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Inspection carried out on 26 September 2019

During a routine inspection

About the service

The Lodge is a residential care home providing personal and nursing care to 61 people at the time of the inspection. The service can support up to 62 people living with frailty, old age, dementia or needing a short time for rehabilitation following a hospital admission.

The Lodge is a large adapted building near the centre of Exeter. There are bedrooms on two floors with access via a passenger lift. There are a number of communal areas on both floors. There is also an accessible garden/courtyard area which is enclosed.

People’s experience of using this service and what we found

People and their relatives were extremely positive about their experience of living at The Lodge. People said they felt safe, well cared for and valued. Comments included ‘I feel very safe, completely. I know that if I have a problem of any sort, I can call the emergency bell. They come with alacrity as I found out when I rang it by mistake. It’s wonderful’. ‘I’m very happy here’. And ‘Its excellent, very safe. The carers are excellent.’

Peoples holistic needs were very well met by a staff team who were well-trained and understood the ethos of ensuring person centred care. The provider ensured the staffing ratios remained high so the best possible care and support could be provided. This included having additional housekeeping staff and kitchen staff. Care, meals and the cleanliness of the home were exceptional in their quality and delivery. Staff received really well planning support training and supervisions to enable them to do the best job possible.

People experienced an exceptional mealtime experience. Most people spoke very highly about the meals offered and the whole mealtime experience. One person said “I have never eaten so well. Lunchtime is a real treat with three courses plus cheese and biscuits if you can fit it in. You can have wine, beer, sherry all part of the service.” A few people were less positive. When we fed this back the registered manager was able to show all concerns raised by people about the menus or quality of food were followed up and addressed if needed.

Our observations of the lunch time experience showed staff worked hard to make the meantime experience for people special. The restaurant was open for a two-hour lunch period. Staff were extremely attentive and supported people to choose, serve and eat their lunch in comfort.

People were valued and placed at the centre of the service. Staff promoted their privacy and dignity, enabling them to make choices and have as much control and independence as possible. The service used a variety of methods to facilitate this including supporting people with communication, assistive technology, providing information in an accessible format and a consistent staff team who knew people extremely well. A huge range of activities were planned with people's hobbies and interest in mind.

The management team and staff genuinely cared for the people they were supporting. They advocated for them at every opportunity. They were there for them and their families at point of admission, when needing to transfer to hospital or at the end of their lives. They had recently achieved a national accredited training in end of life care. They had been commended for the effort they had put into cascading the training and embedding it so all staff understood the core principles of ensuring a person-centred approach to people’s final days. The service was developing a great reputation for achieving the best quality care for people’s final days.

They ensured people were able to maintain contact with their families, even when they were hundreds of miles away, using Skype so that they could see them. The service had a guest room for family and friends to use when visiting if they lived far away or needed got be in close proximity due to ill health.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and

Inspection carried out on 28 February 2017

During a routine inspection

The Lodge Residential Home provides accommodation; nursing care and support for up to 46 older people, there are two floors supporting both people with nursing and residential needs. At the time of the inspection there were 41 people living at the home.

At the last inspection November 2014, the service was rated good with an outstanding rating in well led. At this inspection we found the service good in the five domains.

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.

Quality assurance systems were in place to monitor care, and plans for on going improvements. Audits and checks were in place to monitor safety and quality of care. However, on this occasion the audits had not picked up that a few risk assessments did not highlight the risk, or detail the control measures necessary to reduce the risk. The provider took immediate action when these issues were raised.

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely. People were supported to access external health professionals, when required, to maintain their health and wellbeing.

People were offered a varied choice of meals including soft textured food. Staff were clear about who required support to eat and when. We observed the midday meal being served in the main dining area. The atmosphere in the main dining room was relaxed and cheerful with people talking about their day. The meals were served on small, intimate, well laid tables. People were offered drinks of their choice including alcoholic drinks.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes. People living at The Lodge told us they were happy with the care and support provided. They said the registered manager and staff were open and approachable and cared about their personal preferences.

People were supported by staff who had undergone an induction programme which gave them the basic skills to care for people safely. In addition to completing induction training new staff had opportunities to shadow more experienced staff. This enabled them to get to know people and how they liked to be cared for. People told us they felt safe at the home, One person said, “I can’t fault the service we receive, the staff always make sure I am safe, and yes I do feel safe living here”.

Most people who lived at the home were able to make decisions about what care or treatment they received. Where people lacked capacity to make some decisions, the staff were clear about their responsibilities to follow the principles of the Mental Capacity Act (MCA) when making decisions for people in their best interests.

The service remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. There was a varied programme of activities which made sure people could continue with their hobbies and interests which included French lessons and seated yoga. One person said, “Since I began doing the seated yoga my mobility has improved and I am walking better”.

The service had a complaints policy and procedure which was available for people and visitors to view. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise c

Inspection carried out on 17 November 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

The Lodge is a nursing home providing residential and nursing care for up to 46 people. It is a large Edwardian house with a grand entrance and staircase with additional purpose built facilities over four wings, including a four bedded bungalow attached to the home. On the day of our inspection 46 people were living at the home. The home has 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 and associated regulations about how the service is run.

