Sundial Lodge is registered to provide accommodation and personal care for up to 48 older people. Accommodation is provided in flats which have their own bedroom, lounge and kitchen area. On the first day of the inspection there were 45 people living at the service. On the second day of the inspection there were 44 people living at the service as one person had been admitted to hospital in between the visits.

This inspection took place on 11 and 16 October 2017, both days were unannounced. The service was last inspected in April 2016 when it was rated as Requires Improvement. This was because we found people did not always receive person-centred care, the requirements of the Mental Capacity Act 2005 had not always been followed and risks to people’s health and safety and medicines were not always well managed. We also found there were not always sufficient staff to meet people’s needs. Following the inspection the provider sent us an action plan telling us how they would make improvements. At this inspection in October 2017 we found the improvements had been made.

A registered manager was 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.

Staff received training that helped them meet people’s needs. Training included equality and diversity, food safety, health and safety, moving and transferring and first aid. Where people had specific needs specialist training was arranged such as pressure area care, death and dying and caring for people living with dementia. Staff received regular supervision and appraisals to ensure they remained competent to do their job.

People’s needs were met in a safe and timely way as there were enough staff available. People and staff told us they thought there were enough staff on duty. One person told us if they pressed their call bell staff came quickly “No doubt about that.” People also told us staff had time to chat with them.

The service used a computerised care planning system and staff used hand held devices to obtain and input information about people’s needs. People’s care plans contained details of how their needs were to be met. Staff had good knowledge of the people they supported and delivered care in a respectful and caring manner and all personal care was provided in private. Staff ensured people received care and support that was responsive to their needs. Staff knew people well and were able to describe their preferences. For example, one staff member described how one person liked an alcoholic drink twice a day. Staff told us that many people were independent and their job was to support them to maintain their independence, but be available if needed.

People praised the staff for their attention and comments included “Staff always do whatever you ask them to do”, “Staff are all very pleasant, willing and friendly. Never make you feel you are a problem”, and “Staff are awfully nice, they are very kind to me.”

People could be involved in making decisions about their care if they chose. People told us staff regularly discussed their care with them, to ensure their needs continued to be met. One staff member told us whenever they made recordings on their hand held devices they showed them to the person so they could see what had been written about them. Visitors told us they were kept well informed about their relatives care and one told us this gave them “Peace of mind.” Visitors told us they were made welcome at any time.

There was a regular programme of activities available for people to participate in. Activities on offer included trips out, exercises and games as well as visiting entertainers. People’s spiritual needs were met. People were supported to visit church each Sunday and

Sundial Lodge is a residential care home registered to provide accommodation and personal care for up to 48 older people. There were 44 people living there at the time of our inspection, a small number of whom were living with dementia.

This inspection took place on 20th and 21st April 2016 and was unannounced. We last inspected in October 2013. There were no concerns identified with the care being provided to people at that time.

The service had a registered manager. 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 is arranged into self-contained apartments which include a bedroom, bathroom, dining and sitting area and kitchenette. Most of these apartments are situated within the main building with some apartments behind the main building, known as the Stables and the Mews. A lounge area is available for everyone to use. Meals are provided to people’s rooms on trays by staff. People can also cook simple meals themselves as there is a kitchenette and fridge in each apartment. The home is set in gardens and is close to Torquay seafront and town centre. Two minibuses are available to ensure people can get out and about to medical appointments, supermarket and the town.

The home works well for people who are more independent and everyone we met spoke highly of the service. People and relatives all felt the care and support at Sundial Lodge was safe. However, we found a number of areas requiring improvement. Some people’s health care needs had increased recently and these were not always being managed safely. For example, in relation to choking and dehydration. We also found medicines were not always managed safely in relation to how they were recorded or how they were stored. Staffing levels were not always safe because there were not enough staff available to meet the number and needs of some people living at the home at all times.

