Nutley Lodge Care Home

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. Two providers ran the service as a partnership with their families and had been in the industry for many years. The service was last inspected in August 2015 and was rated ‘good’ overall. Well led was rated as requires improvement as the service had not submitted a notification to CQC in a timely way. This had now been rectified and notifications of events were now sent according to legal requirements.

At this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. One person said, “It’s so lovely here. I wouldn’t want to go anywhere else now.”

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, some of whom were living with dementia and unable to tell us directly about their experiences. They looked comfortable and happy to spend time in the large lounge and entrance hall or their rooms. The staff were preparing for Christmas and there was a large Christmas tree and decorations throughout the home.

People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or enjoyed a musical session with the provider’s wife playing the piano. Some people were living with dementia and people were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely whilst supervising from a discreet distance.

People were provided with good opportunities for activities, engagement and trips out. These were well thought out in an individual way and the providers with their families were very involved in day to day life at the home. People could choose to take part in activities if they wished and when some people preferred to stay in their rooms, staff checked them regularly, spending one to one time with them. One person said how the ‘girls’ [staff] were all lovely. They said, “I can do what I want. I like to read my newspaper in the morning then go down for lunch. They know what I like. There’s lots to do. I like it here.”

People and relatives said the home was a safe place for them to live. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. Any safeguarding concerns had been managed well with provider involvement and the service worked with the local authority safeguarding team. Relatives said they would speak with staff if they had any concerns and issues would be addressed and people seemed happy to go over to staff and indicate if they needed any assistance. People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally.

People were well cared for and people and relatives were involved in planning and reviewing their care, some people were not able to be involved due to living with dementia. Care plans showed that people living with dementia were enabled to make smaller day to day choices such as what drink they would like or what clothes to choose. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on and listening to people’s repeated stories. Staff clearly were knowledgeable about people’s needs, interests, background and personalities. Therefore, they could meet people’s needs in a person centred way. One care worker kindly supported a person saying, “Don’t please others [person’s name], please yourself.”

There were regular reviews of people's health, and staff responded promptly to changes in need. For example, care records showed many examples of staff identifying changes in need and appropriate and timely referrals to health professionals. One person was being supported as their health deteriorated and the staff were working with the local hospice and district nurses in a clear, organised way to ensure the person was comfortable. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.

People were able to access appropriate equipment, for example mobility aids. The premises was clean and hygienic with a homely feel and staff used appropriate infection control methods to ensure people were safe.

Medicines were well managed and stored in line with national guidance. Records were completed with no gaps and there were regular audits of medication records and administration and to ensure the correct medication stock levels were in place. For example, where an audit had identified any gaps in recording medication administration, this had promptly been raised in a staff meeting and additional medication training provided.

Care plans were individualised and comprehensive ensuring staff had up to date information in order to meet people's individual needs effectively. Staff also signed care plans to indicate they had read them to further ensure they were up to date with any changes in people’s needs. Handover and communication between staff shifts was good so there was consistent care. The service rarely used agency staff but were able to fill vacancies if they could not cover shifts, within the staff team.

Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. The staff team was very stable and many care staff had worked at the home for some years. They said they enjoyed the homely, family feel. One care worker said, “Just putting a smile on someone’s face is worth it. I love it here.” Staff clearly had good knowledge in identifying people’s changing needs and providing appropriate care. Relatives said, “We are so lucky, we couldn’t ask for better.”

People's privacy and dignity was respected. Staff ensured people kept in touch with family and friends, inviting friends and family to outings and events regularly. One relative sought us out to tell us how wonderful the staff had been supporting them during their loved one’s end of life care. They said, “It’s a wonderful family home. The providers take people out and mingle in like a big family. We have been so well looked after, we are so lucky. We couldn’t have asked for a better outcome.”

People received information in a format they could understand and communication support enabled effective, accurate dialogue between the service and individuals. Therefore, they could access services appropriately and independently, and make decisions about their health, wellbeing, care and treatment as much as they were able.

The manager and providers showed great enthusiasm in wanting to provide the best level of care possible and valued their staff team. For example, organising staff days out and showing their appreciation. They worked together to ensure people’s needs were met as well as facilitating fun opportunities for people. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people in individualised ways. Staff were very positive about working at the home.

Observations of meal times showed these to be a positive experience in a lovely setting, with people being supported to eat a meal of their choice, where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom. Nutritional assessments were in place and special dietary needs were catered for as well as specialist crockery and cutlery and finger foods to aid independence for people living with dementia .

There were effective quality assurance processes in place to monitor care and plan on-going improvements overseen by regular provider audits.

There were systems in place to share information and seek people's views about the running of the home, including relatives and stakeholders. All responses were positive from the recent quality assurance questionnaire and comments and actions were displayed on the home notice board. People's views were acted upon where possible and practical, and included those living with dementia. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them.

A monthly newsletter and notice board kept people up to date and organised events such as barbecues and garden parties encouraging families and children to attend. This showed that people and their families mattered to the staff, who also shared their lives, families and pets. Two relatives told us they were

We saw person centred comprehensive care plans that ensured that the needs of people were met. A relative we spoke with said 'It is excellent care, absolutely superb.' They went on to say 'Staff are always willing to go further, there are extra touches and we are welcome to visit any time. There are lots of varied activities; lots of people come in, this stimulation is important'. Another relative told us 'Excellent care. When we looked round here it felt like home. I am very happy'.

Staff we spoke with were aware of the importance of safeguarding adults and what to do if they had concerns. One person we spoke with told us that they 'felt safe'.

One member of staff told us that 'new staff get a lot of supervision when they start and until they are confident' and all staff told us they had access to regular training. All care staff we spoke to told us they received excellent support from the manager. One member of staff said 'the manager supports one hundred per cent; an excellent manager'.

Everyone we spoke to was complimentary about the home. One person told us "I've always been happy here". One relative commented on the 'lovely atmosphere' and people told us they felt the care was 'excellent'.

Everyone we asked told us staff asked their permission when caring for them and we observed people's consent being consistently sought.

We observed care being delivered in line with people's individual care plans and people told us in particular about how they felt their emotional needs were well met. One person told us 'if you've got a problem there's always someone to talk to'.

We observed staff administering medicines competently and safely. One person told us 'I don't have to say 'give me my meds' because they do all that at the right times'.

People told us staff were "all so kind and caring", "very very helpful" and "excellent". Appropriate checks had been carried out prior to staff commencing employment.

There was a quality assurance system in place and people told us they felt their views were taken on board by staff. One person told us 'anything we want we get it'. Another person told us 'if there's anything I don't like I see (registered manager) and they put it right'.