About the service:

Ernelesthorp Manor and Lodge is a residential care home providing nursing and personal care for up to 65 people. At the time of the inspection 32 people were using the service. The provider had closed part of the service known as the Lodge. The provider had discussed refurbishment plans for the future of the Lodge.

People’s experience of using this service:

After the last inspection of July 2018 the provider had sent us an action plan to tell us how they would address the areas we raised on inspection. At this inspection we found concerns regarding safe care and treatment, person-centred care, dignity and respect and governance. Whilst the action plan had addressed some of our immediate concerns, it had not been effective in improving the service. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We completed a tour of the home with the registered manager and found some environmental risks which had not been identified by the provider’s audit system.

Risks associated with people's care and treatment were not always identified or managed safely.

This put people at risk of not receiving the right support to meet their needs and showed the provider was not doing all that was reasonably practicable to mitigate risks associated with people's care and treatment.

The provider did not always ensure that safe arrangements were in place for managing people's medicines. We found one person was prescribed medication to be taken as and when required known as PRN (as required) medicine. However, whilst some people had protocols in place to guide staff on how these should be administered, one person did not have a protocol for a pain relieving medicine.

The provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in safeguarding and confirmed that they would take appropriate action if they suspected abuse. During this inspection we identified safeguarding concerns which we asked the provider to report to the safeguarding authority.

There was not enough staff available to meet people needs and we found staff to be task orientated. Staff and relatives told us that there were times during when staff were in short supply.

People's needs and choices were assessed but care and treatment was not always delivered in line with current legislation and standards. Care records did not clearly evidence if people's needs were being met.

Where people were at risk of weight loss, food and fluid charts did not always provide an accurate account of diet taken.

We spent time observing staff interacting with people and found they were not always kind and caring in nature. Staff did not always recognise when people needed support and did not always engage appropriately with people, to ensure their needs were met.

Dignity and respect was not always maintained.

We found people did not always receive care that was responsive to their needs. Care plans we looked at did not always contain the most up to date information or contained information that was contradictory. People were not always provided with opportunity for meaningful activity.

The provider supported people to live healthy lives. We spoke with some healthcare professionals who felt confident that people received appropriate care and support.

The provider ensured that staff received training and support to carry out their role. Staff told us they felt supported by the registered manager.

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 provider was adhering to the principles of the Mental Capacity Act (MCA). People who lacked capacity had decisions made in their best interests.

People's choices for their end of life ca

The inspection took place on 17 July 2018 and was unannounced. The last comprehensive inspection took place in June 2017, when we identified a breach in the well led domain and the service was rated requires improvement. At our inspection of 17 July 2018, we checked if improvements had been made. We found that the provider had failed to make or sustain sufficient improvements in this area. You can read the report from our last inspections, by selecting the 'all reports' link for 'Ernelesthorp Manor and Lodge' on our website at www.cqc.org.uk.

Ernelesthorp Manor and Lodge is a care home. People living 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.

Ernelesthorp Manor and Lodge can accommodate up to 65 people. At the time of our inspection 36 people were using the service. The registered provider had closed part of the service known and the Lodge and people had moved from the Lodge to vacancies available at the Manor. There was no refurbishment or other plans in place for the future of the Lodge.

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.

Risks associated with people’s care and treatment were not always identified or managed safely. This put people at risk of not receiving the right support to meet their needs and showed the registered provider was not doing all that was reasonably practicable to mitigate risks associated with people's care and treatment.

We completed a tour of the home with the registered manager and found that some environmental risks which had not been identified prior to our inspection.

Accident and incident analysis was not taking place effectively and there was no evidence that trends or patterns were being identified, or that actions had been taken to reduce hazards in relation to people's care.

The registered provider did not always ensure that safe arrangements were in place for managing people’s medicines. We found some people were prescribed medication to be taken as and when required known as PRN (as required) medicine. However, whilst some people had protocols in place to guide staff in how these should be administered, some people did not have these. The protocols that were completed had not been reviewed. We also saw that eye creams and ointments were not always dated when opened. Medicines in stock did not tally with the amount recorded on the MAR sheets. Therefore, we could not evidence that people had received their medicines as prescribed.

The registered provider had a system in place to safeguard people from the risk of abuse. Staff told us they received training in this subject and confirmed that they would take appropriate action is they suspected abuse. During this inspection we identified two safeguarding concerns which were reported to the safeguarding authority.

The registered provider ensured that there were enough numbers of suitably qualified staff to support people to meet their needs. However, staff told us that there were times during staff breaks, when staff were short supply.

The registered provider ensured that staff received training and support to carry out their role. Staff told us they felt supported by the registered manager.

People’s needs and choices were assessed but care and treatment was not always delivered in line with current legislation and standards. Care records did not clearly evidence if people’s needs were being met. People mainly had access to healthcare professionals, however there were occasions where this was delayed or d

The inspection took place on 12 and 13 June 2017 and was unannounced on the first day. The home was previously inspected in December 2015. It was overall rated good.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ernelesthorp Manor & Lodge’ on our website at ‘www.cqc.org.uk’.

The service had a registered manager who had been registered with the Care Quality Commission since January 2011. 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.

Ernelesthorp Manor & Lodge is registered to provide nursing and residential care for up to 65 people. It is a purpose built care home situated in the village of Armthorpe, near to Doncaster. The home is in two units, the Manor and the Lodge. The Lodge is more geared to supporting people who are living with dementia. At the time of our inspection 43 people were living at the home. There were 27 people living in the Manor and 16 people were living in the Lodge.

