About the service:

Athorpe Lodge is a purpose-built care home close to the centre of Dinnington. It provides accommodation for up to ninety people in six units. The care provided is for people who require nursing or personal care. Some people living at the service were living with dementia. At the time of our inspection there were 83 people using the service.

People’s experience of using this service:

People were not always protected from the risk of cross infection. We completed a tour of the home with the registered manager and identified some areas which required cleaning and presented an infection control issue.

People were safeguarded from the risks associated with abuse. Risks associated with people's care were assessed and plans were in place and followed to minimise them. On the day of inspection people were supported by enough staff. Following our inspection, the registered manager confirmed there were enough staff available to meet people’s needs. Recruitment was undertaken in a safe way. People's medicines were managed in a safe way and people received their medicines as prescribed. Accidents and incidents were monitored and well analysed and we saw evidence of lessons learned.

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.

Staff were knowledgeable and had received appropriate training and support. People received a balanced diet which met their individual needs. People were offered choice and this was respected.

People were supported by staff who were kind and caring and who maintained their dignity and respect.

Care plans we looked at reflected people's individual needs and preferences. The provider had a complaints procedure which was appropriately followed and people and their relatives felt able to raise issues if needed. People's end of life wishes were documented.

Audits were in place to ensure the service was monitored appropriately. Feedback about the registered manager was positive and staff felt well supported.

People were involved in the service and opportunities to give feedback were in place.

More information is in the full report.

Rating at last inspection:

Requires Improvement (report published 19 June 2018)

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

This comprehensive inspection took place on 1 May, 2018 and was unannounced, which meant that nobody at the service knew we would be visiting. The last comprehensive inspection took place in May 2017 when we identified four breaches of Regulation. People’s needs and preferences were identified, but not always managed in a person centred way. The registered provider did not always ensure the safe management of medicines. The registered provider was not always doing all that was reasonably practicable to mitigate risks associated with people’s care and treatment. Audits of the service had not always identified and issues and did not address them in a timely way. There were insufficient numbers of staff to keep people safe and to meet their needs. The service was rated as Requires Improvement.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions safe and well led, to at least Good.

At this inspection we checked if improvements had been made. We found that the registered provider had not addressed all the concerns raised at our last inspection and the service was rated Requires Improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Athorpe Lodge’ on our website at www.cqc.org.uk.

Athorpe 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.

Athorpe Lodge provides care for up to 94 people over four units. The service provides support for people living with dementia, personal and nursing care. All bedrooms are single occupancy with en-suite facilities.

At the time of our inspection the service had 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.’

Some staff told us there were not enough staff to ensure people’s needs were met in a timely way. However, this was only referred to on one unit. We looked at care records and found they contained limited information regarding risk management. Important information was missing from risk assessments, such as the loop configuration required when moving people using the hoist. Systems were in place to manage medicines safely, however, these were not always followed. Some areas of the environment had been missed in the cleaning process.

Staff had the skills and knowledge to deliver effective care. A balanced nutritious diet was provided for people. However, appropriate support for people’s dietary needs varied between the different units. People had access to healthcare professionals and staff predominantly followed their advice.

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. The service was compliant with the Mental Capacity Act 2005.

During our inspection we found staff interacted well with people who used the service. Staff were kind and caring in their manner.

We looked at care records belonging to people who used the service and found evidence that staff were responsive to people’s needs. However, we identified two people’s needs were not met appropriately. We saw evidence of end of life care plans which met people’s needs and preferences.

The registered provider had systems in place to monitor the quality of the service. However, these needed to be fully implemented and embedded into practice. Residents and relatives meetings took place and people felt they had a voice. However, there

The inspection took place on 16 May 2017 and was unannounced. The last comprehensive inspection took place in April 2015, when the provider was meeting the regulations.

Athorpe Lodge is a care home situated close to the centre of Dinnington. It provides accommodation for up to 90 people. The home is divided into six units; three providing nursing care (Balmoral, Buckingham and Sandringham) and three providing residential care (Hampton Court 1, Hampton Court 2 and Clarence).

At the time of our inspection 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. However, the registered manager was also registered at another service.

The provider had recently recruited a second manager who had been appointed to assist with the clinical aspect of the service. This person was in the process of registering with the Care Quality Commission. Throughout this report this person is referred to as the acting manager. It is the provider’s intention to operate the service using two registered managers due to the size and complexity of the home.

