About the service: Stallingborough Lodge is a care home providing personal and nursing care for up to 47 people, some of whom may be living with dementia. Forty six people were living at the service at the time of the inspection.

People’s experience of using this service:

People and their relatives told us they were happy with the service they received and felt staff had a clear understanding of their needs and preferences. They told us staff listened to them and knew them well, and were responsive to their needs and wishes. People considered staff to be well trained and skilled.

People described an extensive provision of activities and events both within the service and the local community, based on their interests and preferences. People and their relatives were supported to receive information in an accessible way either through easy read, large print and pictorial formats to enable them to be involved in their care and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice. People were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their lives, this was carried out with compassion and dignity.

The environment supported people to have time on their own and time with other people if they chose this. Throughout the environment appropriate signage for people living with dementia was in place to support people to find their way around the service. Cleanliness and health and safety were well managed.

Staff had appropriate skills and knowledge to deliver care and support people in a person-centred way. Staff recruitment was safe and staff understood how to keep people safe. The registered manager used information following accidents and incidents to reduce the risk of future harm.

The registered manager and staff team worked together in a positive way to support people to achieve their own goals and to be safe. Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people's lives.

The values of the organisation of offering choice, inclusion and respect were embedded. This supported people to receive the positive service described.

Rating at last inspection: Good (published 11 August 2016).

Why we inspected: The inspection was a scheduled inspection based on the previous rating.

A full description of our findings can be found in the sections below.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Stallingborough Lodge provides nursing and personal care to a maximum of 45 older people who have a range of physical health care needs, some of whom may be living with dementia. On the day of the inspection there were 45 people using the service. The service is situated in the village of Stallingborough, three miles from Immingham.

We carried out this unannounced inspection on the 8 and 11 July 2016. Our last inspection took place in June 2014 and at that time the service was meeting all the regulations we looked at.

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.

The service had a safeguarding policy in place which made staff aware of their roles and responsibilities. We found staff knew and understood how to protect people from abuse and harm and kept them as safe as possible. People told us they felt safe.

We saw recruitment checks were carried out, although the personnel files for two members of staff only contained one written reference. We also found where potential employment risks had been identified for three members of staff, discussions had been held between the candidate and the registered manager but these and the review of the risk to employ the person had not been recorded. The registered manager confirmed they would complete a full audit and address the shortfalls. We have made a recommendation that the registered provider's recruitment processes are followed more robustly.

There were enough staff on duty to meet people’s needs. Staff told us they received sufficient training to enable them to support people safely and to meet their assessed needs. Records confirmed this. We found staff received guidance, support, supervision and appraisal. This helped them to be confident when supporting people who used the service.

People told us they were supported by kind, caring and attentive staff who knew them well and understood their preferences for how care and support should be delivered. People were treated with dignity and respect throughout our inspection. It was clear staff were aware of people’s preferences for how care and support should be provided.

We found people were supported to make their own decisions as much as possible, for example staff offered visual choices to them, such as meals, clothing and activities. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). In the main, staff worked within mental capacity legislation when people were assessed as not having capacity to make their own decisions. However, we found instances when best practice had not been followed; records to support decisions about the use of restrictive practice such as bed rails were not always in place to reflect capacity assessments and decision-making. The registered manager told us they would address this straight away.

The activities programmes showed people were supported to participate in a wide range of meaningful activities and events within the service and the local community. Staff also supported people to maintain relationships with their families and friends.

Staff were aware of people’s health care needs and how to recognise when this was deteriorating. The support they provided helped to maintain people’s health and wellbeing. Staff liaised with health professionals for advice and guidance when required. Systems were in place to ensure people’s medicines were administered safely.

We found staff supported people to maintain their nutritional needs. They assisted people to make choices about their meals and to eat them safely when required. The menus provided were varied and offered choices and alternatives.

The service was responsive to people

The inspection was carried out by two adult social care inspectors and a representative from the local authority safeguarding team. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, and from looking at records.

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

• Is the service caring?

We observed people were supported in a kind and attentive way. We saw that care staff showed patience and gave encouragement when supporting people.

People who used the service, their relatives and staff completed an annual satisfaction survey. Where suggestions or concerns had been raised the provider had listened and made changes to the service.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

• Is the service responsive?

