The inspection took place on the 18 and 23 January 2018. The inspection was unannounced on the first day, and announced on the second.

Ruskin Lodge 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. Ruskin Lodge specifically provides respite accommodation for people over short periods of time.

The service is located in St Helens and is registered to accommodate up to 23 people. At the time of the inspection there were 12 people using the service.

There was registered manager in post who had registered with the CQC in December 2017. 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 sufficient numbers of staff in post to meet the needs of people using the service. The registered provider had a staffing tool in place to help them determine the number of staff required to meet the needs of people using the service.

Recruitment processes were safe and helped ensure that people were supported by staff who were of suitable character. This helped protect people from the risk of abuse.

Staff had undertaken training in safeguarding and knew how to report any concerns they may have about people’s wellbeing. The registered manager had been proactive in ensuring the wellbeing of one person was protected by ensuring the appropriate support was in place, prior to their returning home.

Staff had the skills and knowledge necessary to carry out their roles. For example staff had good communication skills, and had a good understanding around the medication administration process. Records showed that people had been given their medication as prescribed.

People spoke very positively about the food that was on offer. Kitchen staff were aware of people’s dietary needs, which helped ensure that people were provided with appropriate options.

Where required people were supported to access health care professionals to help maintain their health and general wellbeing. For example, a health assessment for one person had been scheduled whilst they were staying at the service.

Positive relationships had been developed between people and staff. Staff interactions with people were familiar but professional and people presented as relaxed in their company. We observed the registered manager and area manager engaging in friendly conversation with people, which showed they knew people who were using the service.

People each had a personalised care record in place which contained details about their personal preferences, and their day-to-day care needs. Staff completed daily records regarding the care and support provided to people which were detailed and comprehensive. These provided an accurate and up-to-date record regarding people’s requirements.

People’s confidentiality was protected. Records containing personal information was stored securely and the registered provider had undertaken a significant piece of work around ensuring they were on target to meet changing data protection laws. This showed that the registered provider was proactive, and highlighted their professionalism.

The registered provider had quality monitoring processes in place with clear outcome which were followed up in a timely manner. The registered manager had developed a tool for analysing accidents and incidents which could be used to mitigate the risk of incidents from reoccurring.

We spoke to different people about this service to gain a balanced overview of what people experienced, what they thought and how they were cared for. We spoke to three people resident at the service, a relative of people using the service and three staff members. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

People said that all of the staff were, “wonderful and couldn’t be more caring.”

Relatives said they were very happy with the care people received at the home.

People’s care needs were assessed before they arrived at the home and discussed again on arrival. We saw evidence that people consented to the care they received and we saw that staff were cheerful and attentive, and knew each service users’ needs and preferences.

We saw that medicines were managed and administered safely and that arrangements were in place for people who chose to self-medicate.

We looked at requirements relating to workers and saw that there was a comprehensive recruitment policy which was followed in practise and appropriate checks were made before staff worked with service users. All staff received an induction and appropriate training.

We spent time with five people who were staying at the service at the time of our visit. Three people told us about their views and experiences of Ruskin Lodge. People told us they were very satisfied with the care and support provided to them. One person said “I really enjoy coming here. I come four times a year for short breaks.” Another person told us it was like coming to a hotel for a holiday but with additional support available.

People told us they were always treated with dignity and respect. One person told us about receiving an assisted bath and how staff had been polite and respected their privacy and dignity at all times. Another person said “I don’t need help with personal care myself but when somebody rings the buzzer you see staff going straight away.”

We were told there is an excellent choice of food available. One person said “You can get pretty much anything you want.” They said they liked to drink camomile tea and that was always available. We were told the food was of a high quality and there was always plenty available. Snacks and drinks were brought round throughout the day.

People told us there are lots of activities to do. There was a formal activity plan including chair exercises, games and musical bingo. The plan for this was on a notice board and also in people’s bedrooms. People told us about the trips out they had took part in using the service’s minibus.

During our visit we spoke to 10 guests. All made very positive comments about the service provided. They all said that the staff respect their wishes and feelings and treat them with dignity. They said that their requests and preferences are listened to and acted upon.

All 10 people spoken with had been involved in the drawing up of their care plans for the duration of their visit. They said that they give their views about the standard of the service through a quality assurance questionnaire at the end of their visit and directly to the manager and staff who ask for their views. All said that the standards at the home for all aspects of the service are very high.

All 10 people spoken with had never had to make a complaint but knew how they could do so. They said that information about making a complaint is available in their bedrooms.

They said that they are asked about how they like to have their personal care attended to and said that if they need any health or social care professional support during their stay this is arranged by staff following their request.

All were very complimentary about the standard of food provided at the home. They said that the meals are varied and well-balanced, there is a choice and they are asked what meals they would like.

All 10 guests spoken with praised the standards of cleanliness at the service. They all said that the home is kept clean and tidy and that there is evidence of ongoing improvements being undertaken to maintain and improve standards.

They described the support they get from the staff very positively. Some comments made were:-

"The staff are very good, they come when you need them."

"The staff are caring and helpful."

"The staff and managers take a real interest in the people coming here."

"The staff are very caring, nothing is too much trouble for them."

"The staff are really on the ball if you are ill, they call the doctor."

"The staff are brilliant, if we need them in our bedroom we just pull the cord and they are there."

"There are good staff here, the girls are lovely and kind."

"We are very well looked after here, the staff spoil us."

LINKs members provided the following feedback :-

"Our impression is of a very clean, tidy and efficient home. The staff were very attentive, polite and considerate."

“The accommodation is lovely, its like a hotel, there is a wide choice of food, the staff are great, they treat people with respect and ask their views."

The inspection was unannounced and took place on 19 and 25 January 2016.

Ruskin Lodge is owned and managed by the Pilkington Family Trust. The building is purpose built and is located in a residential area of St. Helens. It provides short breaks and respite care for up to 23 people.

The last inspection of Ruskin Lodge was carried out on 13 December 2013 and we found that the service was meeting all the regulations reviewed.

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.

People told us they felt safe when they stayed at Ruskin Lodge. Comments from people at the service included, “Staff will do anything for you”, “Nothing is too much trouble” and “I feel safe and secure when I am here. I get panicky when I go out”.

Staff had received training in how to recognise and report abuse. All staff were clear about how to report concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet the needs of the people who used the service.

People were supported to take their medicines by staff that were appropriately trained. People received care and support from regular staff that knew them very well, and had the knowledge and skills to meet people’s individual needs. People spoke very positively about staff; their comments included; “The staff are great” and "Every member of staff is wonderful, tip top”.

Before people started to use the service the registered manager overviewed and approved all assessments and referrals to ensure the service could meet the person's needs. From these assessments individualised care plans were developed with the person and where appropriate, with their relatives to agree how the care and support would be provided.

Care plans provided staff with clear direction and guidance about how to meet people’s individual needs. People told us that the manager was always approachable.

People said they would not hesitate to speak to the manager or any staff member if they had any concerns about the service they received. People and their relatives knew how to make a formal complaint if they needed to. One person said, “I did have cause to raise a small complaint and the manager dealt with it to my satisfaction”.

There was a positive culture and strong leadership within the service and staff said the manager led by example. Staff said, “Ruskin Lodge is a wonderful place to work” and “I feel the company welcomes and listens to suggestions”.

There were quality assurance systems in place to make sure that any areas for improvement were identified and addressed.