People who used the service, and their relatives we spoke with, told us they were happy with how the care staff provided the care and support. They spoke positively about the staff and told us they were very caring. However, they told us the home was always very short staffed and that more staff were required as they had to wait to receive care and support and at times this was up to 45 minutes.

During our inspection we observed people had to wait at times for assistance and staff were not always present in communal areas to ensure people’s safety. Staff told us at there was not enough staff to be able to meet people’s needs. Staff we spoke with were aware they struggled to give person centred care, due to low staffing levels and felt very frustrated this was the case.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, we found these were not always followed.

Medicines were not always managed safely. We saw that temperatures of fridges used for medicines, were not constantly recorded. We also identified some concerns with the storage, recording and administration of medicines.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There was a designated staff member who was responsible for the management of the DoLS and they had a good understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required.

The meals provided were well presented, nutritious and appetising. However, we observed staff did not always give appropriate support with meals to people who used the service. In particular we found people did not receive adequate hydration to meet their needs.

We spoke with staff and found they knew people well. They were aware of people’s needs and their different preferences, but did not have time to meet these needs effectively. We looked at staff training records and they reflected that most staff had received training. However, updates were required to maintain the provider’s expectations.

We looked at care files, although peoples choices were documented the care we saw delivered did not always reflect people’s care and support needs choices or preferences. We observed staff at times were task orientated and care provided was not person centred.

The provider employed an activity co-ordinator and had recently appointed a second one to provide activities and social stimulation within the home.

The provider had a complaints procedure and people felt

The unannounced inspection took place on 2 September 2015. We last inspected the service in June 2014 when it was found to be meeting the Regulations we assessed. In August 2015 a new management team took over the operation of the company.

Athorpe Lodge is a purpose built care home close to the centre of Dinnington. It provides accommodation for up to 90 people in six units. The care provided is for people who have needs associated with those of older people who have a physical need and/or dementia. All bedrooms are for single occupancy with en-suite facilities.

The service did not have a registered manager in post at the time of our inspection, but an acting manager had recently been appointed. They told us they had begun the process to be registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Throughout our inspection we saw staff supporting people in a caring, responsive and friendly manner. They encouraged people to be as independent as possible while taking into consideration their abilities and any risks associated with their care. Overall the people we spoke with told us they were happy with how care and support was provided. They made positive comments about the way staff delivered care, the way the home was managed and the general facilities available.

People told us they felt safe living at the home. We saw there were systems and processes in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce any risks were in place to ensure people’s safety.

Medicines were stored safely and procedures were in place to ensure they were administered correctly. We saw people received their medications from senior staff who had been trained to carry out this role.

We found there was enough skilled and experienced staff on duty to meet the needs of people living at the home at the time of our inspection. There was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. Staff had received a structured induction into how the home operated, and their job role, at the beginning of their employment. They had access to a varied training programme that met the needs of the people who used the service.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. The people we spoke with said they were happy with the meals provided and confirmed they were involved in choosing what they wanted to eat.

People told us their needs had been assessed before they moved into the home and we saw they, or their relatives, had been involved in planning their care. The six care files we checked reflected people’s needs and preferences in detail. Care plans and risk assessments had been reviewed on a regular basis to assess if the planned care was working, or if changes needed to be made.

People had access to a varied activities programme which provided regular in-house activities and stimulation, as well as in the community. People told us they enjoyed the activities they took part in, but could choose not to participate if they preferred. They were particularly complimentary about ‘Butterfly time’ which took place daily for a short period of time and involved all the people who lived and worked at the home.

The majority of people we spoke with said they had no complaints, but would feel comfortable speaking to staff if they had any concerns. We saw the complaints policy was easily available to people using or visiting the service. We saw that when concerns had been raised these had been investigated and resolved promptly.

There was a system in place to enable people to share their opinion of the service provided and the general facilities available. We also saw a structured audit system had been used to check if company policies had been followed and the premises were safe and well maintained. Where improvements were needed action plans were put in place to address shortfalls.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Due to the complex needs of the people using the service we were unable to gain some people’s views. Therefore we used a number of different methods to help us understand their experiences. This included observing how staff supported people, speaking with staff and visitors, and checking records.

Is the service safe?