Staff did not always deliver care in line with professional guidance in relation to supporting people to eat and drink enough. Some people who were losing weight needed extra calories in their meals or snacks offered, but records did not demonstrate this was always happening. Systems for recording what people were having to eat or drink were not effective or being reliably followed.

Staff and the registered manager had knowledge of the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards, however assessments and decisions had not been recorded fully or in line with legal requirements.

Information in care plans sometimes lacked detail or was incorrect, conflicting or out of date. This meant that staff did not always have clear or up to date guidance from which to work in order to meet people’s needs and preferences. However, there was good verbal communication between staff about people’s care needs. All care staff attended handover meetings in the morning, afternoon and evenings where information was shared about any changes to people’s health or any other important changes or appointments. The registered manager was actively working towards making care plans more person centred and involving people in this.

People and relatives expressed a high level of satisfaction with food at Sundial Lodge. One person said “there is beautiful food here” and “the food is super here”. People made their meal choices a week in advance which most were happy with. Everyone received a copy of their menu choices. However, this did not suit people living with dementia. A relative said they were concerned that they regularly found evening meals left in the fridge that their family member had forgotten about. This meant staff may be unable to determine if people living with dementia were eating

On the day of our inspection 45 people lived at Sundial Lodge. We spoke with six people who lived at the home. We also spoke with seven members of staff including the owner, the manager, the cook, and four care workers. People were satisfied with Sundial Lodge. One person told us it had “A high standard of staffing, accommodation, cleanliness, maintenance and friendliness”

People who lived at the home felt respected and involved in their care. People pursued hobbies and engaged in regular activities at the home. One person told us “I go to town, we have transport that takes us for two hours, sometimes twice a week.”

People’s needs had been assessed and were delivered in line with their care plan. There was a variety of healthy and nutritious food and drink for people. However, feedback about the food was mixed. One person said "it's not as good as it used to be."

People were protected from the risk of abuse because reasonable steps had been taken to identify the possibility of abuse. Care workers understood their responsibilities and knew how to identify and raise concerns. People told us they felt safe at Sundial Lodge.

We found that medication was being managed well and was stored securely at the home. Appropriate and accurate medication administration records were kept.

We looked at the quality assurance systems in place to monitor the quality of care delivered. We saw that the provider monitored the service and sought regular feedback.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. For example we saw people using the service had signed forms consenting to having photographs taken, care planning and ongoing assessment of needs.

People experienced care, treatment and support that met their needs and protected their rights. We spoke with four people using the service. People told us that they were happy with the care they received. One person said "I am looked after very well" another person said "all the staff are lovely, I can’t complain at all".

People were cared for in a clean, hygienic environment. Each individual’s apartment was clean and staff we spoke with were aware of the standards they were to maintain.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We checked the premises and saw that the building and décor were in a good state of repair and appropriately maintained.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We carried out an unannounced visit to Sundial Lodge on Monday 13 February 2012. On the day we visited there were 45 people residing at the home. We met and spoke with eight people living at the service. We also spoke with relatives, a visiting health professional, care and ancillary staff and the registered manager and representative of the company.

The atmosphere within the home was relaxed and friendly, with people spending their time as they wished. People said they felt safe at the home. People told us that the staff respected their privacy and dignity, and helped them to retain as much independence as possible. One person told us, “I can’t speak highly enough of the staff”. Another person said, “Staff are lovely, very polite and caring…”

We asked people if they found there were enough staff on duty at all times to support them each day. The majority of people told us that in their opinion there were, and that they did not have to wait for long periods for staff to respond to requests for support if they called or rang their bells. One person felt that staffing levels could be improved and that in their experience it wasn’t always easy to find staff.

Overall people told us that they were “very happy” living at this home. Other positive comments include; “Things couldn’t be better”, “This is the best place around”, “I have freedom and independence here” and “Anything I want is available to me here”.

During the inspection we observed care and read a range of documents used to plan and evaluate care. Overall we found that the majority of people were experiencing good outcomes at the service. People were supported by caring and friendly staff who had the skills and knowledge to meet their needs.