About the service: Stanborough Lodge is a care home. People in care homes receive accommodation and personal care under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Stanborough Lodge provides a service for up to 25 older people, some of whom may be living with dementia. At the time of the inspection there were 24 people living at the service. Accommodation is provided over two floors and people have access to communal areas.

People’s experience of using this service:

¿ People continued to feel safe living at the service. Risks in relation to people’s health, safety and welfare had been identified and action taken where appropriate. Staffing levels were appropriate to meet the needs of the people using the service. Medicines were safely managed. There were systems in place to monitor incidents and accidents and learn from these.

¿ Staff were skilled and competent and knew the people they supported well. People’s care, health and cultural needs were identified so staff could meet these. People had their nutritional needs met. People were supported to maintain good health. Staff made referrals to health professionals when required. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 and ensured people consented to their care.

¿ People continued to receive care from staff who were kind and caring. People’s privacy and dignity was protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences. One visitor said. “[Family member] loves staying here, not because of the look (of the place) but because of the[staff] who are caring for her.

¿ People received person centred care that met their needs. Care plans gave details of how people would like their needs met. People took part in a range of group and one-to-one activities depending on their preferences. People said they knew how to make a complaint if needed.

¿ People, visitors and staff told us the service was well managed and had an open and friendly culture. Staff said the service had a family atmosphere and they felt well-supported. The registered manager and staff worked in partnership with other agencies to ensure people got the care and support they needed. One person said, "I think [registered manager] is a very nice person, I have great respect for job they are doing. It’s not small task to manage this place."

Rating at last inspection: Good (report published 26 August 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remains Good.

Follow up:

We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

The inspection took place on 27 July 2016 and was unannounced.

At our last inspection on 28 May 2015, the service was found to not be meeting all the standards we inspected. The issues related to the safety of the premises and grounds, incomplete recruitment practices and the lack of opportunities made available for people to pursue meaningful and relevant social activities and interests at the home or in the local community. The provider sent us an action plan stating how they would make the necessary improvements. At this inspection we found that they had made the improvements set out in their action plan.

Stanborough Lodge is a residential care home that provides accommodation and personal care for up to 25 older people, some of whom live with dementia. At the time of our inspection there were 24 people living at the home.

The home had 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.

People and their relatives told us that they felt people were safe living at Stanborough Lodge. The registered manager and staff team demonstrated a clear knowledge of safeguarding matters. Risks to people`s health and well-being were identified and plans developed to mitigate the risks. The registered manager operated safe recruitment practices and records showed that the necessary checks had been undertaken before staff began to work at the home. There were suitable arrangements for the safe storage, management and disposal of people’s medicines.

People received their care from a staff team who felt supported by the management team. The staff had the basic core skills and knowledge necessary to provide people with safe and effective care and support. People enjoyed the food provided and received appropriate support to eat and drink sufficient quantities where needed. People’s health needs were well catered for because appropriate referrals were made to external health professionals.

Staff were calm and gentle in their approach towards people and were knowledgeable about individual’s needs and preferences. Relatives and friends of people who used the service were encouraged to visit at any time and people’s privacy was promoted.

People’s care plans were sufficiently detailed to be able to guide staff to meet their basic care needs. People had opportunities for activity and stimulation in the home. Relatives and people who used the service told us that they would be confident to raise any concerns with the management team. The provider had made arrangements to facilitate feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided.

There was an open culture in the home and relatives and staff were comfortable to speak with the registered manager if they had a concern. The provider and registered manager had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 28 May 2015 and was unannounced. At our last inspection on 20 May 2014, the service was found to be meeting the required standards. Stanborough Lodge is a residential care home that provides accommodation and personal care for up to 25 older people, some of whom live with dementia. The home is comprised of bedrooms and communal areas spread over two floors where staff look after people with varying needs and levels of dependency. At the time of our inspection there were 25 people living at the home.

There is a manager in post who has registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection a number of applications had been made to the local authority in relation to people who lived at the home.

