We carried out an unannounced focused responsive inspection of this service on 4 and 5 October 2018.

The home is registered to provide accommodation and personal care for up to 21 people. At the time of our visit there were 16 people living in the home.

St Denis Lodge Residential Home 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.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

We inspected the home against three of the five questions we ask about services: is the service safe, is the service effective, and is the service well led?

Systems and processes were not always effective. Audits and quality assurance processes were taking place but had not identified that people’s consent forms for areas such as care provision and bed rails had been signed by representatives without the necessary legal authority to do so. They also had not identified that risk assessments were not always personalised and one of the conditions of a person’s Deprivation of Liberty Safeguards (DoLS) was not being met. This meant that the service was not always working within the principles of the Mental Capacity Act 2005 (MCA 2005). The MCA 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff felt supported by management and enjoyed working at the home. One staff member said, “It is a joy to work here. We get along like a family.” Staff had regular, in-depth supervision where they received both praise and had opportunity to develop their practice. People, relatives and staff felt included and listened to. They had confidence that if they raised concerns with management action would be taken to resolve things. The home had established and maintained pro-active working relationships with health professionals which were helping people to stay well for longer and prevent unnecessary hospital admissions.

People were supported by staff who did not always have up to date training. People were supported to have a balanced and varied diet. People were supported by staff who understood the importance of working effectively with health and social care professionals to meet people’s needs. When people’s health deteriorated or fluctuated staff sought advice and guidance in a timely way. Support also extended to accompanying people to routine appointments, courses of treatment, or when receiving visits from health professionals.

People told us that they felt safe living at the home. Staff had a good understanding of how to safeguard people from harm and abuse. They understood what signs to look for and how to raise a concern. The home had robust recruitment processes to ensure that people were supported by staff who were suitable to work with them. People had risk assessments that staff used to help reduce the risk of avoidable harm. We recommended that they make these personalised as they were generic. Medicines were managed safely. Staff demonstrated confidence when supporting people with their medicines and had regular, formal observations to check their competency. The home conducted audits to ensure incidents or near misses were opportunities to learn from and reduce the chances o

This was an unannounced inspection on 2 and 3 May 2018.

St Denis Lodge Residential Home is a care home for up to 21 older people. At the time of inspection there were 17 people using the service. Some of these people have various stages of dementia so had limited verbal communication. There are two floors and there are bedrooms on both. The home has a number of communal spaces including a dining room, lounge and garden.

At our last inspection we rated the service good.

At this inspection we found the service remained good.

Why the service is rated good.

Since the last inspection the registered manager and provider had worked hard to ensure there were continual improvements at the home. These had been recognised by the home retaining its beacon status for end of life care.

People received exceptionally good care from staff who treated them like part of their extended family and knew them incredibly well. People were involved in decisions about their care and the staff continuously were finding ways to share the information with people. Feedback from people, relatives and visitors to the home informed us about how well cared for they felt.

Care and support was incredibly personalised to each person, which ensured they were able to make choices about their day to day lives in line with their needs, hobbies and interests. Information about people's preferences were gathered in detail by members of staff through life stories.

People were supported to have a dignified death and there was extremely good communication with other professionals to facilitate this. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People, or their representatives, were involved in decisions about the care and support they received.

The service provided to people was responsive to people’s individual needs. There were activities coordinators who ran the activities in the home with incredible passion. Staffing levels reflected the ethos that all staff were encouraged to support people with activities and in all aspects of their care. There was a range of opportunities for people and their families to participate in. Activities always considered people’s hobbies and interests and were personalised as much as possible.

The management were constantly looking at current research and trying to find innovative ways to support people in the home. There was a strong emphasis on community participation These provided opportunities for people to reminisce and promoted their well-being by being valued.

Complaints were fully investigated and responded to in a timely manner. The registered manager had a strong ethos of valuing any concern a person or their relative raised because they knew how important it was for them. There were opportunities for people to drive improvements within the home.

The home had an owner and management who strove to provide people with excellent care. People, relatives and staff told us the registered manager was excellent and had ensured the best care and support was provided. The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

The provider wanted to drive innovation and strive for excellence at all times. The management had created opportunities to recognise the quality care staff were delivering. Staff at all levels felt supported and were proud their work to improve the lives for people was recognised. They often went above and beyond to enrich people’s experience and value them as people.

There were suitable numbers of staff to meet people’s needs and to spend time socialising with them. Interactions were on a personal level and not just task based. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely. People were protected from ab

This inspection took place on 26 and 28 January 2016. It was carried out by one inspector.

St Dennis Residential Home provides residential care for up to 21 older people. There were 19 people living in the home at the time of our visit, some of whom were living with dementia.