Staff knew the people they cared for and understood their preferences and personal histories.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated as required.

• Is the service safe?

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

The people who used the service told us they were happy and that they felt safe. We saw that people were treated with respect and dignity by staff.

The home had policies and procedures in relation to safeguarding vulnerable adults. Staff had completed training in how to safeguard vulnerable adults. This meant that people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was checked and serviced regularly so people who used the service were not put at unnecessary risk.

• Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

• Is the service well led?

The service had quality assurance systems in place and records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

What people who used the service and those that matter to them said about the care and support they received.

We asked people if their needs were met by appropriately skilled staff and were told, “They are ever so good, they treat me so well.” Another person said, “The staff know what I need and help me when I ask them; what else could you ask for.”

One person told us, “I think they (the management) do listen to our point of view, they’ve certainly put on trips that we like to do.”

A relative we spoke with explained, “We don’t have any concerns about the home, he (the person who used the service) is safe here, the staff manage all his care and look after his medication so he is safer here then he was before he moved in.”

At the last inspection on 8 October 2013 we were concerned there were not sufficient members of staff on duty at all times. Since then the registered manager had recruited more staff and further recruitment was under way. This will ensure a full complement of staff will be in place.

People spoken with were complimentary about the staff team and said they were well cared for treated with respect. Comments included, “I never feel a nuisance. It doesn’t matter what time I ring the bell”, “This is the best home for miles and the staff are chosen as the best” and “They will do anything for me. You might have to wait a few minutes when you ring the bell but they come and tell me and always come back.”

Staff spoken with told us they received support, supervision and training. They were knowledgeable about how to keep people safe and how to promote their wellbeing. Comments included, “A happy environment; the manager is lovely; any problems are sorted straight away”, “We can just concentrate on caring; we don’t do any domestic or other jobs”and “We have had lots of training.”

Best interest meetings were held when people could not make an informed decision themselves. A decision had been made by the collaboration of a number of healthcare professionals in relation to the person’s best interest.

The six care files that we saw contained a ‘pre admission assessment’ that was used to develop an individual plan of care. Information in relation to medication, hearing, sight and dietary requirements had been recorded.

We checked in several bedrooms and all of the communal areas and found the home to be free from offensive and unwanted odours. We spoke with the relative of a person who used the service and they told us the home was always clean and hygienic.

After the inspection we checked the home’s staffing levels against best practice guidance, we found that the staff deployed was lower than expected to meet the needs of people within the service. Over the last month the home had operated with less care hours being delivered than expected.

The provider had an effective system to regularly assess and monitor the quality of service that people received. The home had an audit schedule for 2013. Audits were completed for topics including dignity in care, infection control, staff and the home’s policies and procedures.

We found that people were treated with respect and that they could make choices in relation to their daily life. One of the people we spoke to told us, “I can choose to have a male or a female help me to bathe.” Another person told us that they were free to do what they wanted and said that they can “Go to bed and get up when they wanted.”

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. A relative told us “The staff are very respectful, they always talk through what they are going to do.” We found evidence that a wide range of professionals were involved in the person’s care.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider ensured that staff had undertaken a wide variety of training, this meant that there was a high level of care at the home, provided by knowledgeable staff.

There were effective systems in place in relation to the recruitment and selection process. We looked at three employee's files and saw that appropriate checks had been undertaken before employment had commenced. This included a completed application form, two references and a Criminal Bureau Check (CRB).

We found that the service had received very few formal complaints. We looked at the complaints record and saw that the one documented complaint had been fully investigated.

As part of our review we spoke with four people who use the service and we asked them questions about the home, the care they received and staff caring for them. Their responses indicated that they felt safe and were happy with the care they received.

They spoke positively about the staff and the care provided and told us that staff treated them with respect. Everyone we spoke with felt they were involved in their care and in making decisions about treatment.

Some of the comments we received included: " We can do what we want, when we want to"; " The staff look after me.

Everyone that we spoke with told us that the food was good and that there was plenty of choice to suit their personal tastes.

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the staff and care provided and told us that staff treated them with respect. Everyone we spoke with felt they were involved in their care and in making decisions about their treatment.

We received comments such as," It's like being at home, we do what we like when we like" and " I don't' want for anything."

Everyone we spoke with told us the food was good and a varied menu was available.