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Inspection carried out on 11 January 2018

During a routine inspection

This inspection took place on 11 and 18 January 2018. It was unannounced on the first day of the inspection and we made arrangements to return on the second day.

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

The service provides support for people who have enduring mental health needs. The home is situated near to York racecourse and is close to shops and amenities.

At our previous inspection in October 2015 the service was rated Good in the key questions ‘Is the service safe’, ‘effective’ and ‘well-led?’ and Outstanding in the key questions ‘Is the service caring’ and ‘responsive?’ This meant the service was rated Outstanding overall.

At this inspection the rating for the key question ‘Is the service responsive?’ changed to Good. The other key questions remained the same. This means the service is now rated Good overall.

The service has a registered manager. 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 service continued to be extremely caring. People we spoke with were unanimously positive in their praise of staff and told us they were very kind and compassionate. Staff knew people well and were highly motivated to provide care that was focussed on people’s individual needs and wishes. It was evident that people felt valued and respected. There was a very friendly and supportive atmosphere in the home.

People were encouraged to be as independent as possible and staff supported people in achieving their aspirations. For example, one person had fulfilled their lifelong ambition to take a helicopter ride.

People told us they felt very safe. There were sufficient staff to meet people’s needs and robust recruitment checks were completed to ensure the suitability of workers. Staff were supported in their role; they received induction, training, supervision and appraisal.

People were supported to have 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 received appropriate support with their medicines. Where people wished to manage their own medicines independently this was encouraged and there were checks in place to ensure it was done safely.

Staff were aware of the importance of supporting people with good nutrition and hydration. Associated information was recorded in their care files. The staff had been successful in supporting people to gain weight, where this had been a concern. We received positive feedback about the food and saw that people, where possible, were encouraged to shop for and prepare their own meals. People had access to healthcare services, in order to promote their physical and mental health.

The premises was homely and suitable for people’s needs. People were involved in decisions about the decoration and the provider had taken steps to make the environment more accessible in response to changes in people’s needs. The environment and equipment was regularly checked and serviced.

There were detailed, person-centred care plans in place, so that staff had information on how to support people. These were regularly reviewed with the person. People were able take part in a range of activities of their choosing and they accessed the community independently or with the support of staff.

People’s views and opinions were sought in individual review meetings and ‘resident’s meetings’. We saw that people’s feedback was acted on. There was a complaints procedure in place, should anyone

Inspection carried out on 6 October 2015

During a routine inspection

The inspection took place on 6 October 2015. It was unannounced. During our last inspection of the service in May 2013, the provider was compliant with all of the regulations we assessed.

Christmas Lodge provides care and personal support for up to 15 people. It does not provide nursing care. The service specialises in providing support for people who have enduring mental health difficulties. The home is situated near to York racecourse and is close to many shops and amenities.

The home has a registered manager. 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.

People consistently spoke of the outstanding care delivered by staff. They told us that staff went above and beyond to ensure they received a person centred service. Staff maintained people’s privacy and dignity ensuring that any care or discussions about their care were carried out in private. Interactions between staff and people were caring and respectful, with staff being consistently patient, kind and compassionate. We observed the interactions between staff and people living at the home. It was clear that staff knew and understood the people they cared for. People’s care remained the focus for staff and people knew that they mattered. It was evident that people were involved in all decisions regarding their care. Care records were detailed and person centred, and we saw people were involved in the development and review of their care records.

People were encouraged and supported to be as independent as possible. The home was innovative in the way it provided person centred care to people, for example getting people to determine what values they thought the staff should display or writing their own care records. It was clear that the support people received meant that they were supported to have an enriching and empowering lifestyle. We saw numerous examples of this during our visit. Examples included each person being supported or independently choosing their own meal, attending meaningful and fulfilling activities with the staffing allocated accordingly or the way in which people had made the home their own in terms of personalisation. The home was run in a way that people using the service remained the focus. It was evident that Christmas Lodge was ‘Their home.’

People told us that their ideas and suggestions were responded to. Staff had a ‘can do’ approach and they really made the most of opportunities to support people in taking risks so that they could participate in things which were important to them. A range of social, leisure, occupational and educational activities were provided. People’s interests were evident throughout the home. People were encouraged and supported to remain autonomous and the service was run in a way which encouraged and support people’s individual aspirations and dreams.

People told us they felt safe; they told us they could approach staff if they had any problems or concerns. We saw that people were encouraged and supported to take risks and there were no restrictions on people’s freedom.

People spoke positively about the staff who worked at the home. It was clear that staff knew and understood people’s needs well. Staff went through a robust recruitment process before starting work. Staffing ratios were responsive to people’s changing needs and preferences which enabled people to lead busy and fulfilled lives. It was evident that staff knew the people they supported and went out of their way to provide a flexible and tailored service.