There was a registered manager who had been in post for four years. 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 home had recently had building work completed and there was an orangery in place of the conservatory. This created more communal space. As well as being a place to sit it also provided more room for activities. There was direct access to the garden. A path was under construction to enable wheelchair access around the garden. There were activity organisers seven days a week who provided a varied programme of activities which included trips out, social events, crafts and quizzes as well as exercise. People who were unable to attend group activities received one to one time doing something that they enjoyed, for example jig-saws or reading. This meant people were engaged in meaningful activity.

People told us they were safe living in the home and had confidence in the staff. There were sufficient trained and competent staff to meet people’s needs. There was one vacant care worker position which had been advertised. There were processes in place to ensure staff were recruited safely. The registered manager monitored staffing levels to ensure there were enough staff to meet people's needs. The home did not use agency staff which meant people received consistent care from staff who knew them well.

Staff had received training in safeguarding adults and knew how to recognise abuse and what actions they would take if they suspected abuse was happening.

People and their relatives spoke highly of staff. They told us staff were kind and caring. They were treated with dignity and respect and had their privacy maintained.

Medicines were administered and stored safely. Medicine Administration Records (MAR) were signed to indicate that peoples prescribed medicine had been taken. Staff had received training and were competent to administer medicines. There were processes in place to ensure that people had received the right medicine at the right time.

Peoples had personalised care plans which were informative and indicated peoples likes, dislikes and preferences. People were provided with choices about all aspects of care and support they received. Staff were able to talk with us about people and demonstrated to us they knew people as individuals. People told us they enjoyed the food and were offered a choice at mealtimes.

People were provided with single rooms with an en-suite toilet and washing facilities. This helped ensure people had their privacy maintained. People had their own commodes if they needed them for use at nights. The process for cleaning the commode buckets was being reviewed by the registered manager to ensure the correct infection precautions were maintained.

There was a clear management structure. The registered manager was supported by a care manager and there were supervisors who organised the shifts so that people received the care they needed. There were systems in place for monitoring the quality of the service

Staff told us they had access to further training .The home was accredited with the Gold Standard Framework training which a nationally recognised training to ensure people received excellent end of life care. The home had good links with the GP surgery and staff attended their monthly meetings.

There were systems and processes in place to ensure there was good communication with people, their families and staff.

During our inspection visit we reviewed the files of nine members of staff, interviewed the registered manager and one recently appointed care assistant.

We found that action had been taken following the last inspection, and processes were in place to support appropriate recruitment and appointment of staff.

We received positive feedback from all of the people we spoke with. We spoke with eight people and one person’s relative. Everyone told us that people’s care needs were met. One person told us “we are beautifully looked after” and another person told us that “I am very well looked after.” The person’s relative told us that it was “reassuring to know (the person) is so well looked after.” People's needs were assessed and care was delivered to meet their needs. People had access to activities.

Medicines were kept and administered safely, and people received their medicines in the correct way. Appropriate arrangements were in place in relation to the recording of medicines.

The provider did not undertake sufficient pre-employment checks.

People were protected from the risks of unsafe care or treatment because there was an accurate record of people's needs.

People expressed their views and were involved in making decisions about their care and treatment. We looked at care records for three people and saw that all had signed to say that they agreed with their care plans. Each person’s care plans were kept in their bedrooms so that people, and with their consent, their relatives could access their records easily.

We spoke with six people who lived at St Denis Lodge. They told us that they were happy living in the home. One person told us the staff were “all lovely without exception” and “so kind” explaining that they always come quickly in response to the call bells. Another person told us, “I really cannot fault them.”

We spoke with the relative of one person who told us they were very happy with the care their family member received. The relative explained that the home had identified their family member as being at risk of developing pressure ulcers and had taken prompt action to alleviate the risk.

Training records showed that staff completed an induction followed by an ongoing programme of training with updates as required.

We saw that people using the service and their relatives had been able to give feedback about the service through annual satisfaction surveys and residents meetings. We saw that people using the service and their relatives had been able to give feedback about the service through annual satisfaction surveys and residents meetings.

One visitor told us that they visited at different times and staff always introduced themselves to their relative and asked if the person needed assistance and how they could help.

The visitor told us that they visit at different times and the persons care needs are met by staff. The visitor said that they trusted staff and were kept up to date with the person’s condition. They also said that they were consulted when needed in the care of their relative and they considered that their views were listened to and acted upon.

People were supported by staff in a sensitive manner and without being rushed to complete activities. Staff called people by their preferred name. People were able to choose how they spent their time.

People had brought in their own furniture, which included wardrobes, dressing tables and chest of drawers, as well as smaller personal items.

A health professional who regularly visited the home said staff make sure they carry out treatment plans and had relevant information available when they visited. The health professional considered that people’s needs were identified and people received a good standard of care.

One person who lived in the home said they had no concerns about the home and they felt safe.

People we spoke with said they had no concerns about the home and they were able to comment on how it was run. A relative had no concerns and they told us that they were able to talk to staff, the manager or provider and any issues were sorted out quickly and without fuss.