This inspection took place on 5 September 2016 and was unannounced. At the last inspection in 31 October 2013 we found the provider was meeting the regulations we assessed.

Waterside Lodge provides nursing and personal care for up to 64 older people, some of whom are living with dementia. Accommodation is provided over four floors with passenger lift access. There are 62 bedrooms, the majority of which have en suite facilities. Three of these rooms can be used for double occupancy. There are a variety of communal areas including lounges, dining rooms, a reading room and a hairdressing salon. There were 63 people using the service when we visited.

The home has a registered manager who registered with the Commission in May 2010. 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.

The registered manager was on holiday when we inspected and despite our unannounced early morning arrival at the home the staff team were welcoming and the service ran smoothly and successfully in the manager’s absence.

Staff showed consistent attention to detail that meant people received an outstanding level of care and support that was completely centred on each individual’s needs. Staff knew each person well and were very responsive in identifying any changes to people’s conditions at a very early stage in order to ensure their changing needs were addressed. The consistently outstanding level of care and support promoted people’s health and wellbeing and enhanced their quality of life.

People and relatives were extremely happy with the care and praised the staff for being very kind and caring and this was confirmed through our observations. Staff were fully dedicated and committed to making sure people could lead happy lives of their choosing and went the extra mile to ensure their individual wishes were met.

People's privacy and dignity was respected by staff with whom positive relationships had been formed and who promoted their individuality. People were enabled and supported by staff to maintain contact with relatives and friends and develop new friendships within the home.

People were supported to lead active lives pursuing their individual interests and hobbies which included trips out. People were involved in planning and making decisions about their care and their preferences and wishes were respected and acted upon.

Staff demonstrated great empathy, knowledge and understanding of end of life care and used these attributes to help people prepare for the end of their life by ensuring their individual wishes were discussed, recorded and respected.

People felt safe in the home and staff knew how to keep people safe without unduly restricting their freedom. Staff had a positive approach to risk taking and enabled people to live as full lives as possible yet understood how to balance this with people’s safety. For example, doors were unlocked which allowed people to go freely in and out of the home yet staff were conscious of their whereabouts. Staff understood the different types of abuse and knew the signs that may indicate this was happening. Staff understood the procedures for reporting any safeguarding concerns and we saw incidents reported were dealt with appropriately and reported correctly to the relevant authorities.

There were sufficient staff to meet people’s needs and preferences and staffing levels were adjusted according to people’s dependencies. Safe systems were in place to manage medicines which ensured people received them when they needed them.

Staff recruitment procedures were robust which ensured only staff who were suitable to work in the care service were employed. Staff received the induction, training and support they req

During the course of our visit we spoke with eight people who used the service and one visitor, along with 12 members of staff. The majority of people we spoke with were being treated with dignity and respect, they were involved in their care and they spoke positively about the staff and the service they received.

One person said “It's very nice. I can have friends to stay. We sit out in the courtyard when it's nice, and there's drinks and cake.” They also said “Whilst unwell a while ago the staff made sure I was o.k. They never made me feel embarrassed. Everything's always very clean, there are no bad smells. The hairdresser's good too”.

Another person said, “The staff are very conscientious and they are always kind to me. I'm able to express my wishes and say what I'm thinking. I'm cautious about complaining, but I have done in the past, and they listen to me.” Another person said “I don't need company, I am not a party goer, but I could join in things if I liked. The staff are very nice, and they treat me with respect.”

There were systems and processes in place to continually review and evaluate the quality of the services provided for people and there was sufficient staff on duty to meet people’s needs.

We spoke with five members of staff and they explained the care and support they provided. They were complimentary about the care provided. One care worker told us, "It's a lovely place; the best I've worked." A visiting healthcare professional was also complimentary of the care provided telling us, staff always consulted with them if they had any concerns about a person.

On the day of our inspection we observed people were well cared for. People were dressed appropriately for the weather, had regular access to drinks and there were a range of activities taking place. People living at Waterside Lodge told us they were happy and received good care.

The bedrooms we looked at were clean and furnished to people's individual taste. However, we did observe bedroom windows in the old part of the building opened very widely which presented a health and safety risk. We brought this to the attention of the Registered Manager who said they would take action to rectify this.

We looked at the care records of seven people and found they provided a clear description of the care people required. When risks to a person's health and wellbeing were identified, there were appropriate risk assessments in place.

People said the staff were very patient and helpful. They told us they followed their preferred daily routine and staff respected this; they said they didn’t have to fit in with staff or the routine of the home.

We talked to a group of people in one of the lounges. They said they had a good social life, they enjoyed chatting, reading newspapers and books and going out to the market, shops and supermarket across the road. The home has a lively, welcoming atmosphere and people living and working there are very friendly. People told us the place was always busy, with plenty of visitors calling in and a range of activities on offer that people could join in if they wanted to. People living in the home are interested and engaged and are being kept mentally active and stimulated. One person said “you don’t get bored here, there’s always something going on”.

Everyone was full of praise about the standard of cleanliness within the home, they said the domestic team were very good. People were also positive about the quality of food, they told us the meals were appetizingly presented with plenty of variety on the menu. The menus are on display in the dining area and people we talked to knew what they were having for lunch. The kitchen is on the ground floor adjacent to the main dining room. This means that people can easily go and talk to the cook and see food being prepared. We saw people having lunch and it was a very much a social occasion, people were chatting and joking with the catering staff. Everyone was asked if they wanted more. Later, people told us they had enjoyed their meal.

People we talked to said they were impressed with the quality of the décor and fittings throughout the home. These are some of the comments people made about the environment: “everywhere is comfortable and nicely furnished” “we love the ornaments and flowers everywhere” “all the furniture is sturdy, comfortable and well made, they buy good quality fittings” “I love my bedroom, it’s big and warm. I can entertain my visitors there if I want to”. We like this lounge because you can look out and see people passing. People we know give us a wave”.