Warren Farm Lodge is registered to provide accommodation and personal care for up to 30 people, who are mainly older people with dementia. At the time of our inspection 30 people were using the service. Our inspection was unannounced and took place on 08 November 2016. The service was last inspected on the 29 April 2014 where the provider was found to be meeting all of the required standards.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Medicines were given appropriately and the recording of their administration was clear and concise. They were kept and disposed of as they should be. People’s long term health needs were addressed and people saw medical professionals when they needed to. People received adequate food and drink.

There were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs. People felt safe and they were able to raise any concerns they had and felt confident they would be acted upon.

Staff were well trained and knowledgeable regarding people’s needs. Staff felt well supported by management and felt able to speak with senior staff at any time.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. Staff interacted with people in a positive manner and their consent was sought before any care was carried out. Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People’s preferences were acknowledged and staff understood people’s likes and dislikes. People were encouraged to participate in activities where they chose to and friendships were maintained.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place. Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs were effective. Quality assurance audits were undertaken regularly and the provider gave the registered manager support.

Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to.

There were 28 people that lived at the home at the time of our inspection. During our inspection we spoke with fourteen people that used the service, three staff, four relatives, the care manager and a visiting healthcare professional. The registered manager was not available at the time of our visit. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask.

Is the service safe?

We saw that people were cared for in an environment that was maintained and suitable to meet their needs. One person told us, “I love my bedroom and the home is great.’’ All part of the communal areas were clean and well maintained. Staff spoken with and records seen showed training was provide so that people’s needs were met safely. We saw that risk assessments and equipment was available to ensure that people had the right equipment to meet their needs. All the people spoken with told us that they felt safe living there.

All the people spoken with told us that staff responded quickly when they needed assistance. We observed good interactions between the staff and the people who lived there. One person told us, “You only have to ask once and it’s done.”

We saw that a recent external audit had been undertaken by the provider and improvement in some records was required. For example more information in risk assessments to ensure staff had the information to provide safe care at all times. However the manager had begun to take action to address this.

The care manager told us that one application under the Deprivation of Liberty Safeguards had been made. Records showed that this had not been reviewed. We asked the provider to establish if this was still current and take the necessary action if required. The manager commenced this process during our visit. This meant the service had procedures in place to protect people when required and make decisions on their behalf to keep them safe.

Is the care effective?

All the people that we spoke with who used the service and their relatives told us they were happy with the care and that their needs were being met. One person told us, “It’s the best home. I looked at a few before I came here, and it was the best then and it is the best now’’. We saw that people were provided with information about the service, for example an advice line was displayed in the entrance to the home, so people could contact them in confidence if they had concerns, details of the resident association and how to make a complaint. All the people spoken with told us there were involved in decision about their care.

We saw that staff knew people well and were attentive to their needs whilst supporting them to be independent. One person told us,” I could not ask for better staff to help me they are all lovely.’’ People were encouraged to do the things they liked. This meant staff responded to individual needs.

Is the service caring?

All the people we spoke with and their relatives told us that the staff were caring. One person told us, “They (staff) help me when I need help but they always ask if they can do anything.”

People told us and we saw that staff respected their privacy and dignity and that they were given choices about their care. One person told us, “I have been here for two years, I cannot praise the staff enough, kind considerate and very helpful’’. This meant people were happy with their care.

We saw that staff were attentive to people needs and spoke with people respectfully. We saw that staff asked people if they wanted drinks and encouraged them to make choices. A relative told us, “There is always a pleasant and comfortable atmosphere and I see staff caring for people.” A visiting healthcare professional told us, “Any instructions given to staff are always followed and they always seek advice.” This showed that staff cared for people and ensured that people’s needs were met.

Is the service responsive?

All of the people that we spoke with told us that staff asked them if they would like to be supported with personal care tasks such as bathing. One person told us, “The staff always ask and wait for me to give them an answer. I have never been made to do anything that I have not agreed to.” One staff member told us, “I always ask people, ‘do you want a bath or shower today and what time would you prefer’.’’ This meant that staff were able to provide care that met people’s needs according to what they wanted on a daily basis. During our inspection, we observed staff members responding to people’s needs. For example, we observed a staff member discreetly ask a person if they could assist them to the bathroom. We also observed staff at lunchtime give people time to decide whether they wanted to be supported to the dining area or have their lunch in the lounge. This meant that staff responded to people in a personalised way taking into account how people felt.

