This inspection took place on the 10 and 11 of August 2017 and the first day of the inspection was unannounced. The registered manager, staff and people at the service were aware of our visit on the 11 August 2017.

The Warrington Lodge provides accommodation and personal care for up to 21 people with a diagnosis of dementia and at the time of the inspection there were 20 people living at the service.

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.

Where wedges were used to prevent people from falling our of bed capacity assessments were not carried out before making best interest decisions. Some documentation included references to making best interest decision to deliver personal care to people who resisted and were at risk of skin breakdown. However, the framework needed to make these decisions were not in place. The registered manager agreed to complete capacity assessments where appropriate.

The staff we spoke with were knowledgeable about enabling people to make day to day decisions. We saw staff gain consent before any task or activity took place. The people at the service were subject to continuous supervision and applications to deprive people of their liberty were made. to the appropriate supervisory authority. Records were clear where Lasting Power of Attorney were in place and copies of activated orders were kept in care records.

People told us they liked living at the care home. They said the staff were kind and that their privacy and dignity was respected. Relatives said their family members were safe living at the service and had no “concerns”.

Members of staff said they had attended safeguarding of vulnerable adults training. Their comments indicated their understanding of the safeguarding of adults from abuse procedures. Staff knew the types of abuse and how to identify abuse. Staff were knowledgeable about the actions they needed to take where their concerns were not taken seriously by the registered manager.

People received care that was individual to their needs. Care plans were detailed and included people’s preferences. People and where appropriate their relatives were involved in the reviewing process of their care needs. There was a programme of group activities and some one to one activities were taking place for people who preferred not to join group activities.

Risks were assessed and appropriate action was taken to meet the identified risk. Staff were knowledgeable about the people at risk and the actions needed to minimise the risks.

The rotas in place showed there was sufficient staff on duty to meet people needs. Catering and housekeeping staff as well as an activities coordinator was employed. Staff said the staffing levels were adequate to meet people’s needs. People told us their care was not rushed and staff took time to listen to them.

Safe systems of medicine management systems were in place. People were supported with their ongoing healthcare needs. The health and social healthcare professionals told us their advice was followed and requests for visits were made at the appropriate times.

Staff were supported with the roles and responsibility. New staff had an induction to prepare them for the role they were employed to undertake. Staff attended training to meet the needs of people which included dementia awareness. There was an expectation that staff completed recognised vocational training for working with vulnerable adults which included Care Certificate and Quality Credit Framework (QCF). There were opportunities for staff’s professional development which included one to one supervision with the in house trainer and annual appraisals with the registered ma

Information was available for people and their visitors about the service provided, dementia related illness. People were involved in decisions about their care and how this translated to care plans.

We spoke with four staff along with the care manager and assistant care manager. Every member of staff said they “loved” their work. One staff member said it was the “best place I’ve ever worked”. Staff spoke about the activities available and people’s choices. Staff demonstrated they had a good understanding of safeguarding vulnerable adults and whistleblowing.

A senior member of staff told us they felt the home was well organised and the management is always approachable”. The organisation of the home was supported by good record keeping in relation to the meeting of people’s care needs, recruitment of staff and maintenance of the property and equipment.

People who lived in the home and their visitors spoke highly of the service provided at Warrington Lodge having praise for the staff, activities and food.

A visiting healthcare professional told us they believed the home recruited good staff and this was reflected in the care provided. They said they felt the carers were “dedicated” and they wouldn’t hesitate to recommend the home to a relative needing care.

One person we spoke with told us they felt the home was “well run”, that “the food was quite nice” and “staff helpful”. They showed us their room and how it was personalised for them. Another person said “it feels like it’s home". They said they were very happy and comfortable and found “staff approachable”. A visitor told us they had looked at a number of homes before choosing Warrington Lodge for their relative because they felt it was “nicer”. They said they felt the home was “brilliant” and “staff were really nice”.

A visiting health professional said they were always received well by the home’s staff who they found to be “cooperative and supportive”. They said they felt it was “an exceptionally well run home with very dedicated staff”.

