West Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during the inspection.

West Lodge accommodates up to 60 older people in one building. People are accommodated over three floors, each of which have separate adapted facilities. The service provides both nursing and residential care. On the day of our inspection there were 59 people using the service.

The inspection took place on 4 December 2017 and was unannounced. This meant staff did not know we were visiting.

We last inspected West Lodge on 7 October 2015 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’.

The service had a registered manager who was on duty during the course of our visit. They had worked at the home for several years as a nurse but became the registered manager earlier in 2017. The registered manager was also a registered nurse. 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.

Staff and the management team understood their responsibilities with regard to keeping people safe and staff members had been trained in safeguarding adults. People we spoke with and their relatives told us they felt very safe at the home. The registered manager shared learning from feedback and safeguarding events with the staff team through recorded meetings.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Health and safety checks were completed and procedures were in place to deal with emergency situations.

The home was clean, and we saw staff followed good practice in relation to wearing personal protective equipment when providing people with care and support. The environment was homely, accessible and dementia focussed. For example, one person who used to be a gardener was enabled to spend considerable time in the accessible garden and greenhouse area.

Medicines were managed safely. We saw medicines being administered to people in a safe and caring way. People confirmed they received their medicines at the correct time and they were always made available to them. We saw nursing staff working with community professionals to ensure end of life anticipatory medicines were available to people when needed.

We found there were sufficient care staff deployed to provide people’s care in a timely manner. We saw that recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people. People told us their needs were attended to very promptly.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date.

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.

People gave positive feedback about the meals they were served at the home. People received the support they needed with eating and drinking by the kitchen team who were trained in the support of people with nutritional needs.

We saw people’s healthcare needs were well monitored and records in relation to the monitoring of people’s health, nutrition and pressure care were recorded.

People were supported by care staff who were aware of how to protect their privacy and dignity and show them respect at all times. The home had a dignity champion who was committed to the role and had ensured people were involved in the day to day running of the service. End of life care was provided by comp

The inspection took place on 7 October 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected West Lodge Care Home on 10 January 2013, at which time the service was compliant with all regulatory standards.

West Lodge Care Home is a residential home in Crook providing accommodation for up to 60 older people who require nursing and personal care. There were 59 people using the service at the time of our inspection, nine of whom lived with dementia.

The service had a registered manager in place. 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.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service. All staff were trained, or had training courses booked, in core areas such as safeguarding, health and safety, moving and handling, infection control, as well as training specific to the individual needs of people who used the service, for example dementia. The service had a training matrix in place to track when staff were due to attend refresher training and we saw this was working effectively. We found that staff had a comprehensive knowledge of people’s preferences, needs, likes and dislikes.

We found that the management, administration, storage and disposal of medicines was generally safe and adhered to National Institute for Health and Care Excellence [NICE] guidelines. Where we suggested areas of improvements to practice the service was responsive.

We observed dignified and thoughtful interactions during our inspection and saw evidence in recorded documentation of the promotion of people’s right to dignified care. We observed numerous jokes shared between people who used the service and care staff. Relatives and external stakeholders told us that people were treated well and unanimously agreed that the service was welcoming and effective.

There were effective pre-employment checks of staff in place and effective staff supervision and appraisal processes. The service was clean throughout.

People told us they enjoyed the food and we saw that menus were varied and people had choices at each meal as well as being offered alternatives if they did not want the planned meal options. We saw that the service had successfully implemented a tool to manage the risk of malnutrition and people requiring specialised diets were supported.

Person-centred care plans were in place in all care files we looked at and the provider had sought consent from people for the care provided. Regular reviews ensured relatives and healthcare professionals were involved in ensuring people’s medical, personal, social and nutritional needs were met.

The service had a full time activities co-ordinator who facilitated a range of group and individual activities. We saw some of these activities during our inspection and saw evidence of a comprehensive, innovative and inclusive approach to providing activities tailored to people’s wishes and interests.

The service had individualised risk assessments in place, a strong quality assurance and internal auditing regime that was adequately resourced and a broad set of policies and procedures to deal with a range of eventualities.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The registered manager was knowledgeable on the subject of DoLS but acknowledged the paperwork supporting a recent DoLS application could have been improved. During our inspection they liaised with the local authority to seek support on the most appropriate way of documenting future DoLS applications.

Staff confirmed they were well supported to pursue their own career progression. All people using the service we spoke with, relatives, staff and external professionals were complimentary about the management and ethos of the service, particularly with regard to visibility and accountability. Staff members were consistent in their understanding of the goals of the service and the importance of maintaining strong community links.

We saw that people looked cared for they were clean and comfortable and they told us that they felt supported and "Very well looked after". They said staff were very kind and helpful. One person said "The staff are really good; I am very pleased that I live here." Another person said "I like everything; the food, the staff and there is always something going on". A visitor said "It is always a pleasure to come and visit, the staff are very kind to everyone."

We saw that people had a choice of well cooked and nutritious food. Staff monitored people's weight and charted food and fluid intake of people who they had identified at being at risk of dehydration of malnutrition and took appropriate action promptly. People told us the food was "Lovely". One person said “We get a really good choice; we are asked what we want. There's a menu that goes round and we tick with the staff the day before what we want".

Staff told us they were supported by the manager, one member of staff said “We get on really well, everyone helps out, it’s a lovely place to work and the residents are really nice people."

We saw that complaints are dealt with according to the home's policy and procedures and when people had raised concerns they were dealt with promptly by the manager.

People expressed their views and were involved in making decisions about their care and treatment. We spent time observing how staff supported people living at the home. We found staff were very respectful in their approach, treating people with dignity and courtesy.

When we visited the home there were 58 people living there, on three floors. We spent time talking with several people, and watched how staff gave them support and care. People were very happy with the care provided. Comments included “I can’t fault the place”. “Nothing wrong with the staff” and “The hairdressers comes in to do my hair.”

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were given support by the provider to make a comment or complaint where they needed assistance.

We carried out this inspection visit to check what progress the home had made to the improvements we suggested in March and in November 2011.

Since the last inspection the manager had resigned. The deputy manager (who had been acting as manager for some months) had recently been appointed as manager. During this visit we saw that the new manager had begun to make improvements.

We spoke with a relative and five residents during this follow up visit. People made many complimentary comments about the service they received at this home.

One relative said, “We’re very happy my mother got a place here. She had to stay somewhere else while we waited for a vacancy, but it has been well worth the wait.”

One person said, “We’re very well looked after here. All the staff are very kind.”

Another person told us, “There’s plenty to do. We've got a notice with the activities on.”

One person said, “We’ve got a tuck shop, or there’s the Post Office just across the road and they’ll help us go if we want.”

People commented that the staff were “very kind” and “look after us very well.”

One relative told us, “The staff are lovely. We knew some of them from the local area and it’s given me confidence that the right people are looking after my relative.”

We saw that the provider invited people to make comments and suggestions about the service. A relative told us, “We visit everyday and we’re always happy with the service.”

The people that we spoke to were generally satisfied with their care at the home.

People told us that all the care staff were lovely and were kind to them. They told us that they were very happy at the home.