On the day of our inspection there was a very calm, friendly and homely atmosphere. People appeared relaxed and happy and were going about their day, seeing visitors, relaxing in their rooms and joining in organised activities. People, their relatives and health care professionals all spoke highly about the care and support The Lodge provided. One person said, “The carers are outstanding. They are very sensitive and empathic. Care is very high quality”. Other comments included, “The receptionist is wonderful, outstanding.”, “Staff are dedicated and the carers are very good.” and “I am very happy here, it’s just lovely.”

The environment encouraged people to be independent. There was lots of space and mobility aids such as handrails and available wheelchairs. The design and décor of the building was of a very high standard maintained by a maintenance team on site. People who were able moved feely around the building and its grounds as they chose. People were involved in decisions about proposed changes to further enhance their day to day lives.

Care records were comprehensive and written to a good standard using a computerised system. They contained detailed person centred information about how individuals wished to be supported. People’s preferred method of communication was taken into account and respected. People’s risks were well managed, monitored and regularly reviewed to help keep people safe. People had choice and control over their lives and were supported to take part in a varied range of activities both inside the home and outside in the community. Activities were meaningful and reflected people’s interests and hobbies and were managed by a dedicated activity co-ordinator. People were also able to organise classes individually such as piano lessons and yoga.

Staff put people at the heart of their work, they exhibited a kind and compassionate attitude towards people. Staff spent time with people and were not focussed only on tasks. The service had an open door policy, relatives and friends were always welcomed and people were supported to maintain relationships with those who matter to them. For example, Christmas lunch bookings for family and friends offered a range of dedicated days so they could enjoy a Christmas meal at the home with their relative and friends. Staff were well supported through induction and ongoing training. Staff were encouraged to enhance their skills and professional development was promoted. A staff member said; “It is lovely here, I was lucky to get the job. It’s so organised and we have meetings and are well supported. We know what to do”. Another staff member said “We like to think we are 5 star with a homely feel.”

Staff understood their role with regards the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Advice was sought to help safeguard people and respect their human rights. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated which records confirmed. People told us they felt safe.

People knew how to raise concerns and make complaints. People told us concerns raised had been dealt with promptly and satisfactorily. Any complaints made were thoroughly investigated and recorded in line with The Lodge’s own policy. Learning from incidents had occurred and been used to drive improvements, for example a “swallowing diary” had enabled staff to make effective changes to how they assisted one person, taking account of their preferences and maintaining their independence.

Staff described the management as very supportive and approachable. Staff talked positively about their jobs. Comments included: “I think people are looked after absolutely fantastically”, “I absolutely love it here, all the staff are lovely to work with and everyone gets on well together. It makes coming to work so enjoyable. We are one big happy family.”

The service had a very open and transparent culture. The registered manager had set values that were respected and adhered to by all staff. All staff spoke of how they felt people were treated as individuals with respect and dignity. They said they were proud of the work they did. For example, staff were encouraged to come up with innovative ways to improve the quality of care people received and external training was sourced which focussed on person centred care. Staff felt listened to and felt able to discuss any issues with each other or the management team.

People’s opinions were sought and there were effective quality assurance systems in place that monitored people’s satisfaction with the service. Timely audits were carried out and investigations following incidents and accidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the home. People were also involved in risk assessments and able to take reasonable risks and do things they wanted to do despite a level of risk being identified.

Inspection carried out on 16 October 2013

During a routine inspection

At the time of the visit there were 43 people living at The Lodge. During the inspection, we reviewed six care records and other records relating to the management and administration of the service. We also used information we had received about the home since the last inspection in March 2013.

We spoke with eleven people who lived at The Lodge, two visiting professionals, two relatives, one visitor, the registered manager and seven staff on duty, including nurses, laundry staff, care workers and maintenance/hotel services staff. We observed how care and support was provided to people. We looked at the homes environment and whether it met the needs of the people who lived there.

People told us they were very happy about how care and support was provided to them, and with the staff who provided that care. We were told that they had the help and assistance they needed. People told us that they liked living in the home. One said �I wouldn�t like to move, I�m very lucky here� another that �staff are wonderful�.

We saw that care, treatment and support was planned and delivered in a way that ensured peoples safety and welfare. Effective systems were in place to reduce the risk and spread of infection and the buildings and premises were well maintained. We saw an effective complaints system with comments and complaints people made responded to appropriately. Records including medical records were accurate, fit for purpose, kept securely and could be located promptly.

Inspection carried out on 18 March 2013

During a routine inspection

During our visit we saw that people were being treated with dignity and respect and people's independence was encouraged. People were spoken to in a respectful way. One person told us "I feel physically better with the attention I receive here, but even more, I feel fulfilled and my days are not lonely anymore."

Care plans were person centred and documented people's wishes in relation to how their care was provided. Staff members understood how people expressed their needs and wishes about how they wanted to be supported with their care.

Staff knew exactly how each person communicated which meant people's wishes were understood and respected. One person told us "the staff are wonderful, the food is delicious - what more can I say."

People chose how to occupy themselves in the service. We observed that people were spending time in the communal areas listening to music and interacting with each other. During our inspection we observed people spending time in their bedrooms having their hair cut and styled and talking to family members. We also saw people being involved with activities in the conservatory with staff members.

Reports under our old system of regulation (including those from before CQC was created)