Nazareth Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Nazareth Lodge can accommodate up to 24 older people. Nazareth Lodge has people living with dementia and has cared for people requiring end of life care. At the time of the inspection there were 22 older people living at the home.

People had meaningful relationships with the staff and were treated with respect and dignity. Providing dignified care was a fundamental aim of the provider and staff understood how to support people needs. Staff were observed to be very kind, caring and compassionate towards people they were supporting.

People were treated with respect, and empowered to have a voice in regards their care and told us they felt listened to. The provider told us, “If you have no voice you cannot exercise choice and control over your life”. People were involved in supporting the management team to employ staff through their recruitment process. People also received the support of volunteers who had been matched through mutual interests. One volunteer told us, “The contribution I gave and also received has made me feel very valued. It is so lovely to give one to one support to people, I have had all sorts of adventures being a volunteer here, it has been an amazing experience for me and I hope I gave something back”.

Staff were highly motivated, worked well as a team and shared a common ethos of providing high quality, compassionate care with regard to people's individual wishes and support needs. Staff were valued, well supported and supervised by the management team. Staff rotas were flexible and regularly amended to ensure people were able to be supported by the staff they knew and trusted. An example was shared where people and their relatives voted for a member of staff who they believed they had received exceptional care and support from. One relative told us “The carers are excellent. When we have to make a choice for voting for one of them I just can’t.”

Staff understood the provider's safeguarding procedures and could explain how they would protect people and who to contact if they had any concerns. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of the risks that people faced and understood their role in managing these to ensure people received safe care.

The service worked very well with other organisations. People, visitors, staff and health and social care professionals spoke highly of the registered manager; they told us they found them to be committed, supportive and approachable. One health and social care professional told us, “We have no concerns here, and are confident people are receiving effective care and support by staff who have the right attitude and skills.”

People were aware of the complaints procedure and told us they were confident if they made a complaint it would be dealt with appropriately. Systems were in place to support people who had communication needs such as a computer with a large keyboard.

People's physical, mental health and social needs were assessed and provided in line with current legislation and best practice guidelines. Staff were well trained, received continued professional development and had the quality of their performance regularly reviewed.

People were encouraged to make choices about their food and people's nutritional intake was monitored where needed.

People living at Nazareth Lodge were able to access the community with support or independently.

The provider encouraged community involvement and links with other providers which ensured that people felt

We used a number of different methods to help us understand the experiences of people using the service. This is because some of the people using the service had complex needs which meant that they were not able to tell us their experiences. We observed care being delivered to people, spoke with staff, and relatives of people who use the service and looked at records related to care delivery.

We looked at three care records and spoke with four people who use the service. We also spoke with two people about their relative’s care. We spoke with six members of staff and the owner. Three of the staff were carers, one was the registered manager, one the deputy manager and one was the chef. We also spoke with the owner of the care home. We saw that people’s care plans were clearly set out and people’s needs met. The care plans included people’s preferences and choices.

We saw that people were treated with respect, and that their privacy and dignity was valued and maintained. All the people who use the service that we spoke with felt they were treated well. One person told us they found the service “absolutely kind and homely”; another person said “wonderful food” and added that the staff “do anything for you”. Relatives of people who use the service told us that people were treated with respect; one relative told us “so homely and caring, staff really know my relative and what they like doing”.

Staff told us they felt very well supported and equipped with the right skills and training to care for people who use the service. Staff were able to describe the provider’s safeguarding procedure and their role in keeping people safe.

The views of people who use the service, their relatives and the views of visiting professionals were surveyed and systems were in place to monitor the ongoing performance of the service.

We observed that the home was designed to provide stimulation within a relaxed atmosphere. We observed people who were enabled to pursue individual activities or be in the company of others or just relax on their own.

We observed participation was strongly encouraged which helped promote independence.

We found evidence of timely risk assessments and that relatives of people using the service influenced decisions about the care and support.

One person told us,” I just think everyone is kind’ This was borne out in evidence from the care records which showed positive and timely care interventions alongside a strong person centred approach toward each resident.

We observed positive relationships between people and staff and between residents.One person who had recently arrived to live at the care home told us, “we all just get on with each other here”

Staff were strongly supported to develop their skills and confidence and given clear guidelines for how they worked. This was reinforced by the manager who spent time with people and staff.

Safeguarding procedures were embedded and appropriate actions were put in place to address concerns as they arose. There was evidence that learning from incidents took place and appropriate changes were implemented.

An unannounced inspection took place on 1 September 2015. A second inspection visit took place on 3 September and phone calls were concluded by 7 Sep 2015. At the last inspection of 27 December 2013 the service was meeting all the standards inspected.

Nazareth Lodge is situated in the middle of a small rural town and provides personal care and accommodation for up to 24 older people, some of whom are living with dementia. The home has rooms over two floors and a passenger lift in place. At the time of inspection 23 people lived in the home as one room was used for short stays.