We spoke with five staff. They all said “I love my job” and confirmed they felt supported by the manager and each other. Everyone spoke about the good team working of the staff group. They told us they could have supervision meetings on request and valued the training they had.

We found that people were encouraged to make choices about all aspects of their care and the recording systems supported this. There was good management of medicines.

The recruitment and numbers of staff showed that people were cared for by an effective team that were trained appropriately.

There were quality monitoring systems that included consulting with people who lived in the home. There was a clear procedure for making complaints.

On the day of our visit, there were only five people living at the home. The home was fully staffed. People were admitted to Warrington Lodge on a phased basis so they could settle in well before the next person arrived.

Due to their dementia, people were not able to tell us in detail about the service they received. We therefore observed people’s behaviours and their interactions with the staff on duty. Staff were attentive and approached people in a gentle, respectful manner. People were comfortable and relaxed in the presence of staff. One person played a table top game with a staff member whilst another person looked at the newspaper. Another person spent time looking out of the window. Staff talked to them about what they saw. Staff were friendly and gave reassurance when required. They told us social activities were being developed in accordance with people’s individual interests. They said involvement within the local community would be developed in due course.

People’s privacy and dignity were maintained. They were encouraged to make decisions about their daily lives. People chose what they wanted to wear, what and where they ate and when they wanted to get up and go to bed. During our visit, two people chose to eat their lunch in their bedroom. Other people chose where they sat in the dining room. Staff explained the contents of the meal and asked people if they needed any assistance. Staff were pleasant in their interactions and encouraged people to eat. All food was well presented and looked appetising. The menu was clearly displayed in the entrance hall. There were pictures of the food on the menu so people could visually see what they were going to eat. There were clear signs around the home to help people find their way around more easily.

The environment was designed with people’s dementia care needs in mind. All rooms contained an en-suite wet room which enhanced people’s privacy. People were able to personalise their bedroom and have a key to the room if they wanted one. People could have their name and/or a picture on their bedroom door so they could locate their room more easily. There was equipment to meet people’s physical care needs. Themed pictures within corridors provided visual stimulation and topics for discussion.

This inspection took place on the 9 and 10 of February and the inspection was unannounced.

Warrington Lodge provides accommodation and personal care for up to 21 people with a diagnosis of dementia.

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 which corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.’

We saw staff offer people choices around activities, menu choices and gained consent before offering support. Members of staff showed a good understanding of the Mental Capacity Act 2005 (MCA). They were clear on how to follow the MCA principles to gain consent. The MCA assessments did not include the decisions people were able to make and the support they needed to make these decisions.

People told us the staff knew how they liked their needs to be met. Staff told us a person centred approach to meet people’s needs was used. They said people were cared for as individuals and not as a group. Care plans were not person centred as they did not say how the person liked their care to be provided. The care plans were not detailed and did not give staff sufficient guidance to consistently meet the person’s needs. We recommend that the service seek advice and guidance from a reputable source, about the management of behaviours staff find difficult to manage.

There was a programme of in-house activities and entertainment and during the inspection visit we saw some people were having pampering sessions from the staff.

People told us they felt safe living at the home. Members of staff had attended safeguarding adults training and knew the signs of abuse and the actions they needed to take if they suspected abuse was taking place. Staffing levels were adequate which meant there were sufficient numbers of staff to meet people’s needs. We saw there were safe systems of medicine management.

People said the staff had the skills needed to meet their needs. New staff had an induction to prepare them for the role they were to perform. Essential training was provided and staff were encouraged to develop their professional qualifications. Support to the staff was provided through individual one to one meetings with a designated member of staff.

The staff we observed used a kind and sensitive manner towards people. People told us the staff were caring and their dignity and privacy was protected. Members of staff gave us examples to describe how people’s privacy and dignity was respected. The “dignity tree” kept in the reception area had the staff posts of their definition of dignity.

People’s views on the quality of the service were sought and overall they were happy with the standards of care and their feedback on improvements were considered. House Committee and Board of Governors assessed the quality of the service and devised future plans to maintain the quality of care and treatment provided to people. Audits were used to ensure standards were maintained and where they were not fully met action was taken to meet them.