We saw people using the service were treated with respect and dignity by the staff who supported them. Care and support was delivered in a safe way by staff who had received appropriate training.

The company had policies and procedures in place to help protect people who used the service from abuse. We found the majority of staff had received training in relation to safeguarding vulnerable people from abuse and further training was planned.

There were systems in place to make sure people received their medications safely and we saw staff responsible for administering medication had completed training in this subject.

We saw there were enough qualified, skilled and experienced staff on duty to meet people's needs in a timely way. The manager told us the number of staff required to meet the needs of the people living on each unit was under constant review.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed on a regular basis. People who used the service and their relatives had been involved in writing plans of care and these were reviewed and updated regularly.

Staff had received appropriate professional development. The staff we spoke with felt they had access to a comprehensive induction and a varied training programme that helped them meet the needs of the people they supported. We saw staff had received regular support sessions and plans were in place for an annual appraisal of their work to be completed.

Is the service caring?

People were supported by friendly, caring and helpful staff. We saw staff interacted with people in a positive way. The people we spoke with, including two visitors, spoke positively about the care and support provided. One person said, “My family visit most days and the staff are very kind.” A visitor commented, “I couldn’t look after mum any better myself.”

Care files contained detailed information about people’s needs and preferences. We saw care and support had been provided in accordance with people’s wishes.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People’s comments indicated they were happy with how staff supported them and the home’s facilities.

Is the service responsive?

Care records demonstrated that when there had been changes in people’s needs outside agencies had been involved to make sure they received the correct care and support.

People who used and visited the service knew how to make a complaint if they needed to. People told us they had no concerns but said they would feel confident raising any issues with the staff.

Is the service well-led?

At the time of the inspection there was no registered manager. However, an acting manager was in post and they had submitted an application to become the registered manager at the home.

There was a quality assurance system in place to assess if the home was operating correctly. This included surveys and internal and external audits. We saw action plans were in place to address any shortfalls found and progress was being made to address these.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to inform and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

This inspection was carried out to check if the provider had taken action to address the shortfalls we found at our last inspection in September 2013. These were regarding providing adequate staffing levels and maintaining accurate records. The provider sent us an action plan saying they would be fully compliant by the end of January 2014.

At this visit we found the provider had addressed the shortfalls we identified at our last inspection. We saw there were enough qualified, skilled and experienced staff to meet people's needs. More staff had been recruited and action had been taken to make sure unplanned staff shortfalls were covered. People’s comments, our observations, and the records we checked, indicated there was consistently enough staff on duty to meet people’s needs in a timely manner.

We saw records were accurate and fit for purpose. Care records had been reviewed and updated to make sure they reflected people’s current needs. We also saw monitoring tools had been completed on a regular basis. Records were kept securely and could be located promptly when needed.

We received information that raised concerns about the level of care people were receiving on Carver Unit. It indicated there may not be enough staff available to ensure people’s needs were being met. Therefore we visited the home along with a representative from Rotherham council’s contracting team to assess these areas.

We were unable to gain the views of the people who were living on the unit due to their complex needs. Therefore we observed how support was provided and spoke with visitors and staff to help us understand their experiences.

The four visitors we spoke with told us they were happy with the care and support staff provided. A visitor said, “I am happy. They keep him clean and shaved.” Another visitor commented, “The home has improved vastly, I would recommend it to anyone, but there is not enough staff.”

Staff comments and the records we checked indicated there was not always enough staff on duty to meet people’s needs. This meant that people had not always received their planned care in a timely manner. We were told people's needs were usually met but staff seemed rushed. A visitor told us, “People coming in seem to need a lot of attention and I feel they haven’t enough staff to meet his needs and see to the people in bed.”

People’s personal records were not accurate or fit for purpose. Although each person had a care plan in place they were not all up to date. We also found shortfalls in monitoring and assessment documentation.

We were unable to gain the views of all the people who were at the home when we visited due to their complex needs. Therefore we also observed how care was provided and spoke with visitors and staff to help us understand their experiences.

We spoke with nine people who used the service, six visitors and six people providing services from outside the home. People’s comments indicated they received the care and support they needed and they were happy with how staff delivered their care. One person said, “I feel that we are lucky. It's not regimented, it's just like home. I can come and see him when I want and they keep me informed about what's happening.”

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

The premises were in a good state of repair, clean and fresh. People told us they were happy with their rooms and the general facilities provided.

