This inspection took place on the 20 August 2018 and was unannounced.

Lugano Residence for the Elderly is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is situated is Buckhurst Hill, Essex.

Lugano Residence for the Elderly provides accommodation and support for up to 27 people who may need assistance with personal care and may have care needs associated with living with dementia. There were 26 people living at the service at the time of our inspection. The home does not provide nursing care.

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.

At our last inspection in January 2016 the overall rating of this service was Good. At this inspection we found the service to be good and continuously working towards a high standard of care as to ensure positive outcomes for people using the service.

The service was safe. The service carried out appropriate recruitment checks before staff commenced employment. There were sufficient staff on duty to meet the needs of people and keep them safe from potential harm or abuse. The service assessed and reviewed people’s health and wellbeing to minimise risk to health. The service had a good management and monitoring structure in place for the management of people’s medicines.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The service supported people to eat and drink enough which ensured people maintained a balanced diet.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. The service undertook regular care plans reviews and changes were made when needed. People were supported to follow their interests and participate in social activities. The service responded to complaints received in a timely manner.

The service was well led. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis. The manager told us that current systems and processes where being updated and improved.

This inspection took place on the 26 January 2016 and 2 February 2016 and was unannounced.

Lugano Rest Home for the Elderly provides accommodation and support for up to 27 people who may need assistance with personal care and may have care needs associated with living with dementia. There were 27 people living at the service at the time of our inspection. The home does not provide nursing care.

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.

The service provided good care and support to people enabling them to live fulfilled and meaningful lives. People were treated with kindness, dignity and respect by staff who knew them well. The registered manager ensured staff had an understanding of people’s support needs and had the skills and knowledge to meet them.

People were cared for by staff that had been recruited and employed after appropriate checks had been made. There were sufficient numbers of staff available to meet the needs of people. Staffing levels were calculated according to people’s needs and were flexible to respond to people’s changing needs. Staff told us that they were well supported to carry out their work and had received regular training and supervision.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Medicines were stored and administered in a safe way.

We found there were policies in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were aware of what these meant and the implications for people living at the service. Where people had been deprived of their liberty, applications had been submitted to the local authority for a DoLS authorisation.

People were supported to maintain their health and wellbeing and had access to, and received support from, other health care professionals. People were provided with sufficient food and drink to meet their needs and were provided with a choice of meals.

People’s bedrooms were personalised to reflect their individual tastes and personalities.

There was a programme of social activities available. People were supported and encouraged to pursue leisure activities in the community and to join in activities provided at the home.

People knew how to raise a concern or make a complaint. Complaints were dealt with efficiently and quickly.

There were quality assurance systems in place which assessed and monitored the quality of the service. These included audits on medication management, incidents and accidents, health and safety and seeking the views of people, relatives and staff.

When we visited the house we were told by the people we spoke to about how nice the staff were and the good care that they were given. One person who lived at the house told us that,"I am listened to by staff". Another person said to us that, "The house was a pleasant place to live in". We were told by staff that they liked to work together and they received good support and supervision.

We observed that there were daily activities which were arranged to meet the needs of each person who used the service. We heard no concerns or complaints about the quality of the care provided by the staff. We spoke with two staff who said that the work was, "Very rewarding" and they were, "Relaxed and happy".

We visited the service on 21 November 2012 and were told that a new manager had started on 31 October 2012. On our arrival and throughout our visit we saw that the home was clean, bright and smelt fresh.

During our visit we spoke with six people who lived at the home and two relatives who were visiting. They told us that people were well cared for and very happy. One person told us, "Staff are lovely. They are always happy and smiling and we have laughs with them." One of the relatives told us, "This is a lovely place. I can't fault it."

People told us that they had been involved in the admission and assessment process and had been given information when they arrived at the home. They told us that they had signed their care plans and relatives had been provided with copies of them but we saw from the records we looked at that this had not always been the case.

People told us that they were involved in their care planning and confirmed that they were present at their care plan reviews, confirming that they were able to influence their care.

We saw that there were robust recruitment processes to ensure the suitability of the staff for the roles for which they had been employed.

We saw that personal records were kept securely and could be accessed easily when required.

People living at Lugano had a wide range of needs. Some people had varying levels of dementia and different communication needs. We were therefore unable to fully understand everybody’s specific issues.

A family member told us that they had looked round Lugano prior to accepting a placement for their relative and said they chose Lugano because it “seemed more homely compared to other homes seen.”

The family member told us that they visited regularly and the manager and staff were always welcoming and helpful. They said that they were always consulted about their relative's care and they reviewed their relative's care plan monthly.

Those people we spoke with said that the meals provided were good, with the exception of one person who felt that vegetarian meals could be more imaginative. Everybody spoke highly of the staff and considered staff to be helpful and supportive.

One person told us “The staff are very nice and attentive.”

A healthcare professional visiting the service told us that they were very impressed with Lugano and found it to be a very pleasant and welcoming home, the staff demonstrated a good understanding of people’s needs and that they were pleased with the support provided by staff to their patient.

Relatives told us that the manager was very approachable and that they felt able to raise any concerns if it were necessary and that they were confident that they would be dealt with appropriately.