People received their medication as prescribed by their GP. They were encouraged and supported to manage their own medicines where possible. Regular reviews took place and staff received training and support so that medicines could be administered safely.

The home was clean, smelt fresh and was well decorated and maintained. People had personalised the environment to make it more homely. It was warm and welcoming.

Staff received induction, training and supervision which supported them to carry out their roles effectively. People spoke highly of the staff employed and we observed warm, caring and encouraging support throughout our visit.

People had care records in place which they had contributed to. People were supported to make their own decisions and when they were not able to do so, meetings were held to ensure that decisions were made in the person’s best interests. If it was considered that people were being deprived of their liberty, the registered manager was clear that the correct authorisations must be applied for.

People spoke positively of the meals and we saw that specialist diets were catered for. People were able to choose what they wanted to eat and to be involved in the shopping and preparation of their meals where possible. People could access the kitchen at any time and were able to help themselves to meals, drinks and snacks.

People had access to a range of health care professionals and staff were able to support people with both their physical and emotional health needs. There were clear records of this within people’s care files. Staff knew and understood the people they supported and were able to respond quickly to any changes in health. This was re-iterated by the health professionals who provided feedback on the service.

The home had appropriate adaptations to make it accessible to people living there. The registered manager and staff regularly reviewed the premises so that any required adaptations could be made.

People’s views and opinions were sought and their ideas and suggestions were responded to. People living at the service were able to bring about change. Staff spent time with people both on a one to one basis and in group discussions so that individual aspirations could really be considered. People did not have any complaints but consistently said they would have no issue raising them if they did.

People living at Christmas Lodge spoke highly of the registered manager and staff. The support from senior management was also said to be consistently good. There was a warm friendly atmosphere and staff spoke of a positive culture. People were encouraged and supported to express their views. There were good links with the local community.

Inspection carried out on 29 May 2013

During a routine inspection

We spoke to five people who used the service and spent time observing the support provided in the home's communal areas. People told us that they were happy with the care and support they received. Comments included �I am very happy here the staff are very good� and �I have no concerns everyone is very helpful.�

We found that people were involved in making decisions about their care and support. People told us, �I get up and go out when I want� and �The staff sometimes help me with my shopping but I decide what I want to buy.�

We saw staff supported people in a dignified way and that people were at ease and well cared for. We looked at the care records and saw that people had been supported to make decisions. We also saw that issues around capacity and deprivation of liberty had been considered.

We found staff were also well supported and received regular training to help keep their skills up to date. We saw there were regular meetings taking place to review staff practice and the performance of the service.

We saw that people�s comments and complaints were listened to and acted on effectively.

Inspection carried out on 17 December 2012

During a routine inspection

We spoke to four people who used the service and spent time observing the support provided in the home's communal areas. People told us that they were happy with the care and support they received. Comments included �I�ve had all the support I�ve needed, they are very good.�

We found that people had been involved in making decisions about their care and support. People�s comments included �we have monthly reviews and everything is gone through, asked if you want any changes, that kind of thing.�

We saw staff acting in kind and attentive ways and people using the service looked at ease and well cared for. Where appropriate people's ability to make decisions, and issues around capacity and deprivation of liberty, had been considered.

Staff were able to tell us about people�s needs and the systems that were in place to make sure that people received the medication they needed. Medication was being given in accordance with people�s prescriptions and needs.

We also found that staff went through a thorough recruitment process, including the required checks, before they started work in the home. People liked the staff with comments including �I think the world of the staff and they do a really good job.�

People who use the service knew how to raise concerns and felt that any issues they raised would be listened to and acted on. Comments included �I can put forward any problems, can speak freely.�

Inspection carried out on 16 December 2011

During a routine inspection

People said staff discussed their care, treatment and support options with them so that they could consent to the help that was being provided for them. People confirmed that their views were sought and acted upon in regard to every aspect of how the home was operated. They said this helped them to feel central to all the decisions being made. One person said �I have signed to say I agreed to the care and support that I receive�. Another person said �The manager asks if I am happy with everything�.

The people we spoke with said that they received the help and support they needed when they wanted it. One person said �The staff are brilliant, they are here to give me a hand with things I cannot do for myself�.

We were told by people living at the home that they knew how to raise issues if they had any concerns. One person said �I would feel happy to raise any issue�. Another person said �If I was not happy I would tell the staff. I feel I am always listened too�. They confirmed that any issue raised would be dealt with.

People we spoke with said that there was enough staff available to help them. One person said �The staff have the training they need to look after me well�. Another person said �Staff are available to me when I need them�.

People told us that they could speak to the manager or provider at any time. They said they felt �at home� and said they were included in decisions about how the home was run. One person said �It is very enjoyable living here. I go to the residents meetings. I would not want to live anywhere else�. Another person said �This is my home�.

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