About the service:

Fulwood Lodge is a 42 bed home providing personal and nursing care to older people with a range of support needs, including people living with dementia. There were 30 people living at Fulwood Lodge at the time of this inspection.

People’s experience of using this service:

Since the last inspection improvements had been made so staff always asked people for consent before providing care and support and there was a wider range of activities available for people to participate in.

Staff were caring and knew people well. People and relatives complimented the service and said they would recommend the home. There was a culture within the service of treating people with dignity, respect and compassion.

People felt safe at Fulwood Lodge. Recruitment processes were robust, and checks were completed before staff started working in the home. There were enough staff on shift to keep people safe and we observed staff respond to people in a timely manner throughout the day. Staff told us they thought there were enough staff to meet people’s needs. Staff supported people safely with their medicines.

The home was clean although some refurbishment of the premises was needed as some areas of the home were looking tired and worn.

Care plans were up to date and most accurately detailed the care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified.

People were happy with the food provided at Fulwood Lodge. The service catered for people's special dietary requirements and staff monitored food and fluid intake levels of people who were assessed to be at risk.

Staff had received training and supervision to ensure they had the knowledge and skills to provide people with appropriate care.

People felt able to raise any concerns with the manager or provider and were confident they would be addressed. People’s feedback was used to make improvements to the service.

Staff felt well supported by the manager and we observed the staff team work well together. The management team fostered a culture of openness and improvement. The manager provided staff with leadership, was approachable and was keen to attain and maintain high standards in the service.

The manager and provider coordinated a range of quality checks and audits of the service to make sure the care and support provided was of high quality. This supported the continuous improvement of the service.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 9 May 2018).

Why we inspected:

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

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. We plan to complete a further inspection in line with our re-inspection schedule for those services rated good. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 23 March 2018 and was unannounced. This meant no-one at the service knew we were planning to visit.

We checked progress the registered provider had made following our inspection on 5 July 2017 when we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in; Regulation 10, Dignity and respect; and Regulation 17, Good governance. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009, Notification of other incidents.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive, caring and well-led to at least good. We found improvements had been made and the registered provider was no longer in breach of regulations.

Fulwood Lodge 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. Fulwood Lodge is a 42 bed home providing personal and nursing care to older people with a range of support needs, including people living with dementia. There were 27 people living at Fulwood Lodge at the time of this inspection.

There was a registered manager employed at the service. 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 we spoke with told us there had not been a wide range of activities or outings in recent months. However, people also told us the newly employed activity coordinator was committed to introducing activities that were enjoyable and beneficial for everyone’s health and wellbeing. We recommend the registered provider ensures these recent improvements are sustained and developed to meet everyone’s needs.

People were usually 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 clearly knew people and their likes and dislikes, however on occasion staff did not ask for consent or give people options before providing care and support. We spoke with registered manager and registered provider about this.

Staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by the registered manager.

There were enough staff available to ensure people’s care and support needs were met. The registered provider had effective recruitment procedures in place to make sure staff had the required skills and were of suitable character and background.

Medicines were stored safely and securely, and procedures were in place to ensure people received their medicines as prescribed.

We saw the premises were clean and well maintained.

People and their relatives told us they enjoyed the food served at Fulwood Lodge, which we saw took into account their dietary needs.

Positive and supportive relationships had been developed between people, their relatives, and staff. People told us they were treated with dignity and respect.

People’s care records reflected the person’s current health and social care needs. We saw these were evaluated monthly by staff and we were told six monthly reviews were to be introduced involving the person and their relatives.

There was an up to date complaints policy and procedure clearly displayed in the reception area. People, their relatives and staff told us the registered manager was approachable and responsive to any issues raised.

People living at Fulwood L

This inspection took place on 5 July 2017 and was unannounced. This means prior to the inspection people were not aware we were inspecting the service on that day.

Fulwood Lodge is a 42 bed home providing personal and nursing care to older people with a range of support needs, including people living with dementia. It is located in the Ranmoor suburb of Sheffield. On the day of our inspection there were 25 people living in the home.

The manager had worked at the service for six weeks and had not completed their registration with the Care Quality Commission (CQC.) A registered manager is a person who has registered with the CQC 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.

Our last inspection at Fulwood Lodge took place on 16 December 2016 and the service was placed 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 in any of the key questions. Therefore, this service is now out of Special Measures.

People living at Fulwood Lodge and their relatives told us they liked living at Fulwood Lodge.

There were enough staff employed to meet the needs of people living at Fulwood Lodge. The manager reassured us they would be able to increase staffing levels as and when required.

We found effective systems were in place to ensure medicines were managed and administered in a safe way. However, improvements were still required with regard to the safe storage of medicines and the use of PRN (as and when) required medicines.

Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. They were confident any concerns would be taken seriously by management.

Effective care based on best practice, from staff with knowledge and skills they need was not always delivered for people requiring pressure area care.

Staff were suitably trained, and received supervisions and appraisals. However, the frequency of these was not consistent across the service.

People living at Fulwood Lodge and their relatives told us they enjoyed the food served at Fulwood Lodge, which we saw took into account their dietary needs and preferences. This meant their physical health was promoted and their choices were respected.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted.

People living at Fulwood Lodge and their relatives told us staff were caring. However, we saw people did not always have their privacy and dignity respected.

We saw and heard positive interactions between people and staff throughout the inspection. Staff clearly knew people well.

There was a range of activities on offer to people living at Fulwood Lodge. People told us they enjoyed taking part in the activities.

