This inspection took place on 21 and 22 November 2016 and was unannounced. Preston Lodge provides accommodation and personal care to a maximum of six people with dementia. At the time of our inspection, there were six people using the service.

Our last inspection on 13 January 2016 found five breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches in respect of medicines management, appliances, deprivation of liberties safeguards (DoLS) authorisations, staffing and good governance.

There was a registered manager in post at the time of our 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 who used the service told us they were satisfied with the care and services provided in the home. During the inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff.

Safeguarding policies and procedures were in place to help protect people and minimise the risks of abuse to people. Care support staff were able to describe the process for identifying and reporting concerns and were able to give examples of types of abuse that may occur. They told us that if they saw something of concern they would report it appropriately.

The inspection in January 2016 found a breach of regulation as controlled drugs were not stored in accordance with legislation. The inspection in November 2016 found that the provider had addressed this and the appropriate medicines storage cabinet was in place. We also found that appropriate arrangements were in place in relation to the recording and administration of medicines.

The inspection in January 2016 found that there was an unpleasant odour in one person’s bedroom and a large stain on the carpet. The inspection in November 2016 found there was no unpleasant odour in any bedrooms or in communal areas. Also the large stain on the carpet had been removed. We also found that some areas of the home which were 'tired' looking at the previous inspection had been redecorated.

The inspection in January 2016 found that the safety inspections for portable appliances was overdue and we found a breach in respect of this. During the inspection in November 2016 we saw evidence that since the last inspection this safety test had been carried out.

On both days of the inspection we observed that care support staff did not appear rushed and were able to complete their tasks. Care support staff we spoke with told us there were enough staff and they were able to complete their tasks. The registered manager confirmed that they did not use agency staff and that the home focused on ensuring there was consistency of care support staff so that people who lived in the home were familiar and comfortable around care support staff.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were also

noted.

During the inspection in January 2016 we did not see sufficient evidence to confirm that care support staff were supported in respect of training and supervisions and we found a breach of regulation in respect of this. The inspection in November 2016 found that the provider had taken appropriate action to improve the service. Care support staff had completed appropriate training and received regular supervision sessions where they had an opportunity to review their personal development and progress.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capac

This inspection took place on 13 January 2016 and was unannounced. Preston Lodge provides accommodation and personal care to a maximum of six people with dementia. At the time of our inspection, there were five people using the service.

The provider met all the standards we inspected against at our last inspection on 19 June 2014.

There was a registered manager in post at the time of our 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.

Positive caring relationships had developed between people who used the service and staff and during the inspection we observed people were treated with kindness and compassion. People who used the service told us they felt safe in the home and around staff. Their relatives confirmed that they were confident that people were safe in the home and around staff. Systems and processes were in place to help protect people from the risk of harm.

There were enough staff to meet people’s individual care needs and this was confirmed by staff we spoke with. On the day of the inspection we observed that staff were not rushed and were able to complete their tasks.

Arrangements were in place in relation to the recording and administration of medicines. People confirmed that they received their medicines on time. However, we found that controlled drugs were not stored in accordance with legislation. We found a breach in respect of this.

Several areas of the environment were in need of redecoration and repairs. We also noted there was an unpleasant odour in one person’s bedroom and a large stain on the carpet.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were also noted. Some risks to people were identified and managed however risk assessments did not clearly reflect all the potential risks to people which could mean risks not being appropriately managed which could result in people receiving unsafe care.

We noted that some staff had received training however there were gaps in some staff’s training and refresher training was required. There was written evidence that some staff had received a supervision session recently. However there was no written evidence that these occurred regularly and for all staff. There was no documented evidence to confirm that staff received appraisals in order to discuss their individual progress and development.

Staff we spoke with had a basic understanding of the principles of the Mental Capacity Act (MCA 2005). However, capacity to make specific decisions was not recorded in people’s care plans and there was a lack of information about consideration of specific decisions they needed to make. Further we noted that staff had not received training in the MCA.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. We noted that the home had made an application for one person but there were outstanding applications that needed to be made in respect of other people who used the service.

People spoke positively about the food in the home and told us that there was a variety of food available. Staff were aware of special diets people required either as a result of a clinical need or a cultural preference. We also noted that the food prepared on the day of the inspection was freshly prepared and looked appetising.

On the day of our inspection we did not observe any activities taking place. There was also a lack of evidence to confirm what activities people took part in.

There was a management structure in place with a team of care staff and the registered manager. The home had an open and transparent culture. Staff were encouraged to have their say and were supported to improve their practice.

The service had a policy in place to monitor and improve the quality of the service which included resident’s meetings and staff meetings. We noted that there was a lack documented evidence to

confirm that regular audits were carried out by the provider. There was a lack of documented evidence to confirm that regular health and safety checks in respect of the premises, housekeeping, infection control, policies and procedures and staff training, supervisions and appraisals were carried out.

We found five breaches 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 the report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

At the time of this inspection there were six older people living in the home. During the inspection we spoke with all of the six people who used the service. Some people due to their dementia needs provided one word answers, gestured, nodded or shook their head in response to the questions that we asked. We spent time observing and we spoke with a relative of a person who used the service, two care workers, the administrator and the registered manager/provider. Following the inspection we spoke with a relative, an advocate and a care manager of people who used the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People who used the service told us that they felt safe, staff were friendly and treated them well. Comments from people included “I feel safe,” “They are good here,” and “I can speak with staff. They listen.” We saw staff interacted with people who used the service in a respectful manner. A relative, an advocate and a care manager told us that they were confident that people living in the home were safe.

