The inspection took place on 23 November 2017and was unannounced.

Tye Green Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Tye Green Lodge provides accommodation and personal care for up to 61 older people including those living with dementia. Accommodation is located over two floors and divided into four units. At the time of our inspection there were 60 people living at the service.

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.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

We saw improvements in how medicines were stored, administered and managed and improved infection control practices were in place. The premises were clean and safe for people as regular checks of the environment and equipment were undertaken.

People received safe care as any risks had been identified and were well managed by staff who knew people well. People told us they felt safe and relatives felt confident that their family members were well looked after.

People remained protected from the risk of abuse as staff had received training and understood their safeguarding responsibilities and the reporting process. Lessons were learned from accidents, incidents and complaints. These were recorded and analysed with actions taken to minimise the risk of re-occurrence.

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 service supported this practice.

Staff received training and support with learning to help equip them with the skills and knowledge required to support people effectively. Staff felt well supported through the supervision and appraisal process and the ‘open door’ policy adopted by the management team.

People were supported to have enough to eat and drink and received timely support to access healthcare professionals when their health needs changed. If people had particular wishes for end of life care these were discussed and recorded. Systems were in place to support people with symptom control and pain relief.

There was a longstanding and stable staff team who were kind and caring and knew people well. People were treated with dignity and respect and felt listened to. People received care and support how they liked it and their independence was encouraged. Visitors were made welcome at the service and people were helped to maintain relationships that were important to them.

Care plans were personalised and were regularly reviewed to reflect peoples' current needs. People’s viewpoints were actively sought and the service responded positively to feedback and complaints. The home environment was warm and welcoming with lots of opportunities for activities, stimulation and social interaction that met people’s needs and preferences.

Staff, people and relatives were all included in the running of the service. Quality assurance systems were in place to monitor the safety and effectiveness of the service and drive improvements. There was robust oversight of the service and clear lines of accountability at staff, management and provider level.

Further information is in the detailed findings below.

Tye Green Lodge provides accommodation and personal care for up to 61 older people including those living with dementia. Accommodation is located over two floors and divided into four units. There were 61 people living in the home when we conducted this inspection.

This inspection was unannounced and took place on 19 November 2015. During our previous inspection on 12 August 2014, we found that all of the regulations that we looked at were being met.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had received training and had an understanding to ensure that where people lacked the capacity to make decisions they were supported to make decisions that were in their best interests. People were only deprived of their liberty where this was lawful.

Although people received their medicines as prescribed and complete records were maintained we found that the record were not always signed by the person who had administered the topical creams.

The provider had a robust recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

People’s privacy and dignity were respected at all times. Staff were seen to knock on the person’s bedroom door and wait for a response before entering and closing the door to protect people’s dignity when providing personal care.

People’s health, care and nutritional needs were effectively met. People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Staff referred people appropriately to healthcare professionals.

Care records we looked at and people we spoke with showed us that wherever possible people were offered a variety of chosen social activities and interests.

The provider had a complaints process in place which was accessible to people, relatives and others who used or visited the service.

The provider had effective quality assurance systems in place to identify areas for improvement and appropriate action to address any identified concerns. Audits, completed by the provider and registered manager, showed the subsequent actions taken, which helped drive improvements in the home.

At the time of this inspection there were 58 people living at Tye Green Lodge.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary, please read the full report.

This was an unannounced inspection. We spoke with seven people who lived at the home. We could not speak with some people due to their needs. We also spoke with the manager and two other members of staff. We looked at written records, which included copies of people's care records, medication systems, staff personnel files and quality assurance documentation.

Is the service safe?

We found the home to be warm and clean. The accommodation was adapted to meet the needs of people living there, was suited to caring for people with limited mobility and was appropriately maintained.

The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. People were protected by safe recruitment practices. There were proper processes in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

We saw that care plans and risk assessments were informative and up to date. Staff we spoke with were familiar with their contents and understood people's needs, which enabled them to deliver appropriate and safe care.

People we spoke with were satisfied with the care and support they received.

Is the service caring?

We spoke with seven people who used the service. One person said to us, "It is very good here. They look after you well and they all try to get things right for you." Another person said to us, "This place is absolutely perfect. Nothing could be improved. The staff are superb." Another person said, "We are free to do as we please. I would recommend it to anyone." Nobody we spoke with raised any concerns with us.

We observed a good rapport between staff and the people who lived at the home. We witnessed the care and attention people received from staff. Staff were friendly, were attentive to people's needs and people were treated with dignity and respect.

Is the service responsive?

People were consulted about and involved in their own care planning and the provider acted in accordance with their wishes. Care plans and risk assessments were regularly reviewed. Activities took place regularly that were appropriate to people's needs.

Two staff members told us that the manager was approachable and they would have no difficulty speaking to them if they had any concerns.

Is the service well led?

The manager had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff, that the service was continuously improving and that people were satisfied with the service they were receiving. The provider undertook regular detailed audits of the service to support the management of the home.

We found that people's care was planned and delivered as appropriate to their needs and was regularly reviewed. One person's relative we spoke with told us, “I was very much involved when we came for the assessment, they asked all sorts of questions about [relative’s] health needs and also about [relative’s] likes and I was able to input into that." They also told us that staff were, "Consummate professionals."

People who used the service were provided with a choice of suitable and nutritious food and drinks. Service users were supported to eat and drink sufficient amounts for their individual needs. One person who used the service told us, “The food here is very good, there is always a choice, and if there is something we don’t want the chef will cook us something individual.”

People who used the service received their medicines in a safe way, and at the times they needed them. One person who used the service told us, “You can set your watch by how regular they are, never early and never late.”

People who used the service were supported by sufficient numbers of staff and the home constantly reviewed their staffing to maintain this. One person who used the service told us, “If I need help I ring this bell and within a minute or two staff are here. They are a fantastic bunch and know exactly what they need to do to help me."

There were systems in place which were designed to regularly assess and monitor the quality of the services provided. People we spoke with felt the management team was approachable and responded to concerns raised.

Many of the people living at the service had complex needs and were unable to tell us directly about their experiences. We used our Short Observation Framework for inspection tool (SOFI) to help us understand people's experiences. We saw that interactions between staff and people at the service were positive and the staff actions validated the people involved even when some behaviours were repetitive.

We noted that in people's care plans their capacity to consent had been considered and in some cases the people involved had signed their plans and consent forms. We found that people's needs were assessed and developed into plans of care. One person told us that they had lived at the home for several years. They said "I am happy here. The staff are kind ....overall I have no complaints."

We spoke with four care staff who were able to demonstrate their understanding of abuse by talking to us about what abuse was, and how they would report it if it occurred. Staff told us that they felt very supported to undertake their roles and they could access support at any time from the senior managers.

We spoke with three relatives who told us that they had been provided with details on how to complain. One relative told us that they had written to the company head office when there had been an issue with access to the garden, and there appeared to be a delay in addressing the repairs. The provider dealt with the matter quickly and resolved the issue.

People with whom we spoke are happy living at the home. They told us that the staff team are good and look after them well. They said ‘The staff are good with your dignity and they are respectful’ and ‘Staff often do little things for you over and above what is needed.’

People living in the home were happy with the food and felt that they had choice and there was a flexible approach to the food available and to mealtimes.

People with whom we spoke were not aware of the complaints procedure but felt that if they had any concerns that they would be listened to and that they would dealt with properly. They said that they saw the managers of the home a lot and they felt comfortable to raise anything.