There were enough qualified, skilled and experienced staff to meet people's needs. People told us staff were able to meet their needs in a timely way.

There were systems in place to gain peoples views and check if staff were following company policies.

People told us they had no complaints but we saw a complaints procedure was available to people who used and visited the service.

We were unable to gain the verbal views of some people but other people we spoke with told us about their experiences of living at the home. We spoke with seven people who used the service, four relatives and eight staff.

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. If anyone was unable to give consent systems were in place to consult other people to make sure things were carried out in their best interest.

People’s comments indicated they received the care and support they needed and they were happy with how staff delivered care. One person said, “If I want something I can always ask and they do their best.”

People had access to a varied activities programme which they said they enjoyed.

People received well balanced meals that provided variety and choice. Staff promoted healthy eating and checked people were eating and drinking properly.

We saw the home provided specialist equipment to meet people’s needs and keep them safe. There was a system in place to make sure equipment was satisfactorily maintained.

Background checks had been carried out on staff before they started to work at the home. This included ensuring staff underwent a Criminal Records Bureau (CRB) check.

We saw the complaints procedure was available to people who used and visited the service. People told us they felt comfortable taking any concerns to the manager.

We have not spoken directly with people who use services in assessing this outcome. However we did speak with two relatives. They told us they were satisfied with the care and treatment provided at the home.

People we spoke with told us there had been a lot of improvements in the last few months and the home was looking much better.

Relatives told us the improvements had been needed, and they were definitely improving the service. They also told us they had been kept informed regarding the works, progress and expected completion.

We did not directly speak with people using the service at this inspection, but we observed people being given care and saw staff interacting with people in a supportive, kind way. We saw people being encouraged to make choices and staff spoke to them respectfully and maintained their dignity.

People using the service told us they were satisfied with the cleanliness of their rooms and the laundry service provided by the home. People told us that they were satisfied with the care provided. One person who was in their bedroom told us they feel staff respected their privacy. They said they could have their meals in their room and they said that they preferred to do that. Relatives told us that they had noticed a marked improvement in the cleanliness of the home and they feel care has improved. They told us they feel communication could be better especially when they are trying to find out information about changes to their relatives care

We have not spoken directly to people who use services at this inspection. Many of the people who use this service could not tell us directly about their care due to a variety of complex needs. We were able to speak to a number of relative’s. Most of the relatives said they were happy with the care provided at Athorpe Lodge, some people said they had concerns that on occasions there did not seem to be enough staff. Some said they had concerns about the environment as parts of the home had unpleasant smells and others said they had not been involved in the planning and reviewing of their relative’s care.

People told us that they had no issues with the care in the home and that activities and social outings were really appreciated.

Visitors told us that people using the service always appeared clean and tidy and they were impressed with how quickly medical help was accessed, although dental and optical needs of people were not always addressed. There were concerns about some people’s weight loss. Nobody had been invited to, or attended, a formal care review.

People commented favourably on the cleanliness of the home and that their bed linen was changed regularly. Visitors commented there were no offensive odours.

A relative explained to us that she appreciated that the home’s policy was to reduce medication where possible and this had been a factor in the choice of this service.

Relatives and other visitors were complimentary about the staff at the home.

When we were talking to people in the lounge we observed staff interacting with people who used the service, they treated people with consideration and people were given time to express their views and make decisions.

People told us that they could remain independent within the home and one person said they liked to sit out in the grounds, although they needed assistance to go to the local shops.

People told us they were able to make choices when participating in social activities. People told us about recent events which included flower arranging and crafts. One person informed us that they occasionally joined in bingo sessions but mostly preferred to spend time in their bedroom.

People who use the service and their relatives told us that prior to moving into the home they were consulted about their care and treatment. One person told us they regretted moving into the home but realised they were unable to manage without help.

One person told us they were involved in their care and their relative had picked Athorpe Lodge as it was close to where they lived.

People told us they enjoyed living at Athorpe Lodge. They said they felt safe and staff were very kind to them. One person said they had made friends with some other people who live at the home, but still looked forward to visits from relatives.

People told us the staff cared for them and helped with personal care, and always respected their dignity.

People told us that the food could be better quality but generally there was a lot of choice at each meal. People told us they were given the choice of food for the next day, although people could not tell us what they had chosen for their lunch.