We found improvements were needed to the way medication was stored to prevent over stocking. The store room needed painting and the room was cluttered and untidy. We found medication was administered safely and key staff had received training and had their competencies checked periodically. Following the first day of our inspection, the registered provider and registered manager acted swiftly to make improvements. This included a full stock check of medication and the return of some items that were no longer required.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

The support plans we looked at included risk assessments, which identified any risks associated with people’s care and had been devised to help minimise and monitor the risks without placing undue restrictions on people.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so that appropriate referrals to health professionals could be made.

There were sufficient staff with the right skills and competencies employed and on duty to meet the assessed needs of people living in the home. Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked.

We found improvements were needed to make the environment more dementia friendly. The registered provider told us they had identified this and they sent us a refurbishment programme which confirmed improvements were due to be completed within the next six months.

We identified the kitchenette on the Lodge required deep cleaning to prevent the risk of cross infection. On the second day of the inspection we saw this had been actioned and a new fridge had been ordered to replace the broken fridge seen on the first day of the inspection.

On the first day of the inspection we did not see any activities taking place. We were told the activity co-ordinator was unavailable to facilitate activities. On the second day of the inspection we observed the activity co-ordinator organising games of bingo. The atmosphere was much improved and people were more stimulated.

Overall, we found the service had a friendly, relaxed atmosphere which felt homely. Staff approached people

We carried out this inspection on 18 December 2014 and it was unannounced. This meant that the provider did not know in advance, when we were inspecting the service. We last inspected the service in September 2013 and at that time, we found there were no breaches in the regulations we looked at.

Ernelesthorp Manor & Lodge is registered to provide nursing and residential care for up to 65 people. It is a purpose built care home situated in the village of Armthorpe, near to Doncaster. The home is in two units, the Manor and the Lodge. The Lodge is more geared to supporting people who are living with dementia. At the time of our inspection 57 people were living at the home. There were 34 people were living in the Manor and 23 people were living in the Lodge.

The home 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.

We spoke with people who lived at the home and their relatives. We were told they were happy with the service the home provided. For instance, one person said, “I have to say, they are all very good. Nothing seems to be too much trouble.”

We observed people were encouraged to participate in activities that were meaningful to them. We saw staff were attentive and patient when supporting people. People were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered choice and if people required assistance to eat their meal, this was done in a dignified manner.

The care records we saw included risk assessments, which identified risks and described the measures in place to make sure people were protected from the risk of harm. There were procedures in place to instruct staff in the action to take if they were concerned that someone was at risk of harm and abuse. The care records we looked at also showed us that people’s health was monitored and referrals were made to other health professionals as appropriate.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS), and to report on what we find. We found that staff had received appropriate training and the registered manager was aware of recent legislation. The records we saw in relation to MCA and DoLS was good overall, but there was room for minor improvement.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes and the staff we spoke with confirmed they attended training to maintain their skills. We also looked at documentation that showed us there were recruitment checks in place and staff confirmed these had been carried out when they had been employed.

We saw a complaints procedure was displayed in the home. This provided information on the action to take if someone wished to make a complaint.

We discussed the quality assurance systems in place with the registered manager. We saw that people and their relatives were asked for their feedback about the quality of the service and we saw that audits of accidents, incidents and falls were carried out and these were investigated to make sure risks were identified and improvements made.

We spoke with nine people who used the service and three relatives who were visiting the home at the time of the inspection. People told us they were happy with the care provided at the home. They said the nurses and care staff were kind. One person said, “They are a really nice bunch.” Another person said, “It’s just like a big family.”

People experienced care, treatment and support that met their needs and protected their rights. Relatives we spoke with said they were happy with the care provided.

We saw that staff treated people with dignity and kindness. We observed that a friendly and positive approach was used, to ensure that the wishes and needs of people using the service were respected.

We found that systems were in place that protected people who used the service against the risks associated with the unsafe use and management of medication.

Appropriate checks had been undertaken on staff when they were recruited to work in the home and complaints were investigated and responded to in a timely manner.

We visited the home because we had received some concerns about the quality of the care and the management of the home. However, we did not identify any concerns during the inspection and no-one raised any concerns with us during our visit. People who used the service said they felt confident to take any concerns to the manager or any of the staff. They felt safe in the home. They made several positive comments about the staff.

We spoke with seven people who used the service. They all told us they received good care. They told us they were able to make decisions about their care and treatment. Some of the comments that people made included,

"The nurses and the care staff listen and take my wishes into account."

“I feel confident to say what I think and need and the staff take notice.”

”I am looked after well."

”The nurses explain my treatment and treat me with respect."

People living in the home said the nurses and the care staff were caring and professional. One person said, "If I have any concerns I talk to the nurses and they sort things out."

We spoke with two people’s relatives, who were visiting at the time of our inspection. They told us the information people received about the service and communication from staff was good. We also spoke with the community matron who said they visited the home regularly and spoke positively about the service that people were provided with.

We spoke with people who used the service and relatives at our last visit to the service in January 2012. They told us they were very satisfied with the service and found the staff to be “Very helpful and friendly”.

We did not speak with people who used the service during this follow up visit.

Relatives told us that staff were friendly, knowledgeable and listened to what they had to say. Relatives said that they were involved in their family member’s care and made care and financial decisions for their family member when the individual was not able to due to their mental health condition.

We spoke with two people who came to look around the home. They said the staff were easy to talk to and knowledgeable about the service. The visitors told us the home looked very nice and there were no odours; they said it was a very pleasant home.

People who spoke with us said they got their medications on time and they could talk to the staff and manager at any time if they had any concerns or worries.