We saw that care plans were reviewed so peoples’ changing care needs were updated to ensure that staff had the current information so they could support them. However, daily records needed to show what people do on a daily basis and contain more details about how people spend their time. There were no restrictions on family members visiting the home showing that the service was responsive to people’s needs and enabled them to maintain relationships with people important to them.

Is the service well led?

There is a registered manager in post who has day to day responsibility of the service provided. This meant staff should have the guidance and support to meet people's needs.

We saw that meetings with people who used the service were held to gain their views about the service and make suggestions for improvement. All the people we spoke with told us that the manager and staff always listen. This meant the provider monitored the service and took people’s views into consideration when making improvements.

All staff told us that they were able to put forward ideas and the provider would listen and try and accommodate where possible to improve the service provided to people. All staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff had the skills to care for people safely.

There were twenty-two people using the service on the day of our visit. The provider did not know we were coming. We spoke with seven people using the service, four relative, three staff and the manager.

People were supported in a way that enables their privacy, dignity and independence to be respected. One person told us, “Staff ask my permission before they do anything’’. They treat me as an individual and my wished are respected. All of the people spoken with commented that they were happy with the service provided. This meant people preferences were respected.

Staff spoken to was able to tell us about people's care needs so that they were cared for appropriately. One person told us “I am pleased with the service I have, the staff look after me well’’. All of the people spoken with commented that they were happy with the service provided. This meant people received the care they wanted

We saw that systems were in place to keep people safe from harm.

Staff received a range of training so that they had up to date knowledge and skills in order to support people safely.

There were systems in place to monitor and seek feedback from the people using the service to ensure people received a quality service.

There were 30 people living at the home on the day of our visit, no one knew we would be visiting. We spoke with six people who lived at the home, three relatives, the area manager deputy manager and cook.

We visited the service to follow up improvements from our inspection in February 2011.

Six people using the service told us they they were fully involved in their care. One person told us "I know about my care plan and what it says, and I know it changes as I do’’.

All three relatives told us they were consulted about their relative’s care and kept informed about their relative’s health so they felt involved in their care.

Staff spoken to was able to tell us about people's needs so that they received care in a way that the they preferred. This meant staff had the information about people using the service so they could discuss people care with the individual.

People were complimentary about quality of the food and told us the cook consulted with them about their meals. This meant people preferences and choices were known.

Staff received a range of training so that they had up to date knowledge and skills in order to support people using the service with their medication. This meant people received their medication with support and as prescribed.

We saw people’s personal information being held securely. This meant peoples personal information was kept confidential and accessed only by staff.

There were 30 people living at the home on the day of our visit. The provider did not know we were coming. We visited the service as part of our planned review.

We spoke with eleven people living in the home, three relatives and three care workers. We received positive comments from all the people we spoke too.

Some of the people who lived at the home had dementia care needs. Some people with dementia are not always able to tell us about their experiences. We used a formal way to observe people during this visit to help us understand their experience of care. We call this a Short Observational Framework for Inspection (SOFI). We spent 10 minutes in a communal area during breakfast and 10 minutes following breakfast and observed two people. We recorded their experiences at regular intervals. This included their state of well being, how they interacted with staff members, other people who lived at the home and their environment.

People's privacy and dignity was respected. We saw staff treat people with respect, talking with them and helping them at a pace the person was comfortable with.

Staff had a good understanding of people's needs and preferences and what they needed to do to meet these needs

People told us they were happy with the care and support they had from the staff. One person told us “I think the home is lovely. The food is good, nice staff, friendly people, warm and clean.’’

Eleven people living in the home told us that they felt safe living at Warren Farm Lodge.

One person told us “I would rather be here than out there, at least I know I am safe here and I am well looked after.’’

Another person told us “I am very happy here they look after me very well. The staff are so caring and have time for you.’’

Staff received regular training to ensure they had the skills to meet people needs.

The provider monitored the quality of the service and has taken action if areas for improvement were identified.

People living in the home told us:

“It’s very much like home, but with all the mod cons’’.

“Nice home’’.

“I am treated very well’’.

“Food nice, but have to wait a long time for my pudding’’.

“The staff are very nice and helpful’’.

“Lovely Girls’’.

“My bedroom is just the way I want it, I have my own things’’.

A relative told us:

“The level of personal care give to my relative was second to none. The respect shown and support given to my relative was overwhelming’’

“We like how you actively involve and encourage family members in a lot of things you do for people. Recognising and showing that family are an important part of the life of their relatives living in the home’’.