Risks to people had been identified and plans put in place to keep these risks to a minimum. However, we found these did not always accurately reflect the current level of care and support the person needed.

More quality assurance systems needed to be introduced to look at the quality of the service provided. Those that were in place were not fully effective at identifying shortfalls in order to improve practice.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in; Regulation 10, Dignity and respect; and Regulation 17, Good governance. We also found a breach of Regulation 18 of the Care Quality Commission (Regi

This inspection took place on 12 December 2016 and was unannounced. This means prior to the inspection people were not aware we were inspecting the service on that day.

Fulwood Lodge is a 42 bed home providing personal and nursing care to older people with a range of support needs, including people living with dementia . It is located in the Ranmoor suburb of Sheffield. On the day of our inspection there were 33 people living in the home.

The manager had worked at the service for nine months and had not completed their registration with CQC. 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.

Our last inspection at Fulwood Lodge took place on 9 November 2015. The home was rated as Requires Improvement. We found the home to be in breach of regulations for safe care and treatment and person-centred care. Requirement notices were given for these breaches in regulation and the registered provider was told to make improvements. On this inspection we checked improvements the registered provider had made. We found there were still breaches in regulations, therefore sufficient improvements had not been made to meet regulations.

Risks to people were not being managed effectively so that people were protected.

People’s safety was being compromised because action had not been taken following the recommendations of the fire risk assessment.

There was no system in place to assess staffing levels against people’s needs. Our observations evidenced there were not enough staff on duty at certain times.

In staff files we found gaps in the information required to ensure people being employed were of good character.

Staff were trained to give people their medicines in a safe way. Medicines were administered, stored and recorded as per recommended guidelines.

Staff were not given appropriate support through a programme of regular training and on-going supervision and appraisal.

A planned programme of social activities was not in place. An activity worker had been recruited and was due to start at the home within the next few weeks.

The manager investigated and responded to people’s complaints, according to the provider’s complaints procedure.

We identified the current audit systems were not robust enough to effectively assess, identify and act upon, risk and improvements required at the service, in order to demonstrate compliance with regulations.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 12; Safe care and treatment, Regulation 18; Staffing, Regulation 19; Fit and proper persons employed, Regulation 10; Dignity and respect, Regulation 17; Good governance. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is 'Inadequate' and the service is therefore 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. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration if they do not improve. This service will continue to be kept under review and, if needed, could

Fulwood Lodge is a care home providing personal and nursing care for up to 42 older people with a range of support needs, including people living with dementia. It is located in the Ranmoor suburb of Sheffield.

There was a manager at the service who was registered with CQC. 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 and associated Regulations about how the service is run.

Our last inspection at Fulwood Lodge took place on 29 January 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 9 November 2015 and was unannounced. This meant the staff who worked at Fulwood Lodge did not know we were coming. On the day of our inspection there were 35 people living at Fulwood Lodge.

We found some people’s medicines were not managed safely, so they were not protected against the risks associated with the unsafe use and management of medicines.

People told us they felt safe living in the home and relatives we spoke with told us they thought their family members were safe.

There were sufficient staff, with appropriate experience, training and skills to meet people’s needs.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

We found the home was clean, with no obvious hazards noticeable, such as the unsafe storage of chemicals or fire safety risks.

Staff were provided with relevant training and support to make sure they had the right skills and knowledge for their role.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of health care professionals to help maintain their health. A varied and nutritious diet was provided to people that took into account dietary needs and preferences so their health was promoted and choices could be respected.

We found there was a risk that people who required wound care and/or assessment may not receive appropriate care and support to meet their needs.

People living at the home, and their relatives said they could speak with staff, the registered manager and provider if they had any worries or concerns and they would be listened to.

We saw people participated in some daily activities both in and outside of the home although people and their relatives said these had been somewhat limited recently.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via surveys, the results of these had been audited to identify any areas for improvement.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management and Person-centred care. You can see what action we told the provider to take at the back of the full version of this report.

We asked people about their experience of receiving care at Fulwood Lodge. One person said: “They [the staff] are very pleasant, very good.” Another person said: “I enjoyed my breakfast but then I always do.” One person told us that they had lived at Fulwood Lodge for a number of years and they had been “very satisfied” with their care.

We checked records relating to consent, observed care and checked training records. We saw that the provider had ensured that all staff, including domestic and catering staff, had received training around the Deprivation of Liberty Safeguards and the Mental Capacity Act. Every file we checked held a mental capacity assessment, setting out whether the person had the capacity to consent to their care, in accordance with the Mental Capacity Act.

The layout of the home met the needs of people with mobility difficulties, and the provider had ensured that rooms were set out in such a way that they were accessible to people using wheelchairs.

We observed staff carrying out their duties and saw that they communicated effectively with each other and provided support to one another to ensure people’s needs were met. We saw that that home’s manager spent a large amount of time in the communal areas of the home, ensuring that they were available to provide support to staff where needed.

People’s personal records including medical records were accurate and fit for purpose.

Some people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. Due to this we have used a formal way to observe people in this review to help us understand how their needs were supported. We call this the Short Observational Framework for Inspection (SOFI).

Throughout the SOFI we saw all staff treat people with respect and courtesy. The atmosphere in the home was relaxed and during our observation we saw frequent positive and friendly interaction between staff and people who use the service. We saw that people who use the service were given choices and supported to make decisions and staff took their time to understand people where they had communication difficulties.

We were able to speak with two people who use the service. They told us they liked living at the home and we received comments such as “The staff are kind”, “The staff are always happy to help” and “The food is nice”.