Squirrel Lodge is a residential care home registered to provide care to 24 older people, some of whom may be living with dementia.

At the last inspection the service was rated Good.

At this inspection we found the service remained Good.

People told us they felt safe living in the service. Risks to people were appropriately planned for and managed. Shortfalls in staff practice around medicines administration had been identified by the managers and a new process was being implemented to address these shortfalls.

People told us there were enough competent staff to provide them with support when they needed it.

Staff had received appropriate training, support and development to carry out their role effectively.

People received appropriate support to maintain healthy nutrition and hydration.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us and we observed that they were treated with kindness by staff who respected their privacy and upheld their dignity.

People were given the opportunity to feed back on the service and their views were acted on.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities and follow their individual interests.

People told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

The managers worked hard to create an open, transparent and inclusive atmosphere within the service. People, staff and external health professionals were invited to take part in discussions around shaping the future of the service.

There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below

We carried out an unannounced comprehensive inspection of this service on 9 October 2014. Breaches of legal requirements were found. These related to care planning, staffing, training and the systems in place to identify and address issues in the service delivered to people. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 9 (care and welfare), Regulation 10 (assessing and monitoring the service), Regulation 22 (staffing) and Regulation 23 (supporting workers) of the Health and Social Care Act 2008 (Regulated Activities) 2010.

We undertook this focused inspection to check that the action plan the provider submitted had been followed and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Squirrel Lodge on our website at www.cqc.org.uk

Squirrel Lodge provides accommodation and personal care for up to 24 older people who require 24 hour support and care. Some people using the service were living with dementia. There were 22 people using the service when we visited on 8 July 2015. This was an unannounced inspection.

There were two registered managers in post, and they jointly managed the service. 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.

During this inspection, we found that the management of the service had followed the action plan they provided to us following our inspection on 9 October 2014, and had made significant improvements. We considered that these initial improvements had been sustained over the months prior to this inspection and a plan was in place to drive continual future improvement.

People told us and we observed that the staffing level was appropriate to the needs of the people using the service. Care staff were positive about the changes that had been made to the staffing level and the deployment of staff, and told us they felt they had more time to spend with people meeting their physical, social and emotional needs.

We found that the training and support offered to staff was now effective in providing them with the knowledge and skills required for the role.

There were improved systems in place to support staff to meet people’s needs effectively. New care planning documents were in place for people using the service, and these accurately reflected people’s diverse individual care needs.

Improvements had been made in the service’s quality assurance processes and procedures. The views of people and staff were now used effectively to drive improvement in the service.

Squirrel Lodge provides accommodation and personal care for up to 24 older people who require 24 hour support and care. Some people using the service were living with dementia. There were 20 people using the service when we visited on 9 October 2014. This was an unannounced inspection.

There were two registered managers in post, and they jointly managed the service. 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.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The provider needed to make improvements to ensure people received care that was safe, effective and responsive to their individual needs.

People’s needs were not always met in a safe way because there were not enough staff available to meet their needs. We saw that this left people alone when they needed help to move or when they needed reassurance and support.

Staff training was not detailed or effective enough to ensure staff understood the needs of people and how they needed their care to be delivered. Although staff had training to support people living with dementia, their practice was out of date and the plans of care did not reflect how individuals should be cared for.

Staff were recruited safely and had checks carried out to ensure they were suitable for their roles. They were caring, respectful and knew people well. People or their advocates were given the opportunity to participate in reviews of care which made them feel involved and listened to. Relatives, health professionals and people using the service were complimentary about the staff.

Care records for people did not document enough specific information about people’s needs in order for staff to be able to deliver people safe and appropriate care. Care staff could not tell us how they would support people with specific and complex health needs. People did not have enough opportunities to be engaged and stimulated during their day. Some people were bored or became agitated with nothing to distract their attention. People, including those with more complex needs, did not have their interests explored as part of care planning to ensure their welfare.

There was a lack of proactive leadership and oversight to ensure the service was being run in people’s best interests. Systems in place to monitor the quality of the service were not robust enough to independently identify issues and take action to improve. Where people, staff and relatives had made suggestions about how to improve things, they felt they had not been listened to.

You can see what action we told the provider to take at the back of the full version of the report.

During the inspection, we spoke with five people who used the service, three staff and the registered manager.

The people we spoke with told us that they were happy with the food and drink provided. One person said, “The food is quite good and we get plenty to drink. We get a drink at dinner and in the afternoon, the food is healthy and we get enough of it.” Another person said, “The food is very good, there is plenty of it.” A further person told us, “The food is very good, I am very well fed and have no complaints. I had a cup of tea this morning and we get plenty to drink.”

People had a good choice of food and individual needs were accommodated. Where there was a concern regarding poor nutrition and hydration, we saw that the service had taken steps to keep people safe against the risk of malnutrition and dehydration.

The service was clean and free from offensive odours. People told us that their rooms were kept clean and tidy.

People told us that they were happy with the staff. One person said, “They (the staff) are great, we always have a joke, they are very nice people here.” Another person said, “The staff are very good.” A further person said, “The staff are very nice, very nice people.”

There was enough equipment to meet people’s needs and it was well maintained and regularly checked and serviced.

Effective recruitment processes were in place to ensure that the staff they employed were of good character and suitable to work within the service.

A high percentage of the people staying in Squirrel Lodge were living with dementia. We were able to talk with four of the people living there and some of their relatives, but to enable us to better access people’s wellbeing we spent time sitting with them observing the care they received and the level of staff interaction with the people.

During our inspection we observed that the staff were attentive to people’s needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought their agreement before providing any support or assistance.

We saw that staff received training essential for caring for older people and when talking to them we found that they were knowledgeable about the people they supported.

The building was comfortable, clean and well maintained. Not all of the radiators were covered to protect people from burns, however the service was taking action to assess the risk to people and were planning to take action.

People told us that they were comfortable living in the service and also told us that they had not needed to make a complaint. One person told us that, “There is nothing I would change.” They also said that, “I have nothing to complain about.”

People were encouraged and supported to make complaints. The manager told us that they tried to ensure that complaints were dealt with informally and that they had received very few formal complaints in recent years.

People who use this service told us that they were happy living at Squirrel Lodge, and that staff treated them in a friendly and respectful way.