This unannounced comprehensive inspection took place on the 21 June 2018. The inspection team consisted of three inspectors, a pharmacist inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Bartley Green Lodge Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bartley Green Lodge accommodates up to 47 people in one adapted building comprising of three units, two of which specialise in caring for people living with dementia. Twenty nine people lived at the home at the time of our inspection visit.

At our last inspection in February 2018 we identified significant improvements were needed throughout the service. We judged the home as 'Inadequate' in two of our key questions and identified six breaches of the Health and Social Care Act 2008 and one breach of the Care Quality Commission (Registration) 2009. We found people's needs had not been assessed or managed to reduce the risk of avoidable harm and found examples of where people had been exposed to actual harm. There were not enough staff to meet people's needs safely and people did not receive their medicines as prescribed. Staff did not always have or embed their skills and knowledge to meet people's health and support needs. We found people did not have their rights upheld in line with the Mental Capacity Act 2005 (MCA). We could not be assured people were having their dietary requirements met. People did not always receive support in a caring way and their privacy and dignity was not respected. People did not receive person centred care that was responsive to their needs. Systems and processes to monitor the safety and quality of care people received was not effective. There was ineffective management of the service and as a result people had experienced inadequate care and support. Additionally, we also found the provider had failed to notify us of incidents as required by the law.

Following our February 2018 inspection the overall rating for the service was assessed as 'Inadequate' and the service was placed in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. We took urgent enforcement action following our last inspection which required the provider to send us a report each month of the actions they were taking to keep people safe and how they intended to improve the service. We also imposed conditions on the provider's registration to prevent any admissions to the home. The provider had complied with the action we took. Following the inspection we met with the provider and asked them to complete an action plan to show us what they would do and when by to improve all the key question(s) to at least "good." The provider sent us their action plan in February 2018 and we looked at their action plan as part of this inspection.

This inspection took place on 21 June 2018 to follow up on our previous findings. We returned on this occasion to check whether people were safe and that the provider was taking the necessary action to improve the quality of care and reducing the risks to people. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or

This unannounced comprehensive inspection took place on the 13, 14 and 21 February 2018. The inspection was prompted in part by increased statutory notifications from the registered provider. From those notifications we identified some vulnerable people were not being adequately safeguarded. The notifications indicated potential concerns about the management of people's care needs. This visit was also brought forward following information of concern being shared with us by the local authority. This inspection examined those risks.

Bartley Green Lodge Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bartley Green Lodge accommodates up to 47 people in one adapted building comprising of three units, two of which specialise in caring for people living with dementia. At the time of our inspection 44 people were living at the home.

Since our previous inspection in November 2016 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

At the last inspection in November 2016, the service was rated Good but required improvement in the key question, ‘Is the service Safe?’ We identified issues around the management of medicines and the management of risks to people.

At this inspection of February 2018 there was not 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. The provider had recently appointed a new home manager who was undertaking their induction. The home manager was present throughout our inspection.

During this inspection in February 2018 we found significant shortfalls in the service. We found examples of where people had been exposed to actual harm and abuse and staff had failed to protect people from future occurrences. We were so concerned about our findings that we made immediate contact with the local authority to discuss the shortfalls and we used our urgent enforcement powers to ensure the registered provider took immediate action to ensure the safety of people who had been identified as at high and extreme risk of harm.

People were not protected from harm due to staff not recognising and reporting safeguarding incidents to the local authority. We found there to be insufficient numbers of staff working at the service to keep people safe. People were not receiving the levels of supervision they needed. People had experienced and were at risk of experiencing unsafe care and support as a result. People did not always receive their medicines as prescribed.

People were not supported by care staff that had the training, skills and knowledge to support them effectively. Staff had received safeguarding training but still failed to recognise abuse and had failed to escalate and follow processes. People were not supported in a way that protected them from unlawful restrictions due to staff lack of understanding and knowledge of the Mental Capacity Act. People did not have their fluids intake managed safely when it had been identified that they were of risk of dehydration. People were supported to see healthcare professionals for routine appointments or when a change in their health was identified.