People told us they felt safe at the home. Staff had received training in how to safeguard people against the risks of abuse. There were enough staff members available to meet people’s needs. We saw that plans and guidance had been put in place to help staff deal with unforeseen events and emergencies. However, not all areas of the home had been managed effectively to keep people safe.

We found that people had been supported to take their medicines on time and as prescribed by staff who had been trained. People told us that potential risks to their health and well-being had been identified, discussed with them and their relatives and reduced wherever possible.

Staff obtained people’s consent before providing the day to day care they required. Where ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) decisions were in place, we found that these had been made with the full involvement and consent of the people concerned or their family members.

People were positive about the skills, experience and abilities of the staff who supported them. We found that staff had received training and refresher updates relevant to their roles. The manager had regular supervision meetings with staff to review their performance and development.

People and their relatives were very positive about the standard of meals provided at the home. We saw that the meals served were hot and that people were regularly offered drinks. People enjoyed a healthy balanced diet that met their individual dietary needs and requirements.

People told us that their day to day health and support needs were met and they had access to health care professionals when necessary. We saw that people were looked after in a kind and compassionate way by staff who knew them well and developed positive and caring relationships with them. Staff provided help and assistance when required in a patient, calm and reassuring way that best suited people’s individual needs.

People were involved in the planning, delivery and review of their care and support. The confidentiality of information held about people’s medical and personal histories was sufficiently maintained across the home. We found that personal care was provided in a way that promoted people’s dignity and respected their privacy.

People told us they received personalised care that met their needs and took account of their preferences. We found that staff had taken time to get to know the people they looked after and were knowledgeable about their likes, dislikes and personal circumstances.

People expressed mixed views about the opportunities available to pursue their social interests or take part in meaningful activities relevant to their individual needs. We saw that where complaints had been made they were recorded, investigated and the outcomes discussed with the people concerned. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way.

Everybody we spoke with was very positive about the management and leadership arrangements at the home. However, we found that the methods used to reduce risks, monitor the quality of services and drive improvement were not as effective as they could have been in all areas.

At this inspection we found the service to be in breach of Regulations 9, 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspectors gathered evidence to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring, Is the service responsive? Is the service well led?

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 20 May 2014. This included speaking with people who lived at the home, some of their relatives and members of staff who supported them and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

During our inspection we saw that people who lived at the home were treated with consideration and respect. Staff provided care and support in a way that promoted people’s dignity, privacy and independence.

We looked at the care records relating to two people who lived at the home. These showed that people’s individual needs had been assessed, documented and reviewed. They provided staff clear guidance about the care, support and treatment that people needed in a way that ensured their health and safety.

The provider had suitable arrangements in place to safeguard people against the risk of abuse. This included policies and procedures which gave staff guidance on how to deal with safeguarding issues if they arose and how to raise concerns by following a ‘whistleblowing’ process. We saw that details of these policies and procedures were prominently displayed in the home.

We checked records which showed that effective recruitment policies and procedures were in place. These ensured that staff employed at the home were physically and mentally fit for the role performed, were of good character and appropriately skilled to meet people’s needs. This included carrying out appropriate checks before staff began work.

Is the service effective?

We looked at care records which showed that people’s choices and preferences had been taken into account in the planning and delivery of the care they received.

We saw that risk assessments had been completed and regularly reviewed in relation to a wide range of issues relevant to people’s care needs and personal circumstances. These included assessments relating to the management of people’s medicines, skin integrity and risks associated with pressure care, nutrition and hydration, mobility and the risk of falls.

Is the service caring?

We observed the lunchtime meal and saw that staff provided appropriate levels of support where necessary to help people to eat and drink in a calm, patient and dignified manner.

People told us they were happy at the home and with the levels of support, care and treatment they received. One person said, “The home is very good indeed. They [staff] are very prompt if you call them and look after me very well. They are very caring.”

Is the service responsive?

We saw that people’s views, experiences and choices were taken into account in the way that care, support and treatment was delivered. One person told us, “I like the home. It’s very comfortable and I can do my own thing. I take a walk in the garden when I feel like it. I decide what to do each day and the home provides lots to do. They [staff] do what I want them to do when I need it. I am in charge and they only help me when I ask or need it.”

