Our inspection was unannounced and took place on 23 May 2016. At the time of our inspection 28 people lived at the home.

The provider is registered to accommodate and deliver nursing and personal care to 30 people. People who lived there were elderly and had needs associated with old age and dementia.

At our last inspection on 11 May 2015 the provider was not meeting one of the regulations that we assessed which related to the governance and the quality monitoring of the service. This had some negative impact on the overall service provided. During this, our most recent inspection, we found that monitoring and checking processes were more thorough and were undertaken regularly and had improved the service provided. However, we found that attention was still required to ensure that staff received the training they needed and that there was a record of this.

A manager was registered with us as is required by law. 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.

Staff knew what to do to keep people safe and prevent the risk of abuse or harm to them.

Systems in place promoted safe medicine management to prevent people being placed at risk of possible ill health. We found that people were given their medicines as they had been prescribed.

Staff told us and records confirmed that they received induction training and the support they needed to ensure they did their job safely.

People, relatives and staff we spoke with confirmed that staff skill mix and staffing levels were adequate to meet people’s needs and to keep people safe.

Staff understood the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

People were offered drinks and food that they enjoyed in sufficient quantities to prevent them from a risk of dehydration and malnutrition.

People’s health care needs were met by the care and nursing staff and a wide range of external healthcare professionals.

People were cared for and supported by kind and caring staff.

People were encouraged and supported by staff to be independent and attend to their own needs when they could.

Staff supported people to keep in contact with their family as this was important to them.

We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered.

There was a range of recreational activities for people to participate in and enjoy.

Systems were in place for people and their relatives to raise their concerns or complaints if they needed to.

People and their relatives told us that the quality of service was good. The management of the service was visible and consistent. There were processes in place to monitor the quality of the service to ensure that people received a service that met their needs and kept them safe.

The provider is registered to accommodate and deliver nursing and personal care to 30 people. People who lived there were elderly and had needs associated with old age and dementia.

Our inspection was unannounced and took place on 11 May 2015. At the time of our inspection 27 people lived there.

At our last inspection in of May 2014 the provider was not meeting three of the regulations that we assessed which related to care and welfare, meeting nutritional needs and the quality monitoring of the service. Following our inspection the provider sent us an action plan highlighting what action they would take to improve. During this, our most recent inspection, we found that activity provision had not improved and issues raised collectively did not demonstrate a consistently well led service.

A manager was registered with us as is required by law. 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, relatives and staff we spoke with had mixed views about staffing levels. Some told us that staffing levels were not always enough.

Staff knew what to do to keep people safe and prevent the risk of abuse or harm to them.

Systems in place promoted safe medicine management to prevent people being placed at risk of possible ill health. We found that where people received support from staff with taking prescribed medicines, this was done in a way that minimised any risk to them.

We found that care staff were trained to support the people who lived there effectively and safely. However, the nursing staff had not received all of the training that they required. Staff told us and records confirmed that they had received induction training and the support they needed to ensure they did their job safely.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted. However, DoLS training remained outstanding as this had been raised in our previous report.

Staff supported people with their nutrition and health care needs. However, menus and preferences required consultation with people to ensure that food provided met their needs.

We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered. Systems were in place for people and their relatives to raise their concerns or complaints.

There was a lack of recreational activities for people to participate in and enjoy.

Staff supported people to keep in contact with their family as this was important to them.

People were encouraged and supported by staff to be independent and attend to their own personal hygiene needs when they could.

All people received assessment and treatment when needed from a range of health care professionals including their GP, specialist consultants and nurses which helped to promote their health and well-being.

Most people told us that the quality of service was good. This was confirmed by the majority of relatives we spoke with. The management of the service was stable; however, processes in place to monitor the quality of the service had not highlighted or resolved all issues we raised at this and our previous inspection.

You can see what action we told the provider to take at the back of this report.

Over the last few months Sandwell local authority and Clinical Commissioning Group (CCG) who monitor and fund the majority of adult social care services had concerns regarding the care and welfare of some people who lived there. The concerns included, a sudden death of a person who lived there, care planning, record keeping and some issues regarding the management of medication. As a result the provider agreed to a voluntary suspension of new placements. The local authority then determined a gradual improvement had been made and agreed that the provider could partially lift their suspension to allow one new admission every two weeks to the home. The CCG suspended their intermediate care contract.

At the time of our inspection 18 people lived at the home (although as one person was away on holiday so only 17 people were actually there). During our inspection we spoke with seven of those people, six relatives, six staff, the manager, and the registered provider. All of the people who lived there and their relatives were very positive about the home and the services provided. One relative said, “It is excellent. Much better than the last place they were in”. Another relative told us, “I have no concerns at all. It is a very good place”. One person who lived there said, “I like living here. I give it nine or 10 out of 10”. A second person told us, “Oh it is wonderful here”. We randomly looked at recently completed surveys that had been sent by the provider to people who lived there, relatives, external health care professionals and staff.