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This inspection took place on 8 and 9 November 2016 and was unannounced. The service was previously inspected in October 2015. During that inspection breaches of legal requirements were found. The issues identified that the provider did not have suitable arrangements to ensure the proper and safe management of medicines and did not have effective systems in place to assess, monitor and mitigate the risks to health, safety and welfare of people who used the service. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. The provider took action and at this inspection we found improvements had been made.

Bartley Green Lodge is registered to provide care and support for up to 47 older people who have needs relating to their age or dementia. Nursing care is not provided. On the day of our inspection there were 43 people at the home and one person was in hospital.

The registered manager was present during our inspection. 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 told us that they had no concerns about their safety. People were supported by staff who had received training on how to protect people from abuse. Risk assessments had been completed to minimise the risk to people but guidance for staff was not easily accessible within some care records. There were appropriate recruitment process in place. People told us that there were adequate numbers of staff on duty to meet their personal needs. The overall management of medicines had improved but we found some of the audits had not identified shortfalls.

People were supported by staff who received regular training to enhance their skills and knowledge. Staff were able to give an account of what a Deprivation of Liberties Safeguard (DoLS) meant for people subject to them; however they were not clear about which people were subject to an authorised DoLS. People told us they were supported to express their opinions about the meal choices. Staff were knowledgeable about how to support people to maintain good health and accessed professional healthcare support for them when necessary.

People told us and we observed that staff were kind and compassionate in the way they supported and cared for people. People were given support to make their own decisions about their individual care and support needs. People told us that staff respected their privacy and dignity.

People told us that they were involved in the planning of their care and support needs. Staff were knowledgeable about people’s personal preferences and what was important to them. Activities on offer to people were available for people based on group and individual preferences and abilities. There was a complaints procedure in place, but concerns and suggestions raised had not always been responded to and used to continually improve and develop the service provided.

All the staff we spoke with said that the registered manager and the deputy manager were supportive and approachable. The registered manager had continued to make improvements so that the home supported people who lived there well. The registered provider had developed and used a variety of systems and audits to ensure the service being offered was safe and good quality.

To complete this inspection we spoke with two people who were using the service, one visitor and reviewed five care records. We also spoke with two staff.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. We saw people being consulted about what they would like to do and people’s preferences were documented within their care records. We spoke to one visitor who told us: “The home is smashing and gives very good care.” During our visit we saw that group and individual activities took place. We saw that staff had time to sit and chat with people. This meant that people had their care and welfare needs met by the service and records helped to inform staff.

People experienced care and treatment which supported their current and long term health needs. We saw that staff had clear instructions within the care records to meet people’s needs. The service was responsive to people’s changing care need requirements. They used external healthcare professionals to support them as necessary. One visiting professional shared with us their views about the service who told us: “I think the home is very pleasant, staff follow our instructions and are very helpful.” This meant that both health and welfare needs were identified and met for people.

This inspection was a follow up in response to a previous inspection conducted on 12 April 2013. At that inspection we found three areas of non-compliance. We asked the provider to complete an action plan detailing how they would ensure they would become compliant.

People’s care and treatment needs had improved but not all care provided met all the known needs of people using the service. We observed people around the home partaking in activities and generally moving around the home. We spoke to family members and staff to understand the experience of people. When speaking with relatives one person said: “We are very happy with the care given to my Mother.” We also reviewed care records for people. We found that some improvements had been made with responsive care planning. However, the provider had identified some people who required additional support with fluids in particular but they had not received adequate support and encouragement in this area. This had resulted in some people not drinking enough at times. This meant that people did not receive the amounts of fluids they required for good health.

The service ensured that safeguarding training was received by most of the staff and was part of the staff meeting agendas. All staff had read and signed the updated safeguarding policy. This meant that staff awareness of safeguarding and how to report it was adequate.

The provider had improved the management systems to ensure that care records were more closely monitored and audited to ensure they reflected the most up to date needs of people within the service.

During our inspection we spoke with six people and visitors and reviewed five care records. We spoke with five staff and reviewed six staff files. One person said: “Its very nice here, the food is great.”

People’s care and welfare needs were not met fully because the care records did not represent the care that people required. They were not evaluated and reviewed in a timely manner.

People were at risk from abuse due to inadequate arrangements to ensure that staff received safeguarding training; there were a significant number of staff who required safeguarding training. .