The service was run by a management team consisting of the registered manager, deputy manager, and the owner. 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 was welcoming, friendly and calm when we visited. People were relaxed, engaged with people around them or enjoying activities inside or in the town. There was a well-tended garden used for relaxation, growing vegetables and keeping chickens. One person told us, “I’m very settled here, it’s very friendly and there is always someone here. It’s just very good.” There were choices in the lay out of the home for people to be together, have time to themselves or have private space with their visitors. Visitors were served with a meal with their relative or friend who lived at the home and offered a sunny conservatory affording privacy and quiet.

All the people who spoke to us without exception used words such as ‘caring’, ‘kind’, ‘thoughtful’, and ‘excellent’ in describing the care and support they received. Another person told us, “everything I have received here –there is nothing to complain of and the care is second to none.” One person told us, “the food is good, staff are kind. The staff are well trained.” Relatives were positive about the service. They told us this was because they felt their loved ones were settled and happy, they were kept informed and had been themselves supported by staff through difficult moments. One relative told us, “my relative took a while to settle. Everyone was courteous and polite; the staff keep you in the loop about everything. All the staff are very nice and respectful.” Another told us, “it’s just so personal here and everyone is consistently caring and understanding.” Another told us, “it’s just like an extremely well run hotel with a feeling of calm. I am sure a lot of hard work goes on in the background but there no pressure is felt out here.” This view was echoed by other visitors we spoke to who knew the service well. The service aimed to provide people a home for life and was committed to offering skilled and compassionate end of life care. We found this principle had been embedded within the service, as reflected in feedback from relatives, staff, and healthcare professionals and through external accreditation.

The owner and staff team were highly committed to offering people new experiences or opportunities to do things connected with their interests. This was combined with a goal to ensure people received one to one attention on a regular basis. There was an outstanding range of activities and social links for people to become involved with if they wished, from making bird boxes, gardening, doing crosswords together, an established computer club and poetry sessions, to receiving visiting birds of prey and donkeys. Events such as ‘fine dining’ were arranged regularly and used as opportunities for people in the home to be involved in the preparation and celebration of a formal social occasions with invited guests. Opportunities were created throughout the week for people to have time with just one other person who was there to listen.

Staff were well trained, well rewarded and supported to continue their professional development and study relevant qualifications. There was outstanding team working reflected in all the comments from staff, people and relatives. All staff demonstrated they understood the core values and vision of the service and described their commitment to high quality care. Members of staff told us, “I love my job,” or “I love working here.” One person told us, “you can tell all the staff are happy in their job.”

The service had invested efforts over the last five years in developing an experienced and caring volunteer visiting service. We saw this yielded particular benefit for people, either who did not have many visitors or who were reluctant to participate in group activities. Others told us they just enjoyed time with someone on a one to one basis just to chat or go out together. One person who needed accompanying when outside due to physical frailty, was visited weekly by a volunteer and enabled to go on long walks around the countryside which was familiar to them.

The owner and staff prided themselves on well-established local links which were used to benefit people who lived in the home, as well as create a local and stable workforce. This helped several people to continue their involvement in their local community. One person explained that they continued to visit the same beauty salon and another told us they were delighted to still be able to attend their own church and opticians. People who were independently mobile came and went throughout the day. One person told us, “you have every confidence here, you can come and go as you like, you’ve got freedom- just let them know when you go out, they let you be yourself.” Some people had produced food or plant items for exhibit at the local show recently and won awards.

Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. Staff demonstrated awareness and knowledge in the area of consent, explaining to us how they would adapt giving information to someone to aid understanding and help them make decisions.

Many people went out of their way to comment on the quality of the food. One person told us, “you get three beautiful meals a day.” The owner and the cook were very involved in continually driving up standards of nutrition and presentation. This had been recognised in several national awards linked to the catering. Where people had special dietary requirements, this was known and catered for by staff.

People’s health and wellbeing needs were closely monitored. People benefitted from excellent links with local primary care services which had been developed by the staff team. We spoke with healthcare professionals who told us the service was particularly effective at seeking advice and following their instructions. This close liaison also was reflected in the excellent end of life care at the home

People’s safety risks were identified, managed and reviewed. Staff knew people well and used this knowledge combined with effectively guidance from senior staff to reduce the risk of harm. There were enough suitable staff to meet people’s needs and promote people’s safety and wellbeing. There were systems in place to protect people from the risks associated from medicines and staff were vigilant in monitoring and using these.

The service sought to understand and improve on people’s experiences and the service overall through a variety of established feedback mechanisms, also seeking views of relatives and other professionals involved with the service. We found an open and transparent culture led by a highly effective leadership team who encouraged listening to people and staff to drive continual improvement. This contributed to the high levels of satisfaction we heard expressed at the service. One person told us, “nothing can be perfect, but I am listened to which makes a difference and I am extremely happy.”