We set out to answer 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, discussions with people who lived at the home, their relatives, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

All people we asked told us they felt safe. All people and relatives that we asked told us that they had not seen anything of concern. One person told us, “The staff are not rough or unkind”. One relative said, “A member of our family visits every day. Nothing like that has happened”.

Staff we spoke with knew of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury.

We found that people’s risks and needs had been assessed. However, instructions in care plans regarding the frequency of the checking of people’s wellbeing were not always followed by staff.

The management of day to day risks and safety should be improved upon. Those include systems to prevent dehydration and malnutrition.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

Systems regarding menu planning and meal variety were effective. All people we spoke with told us that the meals were good. One person said, “I love the food here”.

Most of the non-compliance we determined had already been raised with the provider by external care agencies. (Non-compliance is when the provider does not meet the requirements of the law or there are shortfalls in care delivery or practice). Although the provider had made some changes we still found non-compliance in day to day basic practice. This did not give assurance that the provider was adequately effective.

People’s health and care needs were assessed but they were not always included in detail in their care plans. For example, staff practice for one person did not reflect the instructions in their care plan. When we asked staff to clarify what was required we were given different views. This meant that care plans were not able to consistently support staff to meet people’s needs.

We found that day to day activity provision was not adequate to meet people’s needs. One person said, “There is not much to do”.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning to ensuring that the service is effective.

Is the service caring?

We determined that staff showed people respect and promoted their dignity. We saw that staff showed patience when supporting people.

All of the people and their relatives were very complimentary about the staff. They described them as being, “Caring”, and “Kind”. One person who lived there said, “I like all the staff. They are very kind and friendly”. A relative told us, “I cannot fault the staff here. They are very kind and considerate”.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was caring.

Is the service responsive?

People who lived there and their relatives had been given the opportunity to complete satisfaction surveys. The provider told us that they were in the process of analysing the surveys and would take action and make changes where there was a need. This showed that the provider was willing to listen to the views of the people who lived there, and their relatives, to improve the overall service provision.

The provider told us that improvements had been made since external health care professionals had raised issues. Those external health care professionals had confirmed some improvements. However, our observations and the evidence that we gathered showed that staff did not always perform to the standard that was required regarding the following of instructions in care plans.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make to ensuring that the service is responsive.

Is the service well-led?

At the time of our inspection there was no manager registered with us. It is a requirement in law that the home should have a registered manager. The manager told us that they had made an application to register. The registration of the manager would give people who lived there greater assurance that the service provided would be consistent and well led.

Documents that we looked at and our observations confirmed that records were not all completed adequately to evidence sufficient food and fluid intake to prevent ill health. This showed that staff had not undertaken tasks as they should have done and did not give assurance that the service was well led.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make in relation to the management of staff and quality assurance processes to demonstrate a well led service.

At the time of our inspection 26 people lived at Bartholomew Lodge. Seven of those people were receiving intermediate care. Intermediate care is when people receive care for a short period of time. The aim is for a person’s condition to improve after an injury or illness or for them to recover daily living skills. During our inspection we spoke with ten people who lived there, five relatives, and eight staff.

Everyone we spoke with was very complimentary about the overall service, the care provided, and the staff. One person who lived there told us, “I have had a very good life. I am glad that my daughter found this place for me. The place is good, the food is good, and the staff are good. I am happy and content to spend the rest of my days here”. Another person said, “It is a very good place. We are well looked after”. A relative told us, “It is very good here. I have no concerns. They are well looked after”. All staff we spoke with told us that they enjoyed their work and that they felt that the people who lived there were well looked after and were safe.

During the time we spent with people we saw that staff treated them with respect and dignity. All people we spoke with told us that choices were offered and their views had been taken into consideration. We saw that people's needs had been assessed by a range of health professionals including specialist doctors and the optician. This meant that staff had enabled people to have their health care and safety needs monitored and met.

We found that medication management systems were adequate. People had been given their medication as it had been prescribed by their doctor.

We saw that the environment had been refurbished and enhanced to offer a pleasant place for people to live.

We found that staff were provided with guidance and support to meet people’s needs and to keep them safe.

We saw that complaints processes were in place for people who lived there or their relatives to use if they were not happy with the service provided.

There were 20 people living at the home on the day of our inspection. No one knew we would be visiting. We spoke with ten people who lived at the home, two relatives, six staff and two external care workers.

All people we spoke with told us positive things about the home. One person told us "I have been in other homes before but this one is the best, we have good care and it is very friendly and homely". Another person said “I came here before for short stay care. When I needed long term care I insisted I came back here because I had liked it so much". A third person said "Everything here is wonderful, the staff, the food and the care". One relative said “It is excellent. I can not fault it they are very well looked after". An external care worker told us "I have never seen anything concerning here.This is one of the better places we go to".

We saw that staff were polite to people and showed them respect. People's needs had been assessed by external health professionals including the dietician and speech and language therapists.This meant that people's health care needs had been monitored and met.

Staff were able to give a good account of what they would do if they were concerned about anything or witnessed abuse.

Recruitment processes ensured that staff employed were suitable to work with the people living at the home which protected them from harm.

Records and staff both confirmed that systems had been used to monitor how the home had been run.