About the service Tudor Lodge Residential Care Home provides accommodation and personal care for up to 28 older people some of whom were living with dementia. People who live at the home access nursing care through the local community healthcare teams. At the time of the inspection 22 people were living at the home.

People’s experience of using this service:

People told us they felt safe and happy. There were positive and caring relationships between staff and people, and this extended to relatives and other visitors. Staff understood the importance of providing person-centred care and treated everyone as individuals, respecting their abilities and promoting independence. Staff knew how to recognise and report any concerns they had about people’s welfare and how to protect them from abuse.

Tudor Lodge residential care home continued to be kept clean, safely maintained and furnished to comfortable standards. People had the equipment they needed to meet their assessed needs. Health and safety checks were carried out to make sure the premises and equipment were safe.

There were enough staff, day and night, to support people’s needs. The provider recruited staff safely to ensure they were suitable for their role. Staff continued to receive ongoing training and support to keep their knowledge, skills and practice up to date.

Peoples needs were fully assessed before moving to the service so the provider knew whether they could meet the person's needs. Care plans were individual and representative of people’s needs, preferences, values and beliefs. Risks to people’s health and wellbeing were assessed and reviewed when needed. Staff took action to minimise these risks and keep people safe.

People were supported to maintain good health and to eat and drink well. Staff involved other professionals when people became unwell or required additional services. People received their medicines when they should. The provider followed safe practice for the management of medicines.

Staff were caring, respectful and made sure people’s privacy and dignity were maintained. People and their relatives were supported with care and compassion during end of life care. People were supported to have choice in their daily lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People enjoyed varied social and leisure activities and had opportunities to try new ones. There were meaningful activities for people living with dementia. Staff understood the importance of social interaction and ensured they offered people support and companionship when needed.

The registered manager and care manager showed effective leadership and the service was well run. Staff knew their roles and understood what was expected of them. Staff felt supported by management and each other. People, their relatives and staff told us management were approachable and that they listened to them when they had any concerns or ideas. All feedback was used to make continuous improvements in the service.

The provider had good oversight of the service and used effective systems to monitor quality and safety. Where improvements were needed or lessons learnt, action was taken.

At this inspection we found the evidence supported a rating of ‘Good’ in all areas, and continues to support a rating of ‘Good’ overall. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (August 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

This unannounced inspection was conducted on 20 June 2016.

Tudor Lodge is registered to provide accommodation for up to 27 people with personal care needs. The location is a two-storey property with a passenger lift between the floors. The majority of bedrooms had en-suite facilities. However, the provider was altering the building to create one extra bedrooms, installing a larger passenger lift and providing every bedroom with its own ensuite facilities. The home is situated in Burnham on Sea and located close to public transport links, the town centre and sea front.

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.

People were kept safe because staff were vigilant in monitoring behaviours and indicators of abuse. Staff had received training in safeguarding and were able to explain what they would do if they suspected that someone was being mistreated.

People living at the home had detailed care plans, which included an assessment of risk. These were subject to regular review and contained sufficient detail to inform staff of risk factors and appropriate responses.

People's safety was always at the forefront and the home was producing a personal emergency evacuation plan (PEEP) for each person living at the home and had conducted regular fire drills and fire alarm testing.

Staffing numbers were adequate to meet the needs of people living at the home.

The home recruited staff following a vigorous recruitment and selection procedure. Staff files contained two references, which were obtained and verified for each person. There were Disclosure and Barring Service (DBS) numbers and proof of identification and address on each file.

People's medication was stored and administered in accordance with good practice. We spot-checked medicines administration records and stock levels. We saw that records were complete and that stock levels were accurate.

Staff were suitably trained and skilled to meet the needs of people living at the home. The staff we spoke with confirmed that they felt equipped for their role.

The records showed that the home was operating in accordance with the principles of the Mental Capacity Act 2005 Capacity assessments were decision specific and were focused on the needs of each individual.

People spoke positively about the quality of food. The menu changed every four weeks and clearly identified choices. People told us that they were offered plenty of drinks throughout the day.

People had good access to community healthcare services. The home worked well with healthcare professionals to maintain people's wellbeing. We saw evidence of positive relationships and good communication with healthcare services.

Throughout the inspection, we saw staff engaging with people in a positive and caring manner.

Staff spoke to people in a respectful way and used language, pace and tone that was appropriate to the individual. Staff spoke with people before providing care to explain what they were doing and asked their permission.