People told us they liked the activity opportunities provided at the home. These included arts and crafts, quizzes, exercise sessions, knitting, musical bingo and visiting entertainers. A relative of a person who lived at the home told us, “The care [name] gets here is really excellent. Staff know everyone really well which means that they know and understand how to look after them properly.”

Is the service well led?

People understood the care and support choices available to them and were involved in making decisions as far as they were able to do so. A relative of a person who lived at the home commented, “They [staff] always let us know if there needs to be any changes to [name’s] care or medicines. We have been fully involved from the outset. All of the staff are very respectful, kind and courteous. They are patient and treat people as individuals.”

We saw that people had access to relevant health care professionals where necessary and appropriate including chiropodists, GPs and occupational therapists.

Effective systems had been put in place to assess and monitor the quality of services provided. These included processes to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home. This meant that people had been protected against the risks of inappropriate or unsafe care.

During our inspection on 18 April 2013 we found that records were not kept securely.The provider told us that they would take immediate steps to ensure that people's records were kept securely and were protected from access by unauthorised people. We carried out an inspection on 13 June 2013 when we saw that the provider had replaced the open shelves in the office with a large, lockable cupboard. The manager showed us that the cupboard contained the staff records as well as all the records relating to the people who lived at the home. People's records were therefore kept securely and were protected from access by unauthorised people.

We spoke with five people who lived at the home. They told us that they had been involved in the planning of the care that they needed when they were admitted to the home and had agreed their care plans. They said that staff members always asked before any care procedures were carried out. One person told us that they said, "We'll put your cream on your legs now. Is that alright?"

The people we spoke with said that they were very happy with the care that they received. One person told us that they, "had always been comfortable here." We looked at the care plans of five people who lived in the home. We saw that these were detailed and personalised.

The people we spoke with all told us that they were happy with the food at the home and were given plenty of choice. One person told us, "The food is pretty good here." They also said that the home was very clean. One person told us, "They work very hard. The home is always very clean."

We saw from recruitment files that people only started work after a full Criminal Records Bureau (CRB) check had been received. Two references had been obtained for each new staff member before they had taken up their post.

We saw that people's care plans were kept on open shelves within the office at the home. The records were not therefore protected from access by unauthorised people.

We spoke with nine people who lived in the home. Five of them were sitting together and provided comments about their experiences of living in Stanborough Lodge. They all agreed that this was a good place to live. Everyone got on very well with each other. Staff were very good and gentle, making people feel safe. Staff were knowledgeable of people’s needs and always responded when called. All five stated that they felt safe and protected. All five confirmed that they were treated with respect and used the example of the choice of food to illustrate how much choice people could make. There was a choice of five different meals at lunch time and people could ask for the quantity of food they wanted served to them. One person named the main cook and praised them for, “Excellent meals” and choices: “I can always ask for whatever I want and he would cook it for me.” Two people also added that they could have drinks at any time and as much as they wanted. All five confirmed that they were taking part in their care plan reviews.

Two other people also confirmed that they could influence their care plans and that everyone was asked to sign their care plan reviews.

One person was particularly pleased that there were no restrictions on where people could go and they added that they loved the garden and spent: “ A lot of time there, in the sun”.

All nine people that we spoke with stated that there were enough staff on each shift and that people did not need to wait when they called staff for help and support.

The people we spoke to during our visit on 31 December 2010 said that they are being well cared for and their needs are being met.

The people we spoke to during our visit said that meals provided for them are of good quality and plentiful. They also told us that a choice of meals is offered from the menu and food and drinks are available at other times.

They said that they were happy with their rooms and these were bright, comfortable, warm and homely. They felt safe and the home was kept clean and pleasant. The heating is provided to maintain people’s comfort during the day and night. They commented that staff are ‘caring, helpful and supportive’ and that they are aware of the help and support they need and found them to be professional in their approach and delivery of care.

People told us that there had been no shortage of staff in the home during this cold weather conditions and that their care provision had been maintained as usual.