The inspection took place on 15 and 20 February 2017 and was unannounced.

Vesta Lodge provides accommodation for up to 61 people with residential and dementia needs. At the time of this inspection there were 57 people living at the service.

There was a manager in post who was in the process of registering with CQC. 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 2008 and associated Regulations about how the service is run.

When we last inspected the service on 22 October 2015 we found the provider was meeting the regulations. At this inspection we found that the provider was continuing to meet the regulations. However, improvements were required to ensure continued compliance with the regulations in relation to the delivery of personal care.

There was a welcoming and calm atmosphere throughout the home. Hand cleaning dispensers were placed around the home to enable staff and visitors to sanitise their hands regularly and reduce the risk of infection, and the home mostly smelt fresh and clean and was well maintained. However, there was an unpleasant odour on one of the units. The environment within the unit for people living with dementia could benefit from being more dementia friendly to help people find their way around the unit and to provide stimulation.

There was plenty of information on notice boards such as guidance to support people who were living with dementia, pictures of staff on duty, date and weather boards on each unit, activities for the week, thank you cards and safeguarding information. There were also suggestion boxes for people to provide feedback about the service on each unit. People told us they felt safe living at Vesta Lodge. Staff understood how to keep people safe and risks to people's safety and well-being were assessed and kept under regular review to help to keep them safe. People's medicines were managed safely by staff who had received training.

People had their needs met in a timely way and we observed there were sufficient numbers of staff who had the right skills and experience to support people safely in a timely manner. There was a robust recruitment process in place. However we found some historic recruitment files did not meet the current standards that were currently in place. The manager undertook to review these with a view to bringing them up to the same standard of the current recruitment process. This helped to ensure that staff who were employed at the service were suitable to work in a care setting.

Staff received regular support from their line managers which included one to one supervision and team meetings. Staff told us they felt well supported. People received the assistance they needed to eat and drink sufficient amounts to help keep them well. People were supported to maintain their physical and mental health and staff made referrals to healthcare professionals when required.

We saw that people had not always been assisted with personal care in a timely way. In some cases this meant that people’s dignity was compromised. Although staff told us they completed detailed records of personal care provided we found that sometimes the detail was not included and therefore it was difficult to establish how or if they had been assisted. Staff were knowledgeable about people’s individual requirements in relation to their care and support needs and preferences. People and or their relatives had been involved in the planning of their care where they were able to and where this was appropriate. Visitors were welcomed to the home at all times and were invited to join in events and celebrations throughout the year.

People were supported to participate in some activities that were provided. This was an area that required improvement as activities

This inspection was carried out on the 22 October 2015 and was unannounced.

Vesta Lodge provides accommodation and personal care for up to 61 older people, some of whom were living with a dementia. It does not provide Nursing care. At the time of our Inspection there were 60 people living at Vesta Lodge.

There was 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.

When we last inspected the service on 12 June 2014 we found them to be meeting the required standards. At this inspection we found that they had continued to meet the standards.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection 29 applications had been made to the local authority in relation to people who lived at the service and whose liberty was being restricted in some way to ensure they were kept safe. The registered manager told us that they were awaiting authorisations from the deprivation of liberty safeguarding authority.

We saw that people living at the home had their needs met in a timely way. Call bells were responded to promptly. We saw that care and support was personalised and provided in accordance with people’s individual needs and preferences. Staff were observed assisting people with personal care, eating and drinking and with taking their medicines when required.

We found that staff were able to demonstrate sufficient knowledge of how to manage peoples care safely. Staff had supervision with their line manager and these meetings were recorded.

Care plans and risk assessments were focused on people’s individual needs and preferences with details on people’s lives and past histories. There was evidence of people or their relatives being involved. People’s nutritional needs were met, and food and fluid intake was managed effectively.

The management in the home was effective and there were various audits and monitoring processes in place.

During this inspection we set out to answer our five key questions; Is the service caring,

is the service responsive, is the service safe, is the service effective and is the service well led? The inspection was carried out by one inspector over one day.

Below is a summary of our findings.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. We asked one person, “Do you feel safe.” They responded “Oh very much so, the staff are nice and helpful.”

We looked at the staff training. We noted that staff were up to date with and had received relevant training. That meant staff had the skills and experience needed to support people.

We noted from the care plans that an assessment of needs had been carried out before people came to the home. We saw evidence from the care plans that risks had been assessed and instructions on how the risks should be managed by staff was provided so that people were safe.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We noted capacity assessments and best interest had been completed. We saw one completed DoLS’ Standard Authorisation’ There have been other applications for DoLS.