People's privacy and dignity were respected throughout the inspection. People living at the home had access to their own room for the provision of personal care if required.

Each of the people that we spoke with confirmed that they had been involved in their own care planning. They also confirmed that relatives were invited to contribute to care planning. We saw evidence in care records that people and their relatives had been involved in the review of care.

Information regarding compliments and complaints was clearly displayed and the provider showed us evidence of addressing these in a systematic manner. All of the people that we spoke with said that they knew what to d

We spoke with six people who lived at the home, the registered manager, care manager, and support staff. We also spoke with three relatives who were visiting.

All six people told us that they were satisfied with the care and support they received. One said “They’re always cheerful (the staff), never very negative.” Another said “They’re marvellous here. They help me with a bath and help me feel safe.” Another told us “The care is very good. The staff are very kind and we’re very happy here. They put up with quite a lot.”

All of the relatives told us that they were satisfied with the care and support their relative received. One told us “I know I can go home and my relative will be well cared for. All of the staff are amazing and have a genuine interest in the people living here.” Another relative said “I really appreciate the small things, like when the doorbell is rung it’s always answered quickly, and the hospitality is great, it’s always very welcoming here.”

We found that people had comprehensive care plan files, which contained lots of information on how people wanted to be supported, and what they were able to contribute themselves. This meant support staff could be clear about what type of support a person needed, their choices and preferences, and which parts of tasks they were able to do for themselves.

Whilst at the service we heard and saw staff talking with people and offering them choice and support in a respectful and polite way. A relative told us “The thing I like the most about here is the consistency. I can visit anytime and it always feels welcoming and of a good standard.”

We saw evidence in care plans that the provider was respecting and involving people. We saw people being treated with respect and their views being sought. People told us "I'm extremely happy here" and "nothing is too much trouble for them, they never make you feel you are a nuisance".

We were told by one person that "the activities here are lovely" and we also read a letter of thanks from family members that spoke of the home going "above and beyond" when supporting someone who had become very ill. Individual care plans contained individual assessments and plans. Activity records were in place demonstrating the provider was providing personalised care, treatment and support.

There was guidance in the home on safeguarding people from abuse. Staff members spoken to knew how to report any concerns regarding abuse. We were told that "the atmosphere here is lovely" and another person saying "you can talk to them about anything".

We saw evidence in the notes of staff meetings that the provider had reviewed and made changes to staffing levels by increasing the number of staff in the afternoons. We were told this was an area kept under regular review.

There were quality improvement plans in place and results of satisfaction questionnaires to evidence that the provider was assessing and monitoring the quality of service provision. The provider told us how they felt this was important and gave recent examples to demonstrate how this operated within the home.

People spoken with during our visit were very happy with the care that they received. One person said “You get all the help you need” another person said “I feel very well cared for.” One person commented on the kindness of staff when they assisted with intimate personal care.

Everyone asked spoke very highly of all the staff in the home. One person described them as “Very competent” another person said “Staff are all very helpful and do whatever you ask them to do.”

People living at the home said that they were able to make choices about all aspects of their daily lives. People said they were able to choose what time they got up, when they went to bed and how they spent their day. One person said “I do whatever I choose” another said “I can please myself what I do and what I join in with, there’s no pressure.”

Some people said that they were involved in their care plan and that they signed to say that they agreed with the contents. We saw copies of signed care plans during our visit. Two people said that they did not know what was in their care plan as they had no interest. Both people said that their family members “got involved in that.”

Everyone felt that their care was tailored to their personal needs and wishes. All felt that they continued to be in control of the care that they received. One person said “I know I need to be looked after but I do as much as I can myself and the staff help out when I ask them to. Everything is on my terms.”

Everyone said that their privacy was respected and staff always treated them in a respectful manner. One person commented that staff were extremely “kind and considerate” when assisting them with personal care. During our visit we observed that staff always knocked on bedroom doors and waited to be invited in before entering.

People said that they felt safe at the home. One person said “I feel absolutely safe here.” People also commented that staff were always “helpful and pleasant”.

Everyone said that they would speak with a member of staff or the management if they had any worries or concerns. One person living at the home said “Chris (the manager) likes you to talk to him, he’s always saying if you have any worries he wants to know about them so they can be sorted out.”

People living and working at the home said that there was a very open culture which encouraged people to discuss issues. Staff said that if they had any concerns they would report it straight away. All were confident that concerns would be taken seriously and quickly investigated.