The Old Lodge Nursing Home provides support and nursing care for up to 47 older people, some of whom are living with dementia, have an acquired brain injury or neurological disorder. At the time of our inspection there were 43 people living in the home. At the last inspection, in July 2014, the service was rated Good with outstanding in our question ‘Is this service caring?’ At this inspection we found that the service remained Good and outstanding in caring.

People continued to receive safe care and there were enough staff to provide support to people to meet their needs. People were consistently protected from the risk of harm and received their prescribed medicines safely. Staff had been suitably recruited to ensure they were able to work with people who used the service.

The care that people received continued to be effective. People made decisions about their care and staff sought people’s consent. Where people lacked capacity they were helped to make decisions. Where their liberty was restricted, this had been identified and action taken to ensure this was lawful. People received supported to stay well and had access to health care services and were able to choose what to eat. Staff received training to meet the specific needs of people who used the service.

The care people received remained outstanding. People were treated with dignity and staff were caring and kind. Staff helped people to make choices about their care and their views were respected. The care records detailed how people wished to be cared for and people could plan their future care and make advance decisions.

People were involved in the planning and review of their care and support and family members continued to play an important role. Where people had any concerns they were able to make a complaint and this was responded to.

The service continued to be well-led. Systems were in place to assess and monitor the quality of the service. People and staff were encouraged to raise any views about the service on how improvements could be made. The manager promoted an open culture which put people at the heart of the service.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This visit was unannounced, which meant the provider and staff did not know we were coming. At the last inspection in October 2013 the provider met all the requirements we looked at.

The Old Lodge Nursing Home is registered to provide accommodation and support for 42 adults who may have a physical, medical or dementia related condition. On the day of our visit, there were 39 people living in the home, one person was in hospital.

There was a registered manager in post. They were on annual leave on the day of our visit but visited the home whilst we were there. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People who used and visited the service were happy with the care provided and we observed staff treating people with care and compassionate. The staff were kind and respectful to people when providing support. We saw staff smiling and laughing with people and joining in activities in the home.

Visitors were welcomed and participated in daily events. People told us they could visit at any time and were always made to feel welcome.

People were dressed in their own style and if they needed support, staff helped people to take pride in their appearance. People were supported to have their personal care needs met.

People told us of ways they chose to spend their day. People were supported to participate in their hobbies and interests which included, attending religious services, going shopping and cake decorating.

People were protected from the risk of receiving unsuitable or unsafe care. Records were updated to inform and guide staff about changes to people’s care. Procedures to protect people from the risks associated with medicines were in place to ensure people received their medicines safely.

The registered manager had a training plan in place to ensure staff received the training they required to meet people’s individual needs. Staff received support from the management team to develop their skills and use their knowledge to enhance the lives of people who used the service. They did this by learning from previous situations and keeping up to date with best practice.

People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to complaints. People we spoke with told us they were happy with the service provided and how staff provided their support.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. Some people who used the service did not have the ability to make decisions about some parts of their care, treatment and support. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate decisions are made in people’s best interests, when they are unable to do this for themselves. Staff had an understanding of this and had received training on the systems in place to protect people who could not make decisions, and where restrictions had been placed upon people the necessary documentation for a DoLS authorisation was in place.

Healthcare professionals we spoke with told us the care and attention given to people who used the service was excellent. They all confirmed they would be happy for their relatives to live there.

The staff spoke well of the manager and the way the service was managed. They said they received the support , training and time they needed to deliver the necessary care and support to people.

There were suitable and sufficient systems in place to ensure the service was managed safely. People who used the service were at the heart of decision making and the care was centred around individual’s needs.

Records showed that we, the Care Quality Commission (CQC), had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

The registered manager regularly assessed and monitored the quality of the care at the home. Appropriate and prompt action was taken to make improvements to the care when required.

We spoke with a number of people living in the service and a number of visiting relatives. One person told us “I spend a lot of time here, the staff are all excellent.” Another told us “It doesn’t matter what time I come in, anything I ask for the staff provide” and “It’s the best (care) I can hope for at (person named) time of life.”

Care plans were descriptive and easy to follow, and when we asked staff they were aware of people’s needs and preferences. People received a varied diet and supplementary nutrition and fluids when required.

We observed staff talking with and assisting people throughout our visit, some of which were made indirectly and from a distance. Staff were seen to have undertaken tasks with peoples’ privacy and dignity in mind and showed the staff were aware of their individual support needs.

We looked at how medicines are managed and found that this was well administered, with a well detailed policy and procedure for staff to follow.

We saw that the recruitment was secure so people could be assured that people employed were appropriate to work with vulnerable people. There are a number of quality assurance checks in place to ensure people remain safe at the home.

People and their relatives praised the service and told us staff were respectful and “sensitive”. One person using the service told us that the service was “very nice” and another said they “love this place” and that “staff are very good”. One relative told us that the service was “like family” and another told us that they thought the service was “great”. Another set of relatives told us that staff were “very genuine” in their care of people.

People confirmed that they felt safe using the service and all the relatives we spoke with told us they had no worries about the way care was provided. They praised the staff and one person said they were a “good team”.