Archived: Oriel Lodge

At the last inspection, the service was rated Good. At this inspection we found the service had met all relevant fundamental standards and continued to be rated Good..

The provider had signed up for the dignity and dementia pledge. The service and staff demonstrated their commitment to care for people with dignity, to further improve and to follow best practice for the care of people living with dementia. They ensured they kept up to date with current practice and linked with care provider forums and support groups. They ensured people had access to the local community facilities. The community was invited to enter the home and participate in social activities.

A registered manager was 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.

There were systems in place to assess, monitor and improve the quality and safety of the service. The provider continually looked to make things work better so that people benefitted from an improved service. Any planned improvement actions were followed up to ensure they were implemented.

Staff described the registered manager as supportive and approachable. Comments from surveys and compliments received by the service confirmed that people were happy with the service and the support received.

People were kept safe. Any risks to people's health and welfare were well managed. The premises were well maintained and staff were trained in how to move people requiring assistance from one place to another safely. Staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if concerns were raised and who to report the concerns to.

Pre-employment checks were robust and ensured that unsuitable staff could not be employed to work in the service. The management of medicines was in line with good and safe practice.

Staffing levels for each shift were calculated to ensure each person's care and support needs could be met. The numbers were adjusted as and when people's needs changed. All staff were provided with the training they needed to carry out their roles and responsibilities effectively. The provider placed great emphasis on giving those staff who had proved themselves, extra responsibility. These staff members had taken lead roles in key areas. New staff to the service were well supported and completed an induction training programme. They were supported by a buddy and a mentor until they had settled in to their role. All other staff had a programme of refresher training to complete. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People were supported to make their own choices and decisions where possible. Staff understood the need for consent and what to do where people lacked the capacity to make decisions. We found the home to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were provided with the food and drink they liked to eat. There was a real commitment by the catering staff and the care team to ensure that people enjoyed their food and received a balanced diet. Where there were risks of malnutrition or dehydration there were plans in place to reduce that risk.

Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People received a service that was caring and met their individual care and support needs. The staff were aware of the need for good working relationships with the people they looked after. People said they were well looked after. There were many examples of where the staff had gone that extra mile to meet people's social and emotional needs which had resulted in improved well-being.

Care planning processes ensured that each person was provided with person-centred care and where possible had been involved in drawing up their care plans. Care plans were well written and provided detailed information about how the person wanted to be looked after and how their care was to be delivered. People were encouraged to have a say about things that mattered to them and to raise any concerns they may have.

Further information is in the detailed findings below

The people who lived in the home had varying levels of dementia and were not able to tell us about their experiences. One person told us how they were feeling and about their family.

We spoke with two visitors. One visitor told us when they visited the home they were greeted by friendly staff. The other relative told us a member of their family was having respite care at the home. We were told 'the staff seem nice. They are doing what they can.' We were told the staff were supporting their relative on respite care to stop smoking.

We saw staff use music to interact with people and when people became anxious they sat with them. We observed the lunchtime meal and we saw staff wait for people to finish one course before they were offered another. We heard staff ask people if they were finished before they removed plates. We observed a member of staff support a person with eating their meal. This person was calm which meant the pace the member of staff was using was suitable to the person.

People who lived in the home were not always cared for in a dignified manner and their rights respected. This was because for some people the hygiene equipment used by the staff to deliver personal care was degrading. Permission was not sought from the people whose images were added to staff's (and possibly members of the public) social networking sites. Equipment was not used to keep one person safe from falling out of bed. We saw staff were using a chair and rolled pillows under the mattress to prevent one person from falling out of bed at night.

People were not safe from other people who used aggression to communicate. When one person slapped another person during our visit we heard staff support one person to another area of the home. Staff told us there were two people who showed aggression towards staff and other people in the home. Staff told us for some people the instructions on how to manage behaviours others found difficult was not effective. We read incidents reports where people who lived in the home had sustained injuries from other people. This meant staff were not always able to prevent abuse towards others from happening

Care plans for three people with mobility needs contained the same details. The care plan guidance we read for three people who fell frequently was the same but the staff description on how to support these people differed from their care plans. Even though staff told us people who fell frequently were able to stand with support, lifting equipment was not easily accessible in the event of an emergency. This meant these individuals may not be protected from safe moving and handling techniques.

We used Short Observational Framework for Inspectors (SOFI2) to observe the way people engaged with each other, the staff and their surroundings. We saw staff interacted with people in a positive way. Staff spoke to people at eye level, they used short sentences and gave them time to respond. We saw staff offer choices at lunchtime and used an enabling manner to help people maintain their independence. Staff used signs and colour to direct people to where they wanted to go. Staff asked people 'Where do you want to go and it's the one with the red door.'

We saw staff encourage people to use other parts of the home when they became restless. We heard staff encourage people to participate in other activities for example, jigsaws.

A healthcare professional told us staff were using better methods of response towards people who at times became aggressive. We saw one person tell staff they were hungry immediately after lunch and we saw staff take the person back to the dining room for a snack without trying to explain they had just eaten.

Staff told us the staffing levels were adequate and allowed for them to spend one to one time with people.

The provider had systems in place to seek the views of people about the running of the home.