Syston Lodge Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to accommodate 25 older people; at the time of our inspection, there were 19 people living in there.

At our last inspection in March 2017, this service was rated overall as requires improvement. At this inspection, improvements had been made and sustained and the service is rated overall good. The inspection took place on the 15 May 2018 and was unannounced.

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.

People received care from staff that knew them and were kind, compassionate and respectful. The staff were friendly, caring and passionate about the care they delivered.

Detailed care plans were in place, which enabled staff to provide consistent care and support in line with people’s personal preferences and choices. End of life wishes were discussed and plans put in place.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

Staff were appropriately recruited and there were sufficient staff to meet people’s needs; staffing levels were kept under review. People were protected from the risk of harm and received their prescribed medicines safely. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

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 home supported this practice. There was a variety of activities available for people to participate in if they wished to and family and friends were welcomed at any time.

Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day-to-day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

Staff had access to the support, supervision and training they required to work effectively in their roles. Development of staff knowledge and skills was encouraged.

The service had a positive ethos and an open culture. The provider was committed to develop the service and looked at ways to improve the service. However, the systems in place to monitor quality and health and safety needed to be strengthened to ensure that shortfalls in the environment were identified and appropriate timely action taken.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.

We carried out an unannounced comprehensive inspection of this service on 5 December 2016. Syston Lodge Residential Home is a purpose built home situated in Syston. It provides accommodation for up to 25 people spread over two floors. There is a passenger lift and stairs to access the upper floor. At the time of our inspection there were 22 people using the service.

The service is required to have a registered manager in place. 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 not had a registered manager working at the service since November 2015. The manager had been overseeing the management of the service since November 2015 and was in the process of applying to become the registered manager of the service.

At our previous comprehensive inspection of the service on 12 January 2016 two breaches of legal requirements were found. After the inspection, the provider sent us an action plan detailing what they would do to meet legal requirements in relation to these breaches. This was to ensure that risks associated with people’s health, safety and welfare were appropriately assessed, premises and equipment were safe and properly maintained and that the provider acted on feedback. These actions had all been completed.

People were protected from the risk of avoidable harm or abuse because staff could identify the potential signs of abuse and knew how to report and escalate any concerns. Risks to people’s safety were assessed and control measures put in place to reduce them. Accidents and incidents were recorded but there was a risk that people’s injuries could deteriorate and staff would fail to notice as the records did not support the ongoing monitoring of them. Medicines were stored appropriately however the recording of medicines did not always evidence best practice.

There were enough staff to keep people safe. Staff felt supported, received an induction, regular supervision and an annual appraisal to support and develop their practice. Staff understood their roles and responsibilities. Staff received training to enable them to meet people's needs. Training was not always renewed to ensure that staff knowledge was up to date with best practice.

People were supported to have 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’s day to day health needs were met and people had access to external healthcare professionals when they needed them.

People told us that the staff were kind. Staff members knew people well and were able to tell us about their likes and dislikes. Staff did not always respond to people in a kind and considerate way. Relatives were able to visit their family members without unnecessary restriction. There was information on display at the service in relation to external support groups that were available and about advocacy and people’s rights.

Planned activities took place at times throughout the week. Activities were not always specific to people’s individual preferences and aimed more at group sessions for people to enjoy.

People contributed to an assessment of their needs. People's care records were reviewed but people were not involved in the review process. People who used the service knew how to and felt able to raise any concerns. Relatives did not always feel able to openly to raise their concerns.

Audits throughout the service were carried out and where any concerns were identified they were addressed. Quality assurance surveys were in place. However no action plan was developed from people's feedback to show what actions were going to be taken as a result.

This inspection took place on 12 January 2016 and was unannounced. At our last two inspections of the service on 26 February 2014 and 22 August 2014 the service was in breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Safety and suitability of the premises. Following the legislative changes of 2015 this correlates to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 12 Safe care and treatment. The service had also been in breach of the same regulation at the previous inspection on 26 February 2014. The service sent us a plan of the actions that were going to take to ensure they were compliant with the regulation. At this inspection we found that although some areas had been addressed there were still some concerns relating to people's safety and welfare within the premises.

Syston Lodge Residential Home is a purpose built home situated in Syston. It provides accommodation for up to 25 people spread over two floors. There is a passenger lift and stairs to access the upper floor. At the time of our inspection there were 19 people using the service.

There is a registered manager at the service, however at the time of our inspection they were not at work. 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 provider had arranged for a manager from their other service to oversee the day to day management of Syston Lodge Residential Home in the registered managers absence.

People at the service felt safe. They were supported by staff that understood their responsibilities to identify and report any signs of abuse using the provider’s safeguarding procedures. People’s safety was supported by the provider’s recruitment practices. Relevant checks had been carried out on staff before they started work.

Staff were aware of risks associated with people’s care and support, although these had not always been updated in people's plans of care. Accidents and incidents were recorded but on one occasion we found that there had been a delay in a person seeking further medical attention following a fall.

People were supported by staff with the right training and support to meet their needs. However staff did not have a consistent understanding of people's dietary needs. The provider could not assure themselves that people that required a fortified diet were always being provided with one. People were provided with a choice of meals. People were offered regular drinks and snacks throughout the day.

Staff obtained people's consent prior to assisting them with any care and support. The management team were aware of their roles and responsibilities under the Mental Capacity Act 2005.

Staff treated people with dignity and respect. People were able to spend their time the way they wanted and their choices were respected. People were able to spend private time alone or with other people in communal areas of the service. Staff were caring and attentive to people's needs.

