We inspected the service on 31 October 2016 and the visit was unannounced.

Primrose Lodge is a residential care home and provides care for up to 15 people. There were 15 people were using the service when we visited and many were living with dementia.

At the time of our inspection there was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Relatives had no concerns about their family members’ safety. Staff understood their responsibilities to protect people from abuse and avoidable harm and to remain safe. The provider had procedures in place to manage incidents and accidents. These included seeking the support of health care professionals to reduce future occurrences. Risks to people’s health and well-being were assessed and reviewed. For example, where a person was at risk of damage to their skin, staff had up to date guidance available to them that they followed.

Staff that applied to work for the provider had checks on their suitability carried out before they started their employment. This included references from their previous employer. We found that the provider had employed suitable numbers of staff to meet people’s support requirements.

People received their prescribed medicines safely by trained staff who were assessed for their competency. The provider had made guidance available to staff on the safe handling of people’s medicines that we saw them following. This included staff storing people’s medicines safely.

Staff had the necessary skills and knowledge to offer effective care to people. Staff received training in areas such as health and safety and infection control. Staff received an induction when they started working for the provider so that they were aware of their responsibilities. Staff also received regular guidance and feedback from a manager to make sure they were offering care that met people’s care requirements.

People were supported in line with the Mental Capacity Act 2005. People were asked for their consent when staff offered their support. Where there were concerns about people’s ability to make decisions, the registered manager had assessed people’s mental capacity. The provider told us they would make improvements to make sure that these assessments always followed the requirements of the Act. The registered manager had made applications to the appropriate body where they had sought to deprive a person of their liberties.

People and their relatives were satisfied with the food and drink available to them. We saw that mealtimes were enjoyed by people. The provider had sought specialist advice where there were concerns about people’s eating and drinking. People were supported to maintain their health and well-being. This included having access to healthcare services such as to their GP and physiotherapist.

People’s dignity and privacy was respected by staff who showed kindness and compassion. We saw that people’s care records were stored safely and staff spoke about people’s care requirements in private. People’s families could visit without undue restriction to maintain relationships that were important to them.

People were supported to retain skills to maintain their independence. For example, some people required extra time to enable them to walk and we saw staff offering this. Some people were involved in decisions about how their care was provided. Other people received the support from their representatives who were involved in making decisions about their care to make sure it was provided in ways that were important to people.

People undertook activities that they were interested in. We saw people

We spoke with four people who used the service. They told us they received the care and support they required. They said they liked the staff and enjoyed the meals provided. One person said, the food is "brilliant". We observed that staff interacted with people who used the service in a caring and professional way. Staff communicated effectively and were knowledgeable about people's individual needs.

Care plans were person focused and included the individual needs and preferences of people who used the service. Risk was assessed and risk management plans were in place.

Staff received the training and support they required to do their jobs. The provider assessed and monitored the quality of service provision. People who used the service were asked for their views and appropriate changes were made.

We spoke to two people who used the service and a relative of a person who used the service. We also looked at comments that had been made in a recent survey of people who used the service and their relatives.

One person who used the service told us, "I like everything about living here. I feel comfortable. There is always something to do, we are occupied. I can't fault it in any way. The carers are so good."

Another person told us, "I'm happy with the way I'm looked after. I feel really at home. It's family-like here. We're not shut off from the world, we're part of a community."

A relative told us, "I'm very pleased with the care. We were fortunate to have got mother into this home. Mum's needs are met. Mum loves it. It takes away all the worries and stresses she had. Our mum is in safe hands."

Comments made in a recent survey included:

`I am more than happy with the way my wife is treated and cared for by all members of staff and would not wish her to be in any other residential home.'

'Excellent care home, very pleased with the level of care.'

'The staff are always friendly, caring with excellent communication skills which benefits both relatives and residents.'

This was an unannounced comprehensive inspection that took place on 8 and 9 October 2015. The first day of the inspection was unannounced.

Primrose Lodge is a care home registered to accommodate up to fifteen people who are aged over 65 and who have diagnosis of dementia and / or a physical disability. The home had fifteen single bedrooms, and was a single storey building. At the time of the inspection fifteen people were living at the service.

The service had 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.’

All the people we spoke with, who were able to give their views said they felt safe living at the home and liked most of the staff.

The feedback from relatives we spoke with was that they felt people were cared for, happy and safe.

The atmosphere in the home was calm and friendly, and the staff we spoke with had a caring attitude towards the people they supported.

Staff knew how to identify and report abuse and the provider had a system in place to protect people from the risk of harm.

People received their medicines safely but where PRN (as required medicine) was prescribed, protocols were not in place to explain how this should be administered and there was a risk that they would not receive the right amount of the right medicine at the right time.

Levels of infection protection were low. Significant areas of the service were dirty or unhygienic. These were attended to during the course of the inspection.

Some people may have been unlawfully deprived of their liberty at the home, and people were not being supported to make decisions appropriately where their ability to do so unaided may have been in doubt The registered manager knew the correct process to follow in care plans about the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) but had not followed the process or implemented assessments fully as required by the legislation..

Staff were knowledgeable about the people they were supporting used this information to provide personalised support. People’s care plans included information about what was important to them and details of their life history.. Staff did not encourage people to pursue their hobbies and interests.

People were aware of the complaints procedure and felt able to raise any concerns.

There were audits in place to monitor the quality of the service. These audits had failed to identify shortfalls in the cleaning and maintenance.

We have made a recommendation for the service to consider the guidance from the Health and Safety Executive in relation to radiators within the service.