Is the service effective?

We noted from the care plans we had looked at that each person or their relatives had signed the service provision ‘information on admission’ checklist. The checklist provided information about the home including the type of care they provided.

People who used the service and their relatives had also given their consent to have photographs taken for the use of identification by the home. The staff members we spoke with said that they always consulted the people on how they would like to be supported with their personal care and other activities.

Is the service caring?

People who lived in the home spoke very positively about their experience and said they had been consulted on all aspects of their care. One relative said, “She did not have any concerns about the quality of care for her [Relative].” Another said, “I have no concerns about the care and the staff. They are very nice and are very busy, would like [Relative] to have some stimulating activity, particularly mid-morning when they are alert.”

Is the service responsive?

We noted that the care plans had been written from the person’s perspective and were centred on their needs. The staff we spoke with told us that the care plans were easy to follow and that they were aware of people’s identified needs and that they ensured that people’s needs were met appropriately. Care plans were reviewed on a regular basis.

We saw the provider had a complaints policy in place. We looked at the complaints log and saw that complaints were looked at in line with home’s policy.

Is the service well-led?

The provider had sent out annual surveys to residents and their families and or advocates. There were regular staff and residents meetings. We saw action plans that had been compiled from questionnaires. This meant people’s views and comments were sought by the provider.

We saw that there were policies in place for infection control, moving and handling and medicine. Regular audits had taken place. We saw the provider had a business continuity plan that had contact details for suppliers in case of an emergency.

We carried out a responsive inspection at Vesta Lodge on 4 March 2014 after receiving information of concern. We found the home to be visibly clean and pleasant. We found that people had their personal care needs met and some people were seated within the homes 'tea room' or in the main reception area. Others had chosen to remain within their units or in their rooms.

People we spoke to told us that people were 'looked after well' and were 'happy', but that staff were 'always busy' and seemed 'over stretched'. Staff we spoke to told us that they 'enjoyed' working at the home and felt that the management was 'doing their best'. We were told by some staff and people at the service that 'sometimes' there was not enough staff.

We found that the provider was meeting the regulation for informing the commission of any deaths that occurred within the home and used the correct reporting procedures. We did however find that the provider was not meeting the standards for providing a sufficient number of staff to protect people from the risk of harm because on the day of our inspection we observed that on two of the four units people were left unsupervised in communal areas.

We previously inspected Vesta Lodge on 5 July 2013. During this inspection we found that the provider was not meeting the standards required for meeting the nutritional needs of the people who used the service.

We carried out an additional inspection at Vesta Lodge on 28 October 2013 to see if the provider had addressed the concerns we had identified. At this inspection we looked at the kitchen areas; peoples care plans and their nutrition and fluid charts. We found that the provider was meeting the requirements of this standard.

We saw that the quality of the food provided to people had been maintained but that the provider had introduced regular stock checks within the kitchen to ensure that food was stored and labelled correctly at all times.

We visited Vesta Lodge on 5 July 2013. On our arrival we saw that people were gathering in the main reception area preparing to go on a trip to the local lakes. During the day we spoke with people who used the service and their families, we were told that people felt like Vesta lodge was 'their home' and that they were provided with continuous feedback on their relative’s progress. We were told that the staff all 'speak nicely' to people who used the service.

People told us that the staffing team was an 'all round team' who supported each other and that the house keeping was 'on the ball' and ensured that everything was always clean and hygienic. Whilst at the service we found that people looked happy and that their personal care needs had been met. We noted that some people were in the communal seating areas whilst others had chosen to sit in their rooms or were freely moving about the home. We did however find that the provider had not satisfied the requirements relating to people’s nutritional needs.

During our visit, on 22 August 2012, we spoke with several people using the service and they were all complimentary about the care provided. People felt that they were well looked after. A person commented that they had ‘no complaints’ about the service and added that the staff were ‘very kind’. This was echoed by another person who said, “The staff are marvellous. They are polite and very helpful.”

People told us that there were activities each day, and they could join in as they wished. There was a choice of dishes each mealtime. We noted a person had chosen prawn cocktail and salad as a starter while others had soup. People were given a selection of sandwiches to choose from during lunchtime. A person commented that the main meal was served in the evening. They said that they had a choice of hot meals, and had plenty to eat There was a selection of soft drinks for people throughout the day and at mealtimes.

A relative we spoke with commented, “The staff are very good. They always keep us informed.” Another relative said that staff were ‘polite’ and always made them ‘feel welcome’. During our visit, we observed a person and their relative being served lunch at a corner table, and their privacy was respected.