Staff understood their role in safeguarding the people whom they supported.

Staff were clear about their roles and responsibilities. Staff received appropriate support and advice from the registered manager. Arrangements were in place to keep staffing levels under review. Staffing numbers and skill mix met people’s needs.

The home had systems in place to identify, assess and manage risks relating to the health, welfare and safety of people who used the service.

Arrangements were in place for managing medicines safely.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS authorisations for some people may be required.

Incidents were responded to appropriately. Arrangements were in place to ensure that the home was clean.

Is the service effective?

People told us that they were happy living in the home and received the care and support that they wanted and needed. Comments from people about the staff included “Things are very good,” “The food is good, I like it,” and “They help me when I need it.”

Staff told us that there was good communication amongst staff about the service and people’s needs, which enabled them to provide the care and support people needed.

People's care needs had been assessed and care and treatment were planned and delivered in a way that promoted people’s safety and welfare. People’s care plans had been regularly reviewed. However, it was not evident that people participated in the monthly review of their care plans.

Is the service caring?

We saw that people were supported by kind, attentive staff who approached people in a friendly manner. Staff spoke with people who used the service in a respectful way. People living in the home told us staff were kind and listened to them. A relative and an advocate of a person who used the service told us that people were well cared for and were treated with respect by staff. A care manager told us “They are providing a good service.”

Staff were knowledgeable regarding the specific care needs of people and respected the choices that they made. Staff had an understanding of people’s cultural and religious needs and arrangements had been made to meet these needs. People’s privacy and dignity were respected. People took part in a variety of activities of their choice.

Is the service responsive?

People received individualised care that was responsive to their interests and preferences. People told us that they participated in decisions about their care. A person who used the service told us that they “felt involved” in their care. People's care and health were monitored closely. Written notes about people's health and care were completed by staff.

People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of healthcare and social care professionals.

People who used the service told us that if they had any concerns or complaints, they would feel comfortable raising them with staff and/or those important to them.

Is the service well-led?

The registered manager had owned and managed the home for many years. She was knowledgeable regarding her role and responsibilities. The registered manager was accessible for advice and support and worked in the home most days during the week. Staff meetings took place regularly so staff views about the service could be taken into account.

The service worked well with other agencies and services to make sure people received their care and support in a joined up way.

Peoples’ relatives, an advocate and a care manager told us that they frequently discussed people's progress with care staff and the registered manager.

Regular checks had been carried out in areas such as fire safety and the cleanliness of the premises.

During the inspection we spoke with all the people who used the service, two relatives of people who used the service, two care staff, the registered manager/owner, and a community support worker. People who used the service told us that they were happy living in the home and the staff were kind and treated them well. We saw people who used the service approach staff without hesitation and they accessed their bedrooms, communal areas including the garden freely.

People were supported to make choices. These included decisions about what they wanted to do and when they wanted to go to bed. Staff interacted with people who used the service in a respectful and very sensitive manner. Comments from people who used the service and relatives of people included, “It’s fine here,” “the owner and her team are fantastic,” and “the staff are very friendly and very good.”

Each person who used the service had a plan of care that included up to date information about the individual support and care they needed. People’s health, safety and welfare were protected as they received the advice and treatment that they needed from a range of health and social care professionals. People knew how to make a complaint. Staff had the skills to meet people’s needs and they received appropriate support and advice from the manager.

During our inspection of Preston Lodge we spent most of the time talking to people living in the home to gain their views about the service provided by the home.

People showed signs of ‘well being’. They were appropriately dressed; they smiled and talked with each other and with staff. We asked people if they felt they received the care they needed and wanted. People spoke positively about the care they received and were happy with the staff that supported them.

People approached staff without hesitation. We saw staff provided support for people in a friendly, sensitive and professional manner.

People told us that staff respected their privacy and understood their needs. They spoke about the activities they participated in and enjoyed.

Comments from people included “the staff are ok”, “I can talk to staff”, “I can choose what I want to do, I like to catch a bus and go shopping” and “I like my room, I have my own things.”

People told us they were supported to make choices regarding food and drink. People commented “I like to cook and I can cook food that I like here”, “the food is ok” and “I choose my breakfast”.

People told us they felt safe and knew who to talk to if they had any worries or concerns. One person told us “I talk to staff and the manager if I am worried”.

People told us they had access to hospital appointments and to health care and social care professionals such as doctors, opticians, chiropodists, district nurses and social workers. A health care professional spoke positively about the care provided to people in the care home.

People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals.

As part of this review, we spent time talking to all the people using the service to gain their views about what it is like living in Preston Lodge. They told us they were happy living in the home, they liked their bedrooms, the food was good, they had their health and spiritual needs met, the staff were approachable, listened to them, and they had the opportunity to participate in some activities of their choice.

People were positive about the care and support they receive at the home. People spoke of the staff being ‘nice’, ‘friendly’ and approachable. They told us they felt safe living in the home and they knew who to talk to if they had any worries or concerns. A person confirmed that she had access to a telephone. Another person told us she went out to the local shops when ever she wished.

People told us they could choose what to eat and generally enjoyed the meals provided.

People said they saw a doctor when they needed to, and had contact with a variety of other health care and social care professionals. A person spoke of recently having seen a doctor.

People confirmed that they were happy with the environment of the home, and were happy with their bedrooms. They told us that they had brought some personal items including some photographs and pictures with them, when they moved into the home.

We saw records of feedback from relatives of people living in the home. This told us they were happy with the quality of the service provided by Preston Lodge. Comments included staff ‘are willing to listen’, ‘everyone keeps me informed’, and I ‘could not ask for better’.