regular basis.

Is it well-led?

People that used the service, their relatives and external professionals completed a satisfaction survey once a year. The registered manager told us if any concerns were raised these would be addressed promptly. Comments included: “The home is wonderful”. “Home is led by a brilliant manager and all staff”. “I am well looked after here”. Comments from externals professionals included: “Staff are always knowledgeable about people” and “Privacy is always respected”.

Some people we spoke with were able to tell us their experience. They confirmed they felt listened to by staff and knew how to raise a complaint if they needed to.

We first inspected Hengrove Lodge on 15 May 2013. During our inspection we highlighted that improvements were required in Regulation 12 'cleanliness and infection control'.

The provider submitted an action plan that identified the actions that had been taken to improve this area. We returned to the home on 30 July to review the improvements made. We did not speak with people who lived in the home this time about this outcome, as they were observed in the dining room engaged in the lunchtime activity.

During our inspection we spoke with the registered manager, a member of the care and kitchen team, examined the cleaning records and undertook an inspection of the areas that were highlighted at the last inspection as requiring improvements.

The registered manager told us they had improved their systems and monitoring of the cleaning schedules. Records that we viewed confirmed this.

The conclusion of our inspection was that the provider was compliant with regulation 12.

At the time of our inspection 13 people were living in Hengrove Lodge. During our inspection we spoke with people living in the home, staff, relatives and examined the care records for people living in the home.

Not all people were able to verbally tell us about the care they received and if they were happy. Therefore we observed how staff interacted and supported people in communal areas, to enable us to make a judgement on how their needs were being met.

We observed some people being supported and examined their care plan documentation to ascertain if an appropriate level of care was being provided, in line with their assessed needs.

Overall people we spoke with who used the service and their relatives were happy with the care they received. Comments included; “they keep us nice they love us”, “I love all the girls here they are very kind”,” I feel safe here”, “I'm happy here the food is lovely I eat it all”.

A visitor told us their relative had recently moved into the home and told us the staff kept them informed of any changes in their relatives needs. Relative comments included; “staff try really hard here to make X comfortable. I do feel they involve me as I come here quite a lot”.

We used a number of different methods to help us understand the experiences of people using the service including talking with people who live there and their relatives and with staff and managers, looking at records, care files and observations of practice.

We spoke with seven people who use the service, three relatives, six staff and one visiting professional. People who use the service told us, “Its lovely here”, “The staff are lovely and helpful”, “We are like a family here” and “It’s different here than being at home but they are helpful”.

We spoke with three relatives who said,” They have done wonders since moving my relative here”, “The manager’s door is always open and they will deal with any concerns straight away” and “The home has no unpleasant odours”. Another person said “We are happy with the service here, It’s a nice small home much better than a bigger home”.

One professional who was visiting the home told us, “I visit several times a week and this home is really good for keeping appointments, they have good communication across the team and referrals are appropriate. It has a lovely relaxed atmosphere whenever I come”.