The home was clean and tidy. One visitor when asked about the home said: ”I’m impressed with the place.” Staff knew how to prevent the spread of infection by using preventative practice such as wearing gloves and aprons when delivering personal care.

Staff recruitment processes were in place, the home followed its own recruitment policy and procedure. Good character checks had been undertaken and staff had been assessed as fit to undertake the tasks required.

A number of staff still required their induction training which included some health and safety training. Following the inspection we were informed that the dates for induction training had been booked.

People using the service and staff were involved in monitoring the quality of service provided at the home. The provider has planned a customer feedback survey which was to commence later in April 2013.

This report provides details from two separate inspection visits which took place months apart. The first inspection visits were in February 2015 and the second inspection visit was in October 2015. We were unable to provide a report from our visits in February but felt it valuable to provide summaries of both visits together with the judgements from the most recent inspection visit in October 2015. Both visits were unannounced. Prior to the February 2015 visits we had last inspected this service in October 2013 where we judged that the service was compliant with regulations.

Bartley Green Lodge provides accommodation with care and support for up to 47 older people who live with dementia. At the time of our visit in October 2015, 43 people were using the service.

There was a registered manager in place on both of our visits but the registered manager had changed between our February visits and our visit in October 2015. 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.

At both our February visits and at our October 2015 visit we found that people were not having their medicines administered, stored or accounted for properly. We found that some people were not receiving their medicines as prescribed. Arrangements for administration of some medications was not safe. The overall management of medication was not meeting the legal requirements and you can see what action we told the provider to take at the back of the full version of the report.

We told the provider following our visits in February 2015 about our concerns about how the systems in place had failed to identify areas where the home needed to improve. At that time we had evidence that there had been changes in both management, increased training and changes to the monitoring systems but this had failed to ensure that improvements were made quickly. At our visit in October 2015 we found that checking, monitoring and audit systems had not sufficiently improved to ensure that ongoing failures, deficits or inadequacies were identified and acted on in line with requirements of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Staff knew how to recognise signs of abuse and who to raise concerns with. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions, although these were not always sufficiently revised following changes in people’s health or risks to them.

In February 2015 people were not supported by appropriate numbers of staff to meet their health and social care needs. At that time the provider had not ensured that the staffing levels reflected the support people needed. Following this visit several people who had complex care and nursing needs had moved from the home to other services. When we visited in October there were enough staff to meet people’s needs

There were robust recruitment and induction processes in place to ensure new members of staff were suitable to support the people who lived in the home.

Staff we spoke with had knowledge about the people and their health needs. Staff told us that they had received training however this did not always result in staff being competent to ensure that people received the care outlined in their care plan.

The registered manager and staff we spoke with were knowledgeable of the requirements of the Mental Capacity Act 2005. In February we found that staff did not support people with their personal care if they did not consent . However this had resulted in some people not having support with their personal care for long periods and records about whether people had effectively attended to their own personal care were not clear. Steps had not been taken to look at ways in which people’s capacity to accept care could be improved. In October 2015 we saw that this had improved and observed how people were encouraged to consent.

People who did not need support to eat and drink were offered choice of suitable food in a calm atmosphere and improvements had been made to enable people to have drinks more easily. We found in October 2015 that people who needed support to eat and drink enough to maintain good health were not receiving the support they required.

People told us they were happy with the care staff. Staff spoke in appropriate ways about people who they supported. At times the care provided was task centred and this meant people did not get the support they requested. Staff knew how to maintain people’s privacy and dignity when delivering personal care.

There had been some improvements to the amount of activities that people were offered between the February visit and the visit in October 2015. However, people were not always offered the activities that were advertised as available within the home. Improvements had been made so that people who liked to walk around the home had a few things that they could pick up and look at and one or two people had items reflecting their previous interests and hobbies. Improvements had been made to the recording of concerns, complaints and compliments, and these were managed appropriately.

The new registered manager of the home was viewed positively by people who visited the home. Relatives and some staff told us of the improvements that the registered manager had made to the home. Relatives told us that the registered manager listened and two staff told us that the registered manager supported staff on the units when the home became busy.

We met with the provider following our October 2015 visit and they told us of actions that they had taken and were continuing to take to improve outcomes for people an ensure that people were provided with a service that met their needs at all times.