We carried out an unannounced inspection on 24 May 2017.

Highview Lodge provides accommodation and nursing care for up to 77 people, some of whom live with dementia. At the time of our inspection there were 74 people living in the home.

The service had 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm. People’s medicines had been managed safely.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by staff who were exceptionally caring and respectful, and who knew them well. People enjoyed living in a person centred home which catered for their requirements.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. The service supported people with health care visits, such as GP appointments, optician appointments, chiropodists and hospital visits.

There was a formal process for handling complaints and concerns. The registered manager encouraged feedback from people and acted on the comments received to continually improve the quality of the service. There were effective quality monitoring processes in place to ensure that the home was meeting the required standards of care.

During this inspection we found that the home was meeting the needs of the people who lived there. Improvement had been made following our previous inspections in November 2012 and in July 2013.

We saw that the people who lived in the home were well cared for, staffing levels had been increased to meet the people’s identified needs. Staff had undergone training and were now meeting the peoples’ needs in a person centred manner.

The people looked well groomed and well cared for and those we spoke with confirmed this. Visitors told us that they were happy with their relative’s care.

The staff told us that they now have time to care for the people and engage with them in order to stimulate them and to improve their wellbeing.

During our visits to Highview Lodge on the 03 and 09 July 2013 we found that the compliance actions we required the home to meet following our inspection in November had not been met. The concerns we identified related lack of staffing and promotion of people’s dignity and independence. We did not find that the service had listened to the concerns we raised with them as improvements had not been made.

We had mixed comments from the people who live at Highview Lodge, some told us that the liked living there and others said that they wanted to go home. We were told that the staff were nice but that they were very busy. One person said that it was a 'dammed awful place' and that they wanted to go home.

We found that staff worked in a task led manner and had unreasonable workloads which meant that they did not have time to offer person centred care to the people.

We found that most of the people who lived at Highview Lodge were unable to communicate with us directly. We observed the care of the most vulnerable people who lived in the home and found that there was not enough staff on duty to deliver person centred care to the people.

We found that staff had to complete a high number of domestic tasks, which left little time to meet the needs of the people beyond their basic care. We saw that people were left unattended for long periods of time. We saw that people’s dignity and independence was not promoted.

We heard staff discuss people’s needs in a public area where they could be overheard. If the staff had withdrawn from the area to discuss the person concerned, in private, the rest of the people would have been left unattended.

The records we reviewed showed that the staff had received training in all mandatory area of care delivery and that all the staff had been trained in the care of people who have a dementia.

The staff we spoke with consistently told us that they would like to be able to deliver person centred care but they didn’t have the time. They told us that they like to take their breaks while chatting to the people as this was usually the only opportunity they got to chat to the people.

Visiting health professionals told us that the care of the people had improved in the past year and that they worked well with the staff.

We used a number of different methods to help us understand the experiences of people using the service who were living with dementia, which meant they were not able to tell us their experiences. We observed how the staff interacted with them, and understood how each person was able to communicate their needs. We observed one person sitting with a member of staff who was quietly holding their hand, while they looked around at other people nearby. The care plan for this person stated that they liked a quiet environment, and that staff should approach them quietly and talk to them to encourage their awareness of their environment. We spoke to the relative of one person, who told us that the staff showed understanding of their relative’s needs, and treated them with respect and dignity.

The people who we spoke with in other areas of the home praised the staff, and said that staff were always available to assist them when needed.

They told us that they were aware of the measures that were in place to ensure their safety, for example for two people to provide their care.

This inspection took place on 03 March 2015 and was unannounced. Highview Lodge is a care home that provides accommodation and personal care for up to 77 older people some of whom may be living with dementia. On the day of the inspection, there were 74 people living in the home.

The service has a registered manager. 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 and they were protected against the possible risk of harm or abuse. Risks to individuals had been assessed and managed appropriately. There were sufficient numbers of experienced and skilled staff to care for people safely. Medicines were managed safely and people received their medicines, regularly, on time and as prescribed.

People received care and support from staff who were competent in their roles. Staff had received relevant training and support from management for the work they performed. They understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. They were aware of how to support people who lacked mental capacity. People’s nutritional and health care needs were met. They were supported to maintain their health and wellbeing and had access to and received support from other health care professionals.

The experiences of people who lived at the care home were positive. They were treated with kindness and compassion and they had been involved in the decisions about their care. People were treated with respect and their privacy and dignity was promoted.

People’s health care needs were assessed, reviewed and delivered in a way that promoted their wellbeing. They were supported to pursue their leisure activities both outside the home and to join in activities provided at the home. An effective complaints procedure was in place.

There was a caring culture and effective systems in operation to seek the views of people and other stakeholders in order to assess and monitor the quality of service provision.