People contributed to an assessment of their needs, Care plans contained information about people’s likes, dislikes and preferences and things that were important to them such as their religion.

People were supported to pursue their interests and hobbies. Arrangements had been made so that people could continue to observe their faith.

People did not feel confident about raising their concerns about the service. The provider had a complaints policy available to people.

Staff at the service shared the same vision and values which was consistent with the services statement of purpose. Staff felt well supported and enjoyed their work.

Premises and equipment were not adequately maintained to ensure peopl

Our inspection team was made up of one inspector. There were 22 residents of the care home on the day of our visit. We spoke with 11 people who used the service and five members of staff. They helped answer our five questions which are set out below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, 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 safe?

People told us they felt safe and were treated with respect and dignity by the staff. There were sufficient staff to meet people's needs. Staff had regular supervision and annual appraisals were being completed. Staff had received mandatory training. This meant that staff had the right knowledge to meet people's individual needs.

No person in the home was subject to Deprivation of Liberty Safeguards (2007). We saw no restrictions on people’s liberty. Specific training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had been provided for staff. The Mental Capacity Act and Deprivation of Liberty Safeguards is legislation used to protect people who might not be able to make informed decisions on their own about the care they receive.

Improvements were needed in ensuring people were protected against the risks associated with waste disposal and in the maintenance of some bathroom areas.

Is the service effective?

All people we spoke to told us the care and support provided was good and they got on well with staff. They said staff were helpful and listened to them. One person told us, “They are really good – you can’t fault it”. Another said, “They all do their best for us”.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. Care plans considered all aspects of the person's circumstances and were centred on them as an individual. Information was given on how best to provide different aspects of a person’s care. This helped staff provide care and support according to the person’s needs and choices.

Is the service caring?

All the people we spoke with understood the care choices available to them and told us staff supported them in making their choices. They were all positive about the staff and how their care was provided. One person told us, “We can choose what we want to do”. This meant that people were encouraged to make their own decisions about their daily life.

We observed effective communication and good relationships between the staff on duty and the people living in the home. Staff made sure they gave individual time to those people who needed this. This helped to make sure people felt listened to and their needs were met.

Is the service responsive?

People had regular opportunities to do things they enjoyed. A range of activities was provided for people who used the service. People told us they enjoyed these activities.

Information on how to make a complaint was available in the home and in the information pack given to people who used the service and their representatives. There had been no recent complaints.

Is the service well-led?

The service had a quality assurance system in place. We found that a range of internal audits were carried out to assess and monitor the quality of service that people received. Any action needed to improve the service was identified and followed up.

People who used the service were asked for their views about the quality of care and support being provided. This meant that the care and service provided was informed by the comments made by people who used the service.

We spoke with five people that used the service, their relatives and a number of staff when we visited. People we spoke with said they felt safe, and were happy to speak with staff if they had a problem. One person said, “I would speak to (named staff) they are really nice and we often have a little chat.”

We also spoke with a relative that was visiting, they said “I think the home is wonderful, the staff are nice and very helpful.”

People felt their food and meals were good, and they had a good choice.

We looked at the medication system and found that this was operated efficiently and medicines were stored appropriately.

We found care plans and risk assessments were reviewed regularly. Other information included in the files covered people’s nutritional needs and information that could be used in an emergency.

We noted that a repair to a broken window and some information on control of substances hazardous to health (COSHH) were needed to ensure people’s safety in the home.

We also noted that further guidance could be given to staff about the temperature storage for medicines.

We did not visit the home to perform this part of the inspection and therefore did not speak to any people using the service.

Our inspection of 4 September 2012 found that there was poor medication administration, which meant that the arrangements were not sufficiently robust to keep people safe. We also found that there were poor arrangements around locks on doors to promote privacy and dignity; there were also some bedrooms which did not have appropriate door closers.

We received a comprehensive action plan on 3 January 2013 and further more detailed information the following day. We reviewed the action plan and additional evidence, which explained how the staff are going are going to improve areas we highlighted to ensure compliance.

We returned to the home to ensure staff had made improvements to three outcome areas and saw improvements in all. We observed staff talking with and assisting people throughout the day. This was done with the people's privacy and dignity in mind and showed the staff's awareness of peoples individual support needs.

We looked at the quality assurance questionnaires that were put out in January 2012. People were asked to comment if they were satisfied with the services provided in the home and could add comments or return these anonymously if they wished. We looked at the feedback compiled from the 16 returned forms. We noted comments such as “too much sausages”; “waiting too long at tables”; and “in the summer we could have a coach trip’. We saw other types of quality assurance that was used in to ensure peoples safety in the home.

We saw that staff were receiving training on a regular basis, and that they used a number of documents to ensure people's care was appropriate and safe.

We looked at the medication system and noted errors in two records where staff had given people less medication than they were prescribed.

We looked around the home and noticed some issues with door locks and asked the fire authority to follow these issues up.

During our visit people were taking part in a bingo activity, talking in small groups and eating a meal. We saw visitors arrive and sit with their relatives in the lounge areas and join in the activities. We heard people use call bells in their bedrooms and staff respond. We observed people and their interactions with each other and with staff.

We spoke with four people who used the service. They told us they were satisfied with the service, liked the staff and the home cooked meals. We spoke with four visitors who told us they were happy with the service and praised the use of the computer and camera for relatives to keep in contact with people living at Syston Lodge.