This was an unannounced inspection carried out on 15 and 21 June 2018. We saw the registered provider had responded to the breach of the regulations we identified at our last inspection in March 2017. We found staff were receiving regular supervision and appraisal and medicines were managed safely.

Lindhurst 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.

Lindhurst Lodge occupies a central position at Athersley North, approximately three miles from Barnsley town centre. The home is registered to provide accommodation for up to 37 older people who may require assistance with personal care.

There was a registered manager 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.

Infection control was not well managed as several areas of the home were found to be unclean. Equipment which was due to be cleaned on a weekly basis had not been done. The registered provider was laying new carpet in the living rooms, dining room and had done by day two of our inspection in the stairwell.

Privacy and dignity was not always maintained as people had their dietary and support needs printed on table mats which had their name listed. Boxes of incontinence pads were stored in people’s rooms. Action was taken to remedy both these concerns.

People and relatives told us there were not enough staff in the home. We were concerned about the number of staff on night shifts.

Mental capacity assessments were not in place where people had authorised deprivation of liberty safeguards and best interests decisions taken on their behalf. Consent for the use of CCTV had not been received. All Deprivations of Liberty Safeguard authorisations were up-to-date.

People told us they felt safe and they were happy with the care they received from the staff and support from the registered manager. However, safe recruitment processes were not followed as risk assessments were used in the absence of references from a last employer.

Not all audits were fully effective as concerns we found during our inspection had not already been identified. The times of checks recorded on high dependency charts were pre-printed as exactly on the hour and we found an example of staff completing several hours of entries at the same time.

Supervision and appraisal records were sufficiently detailed and staff felt well supported by the registered manager. Staff training completion rates were found to be high.

People received access to healthcare from different professionals. People spoke positively about the food experience. The need for clearer recording of dietary needs in the kitchen was highlighted.

Medicines were well managed, although kitchen staff were using an unlabelled tub of thickener for two people.

People knew how to complain and complaints were appropriately managed. People were satisfied with the activities provision. Evidence of ‘resident’ and relative as well as staff meetings was seen. Surveys were sent out to people, relatives and staff.

Care plans required clear instructions on how often people needed to be repositioned. Personal emergency evacuations plans were in use and recent fire drills had taken place.

Advocacy services were actively being used for two people. People’s equality, diversity and human rights were upheld and people’s information access needs were clearly considered. Links with several groups in the local community had been made.

The registered manager was referred to positively by people, relatives and staff who added they were approachable.

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We carried out this inspection on 6 March 2017 and it was an unannounced inspection. This meant no-one at the home knew we were going to carry out the inspection.

Lindhurst Lodge occupies a central position at Athersley North, approximately three miles from Barnsley town centre. The home is registered to provide of accommodation for up to 37 older people who may require assistance with personal care. On the day of our inspection there were 32 people living in the home.

There was a registered manager 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.

We checked progress the registered provider had made following our last inspection on 11 November 2014 when we found a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.This has been superseded by Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe care and treatment. The registered provider sent an action plan detailing how they were going to make improvements. We found sufficient improvements had not been made to meet this regulation.

We checked the records of medicine administration. We found some gaps where staff had not signed to confirm a medicine was given. We also found it was not always clear the reason why a medicine was not given. This was because staff had not always used the correct code or recorded further information so it was clear why a medicine was not given.

People told us they felt safe living in the home and staff had a good understanding of abuse and their responsibilities in safeguarding adults.

Any identified risks to people were considered and actions taken to reduce or eliminate the risk so that people were kept safe from harm.

There was a system in place to assess staffing levels against people’s needs. Our observations evidenced there were enough staff on duty to meet people’s individual needs.

Thorough checks were carried out prior to staff being offered a job at the service which helped to ensure people being employed were of good character.

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

People were encouraged to maintain a healthy lifestyle which included being provided with meals that took into consideration their preferences and being supported to access healthcare professionals.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions for themselves.

The interactions between people and staff were cheerful and supportive. We saw staff assisting and supporting people in a way that maintained their privacy and dignity.

Each person had a care plan. Some people who used the service and their relatives said they had not been involved in the reviews of care plans. The care plans seen did not contain a full range of information regarding people’s care and support needs which would have assisted staff to provide more personalised care.

There was no activities worker in post which meant there was not a full programme of activities provided which were tailored to meet people's individual needs.

The service had a complaints policy and procedure. People and relatives told us they could talk with staff and the registered manager if they had any complaints or concerns.

We identified the audit systems in place to check medicines and care plans were not robust enough to effectively act upon risk in order to demonstrate compliance with regulations.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations

Lindhurst Lodge occupies a central position at Athersley North, approximately three miles from Barnsley town centre. The home is a purpose built care home providing personal care and accommodation for 37 older people. It is a two-storey building with a passenger lift. The home is dated and although it is clean and spacious, the fixtures and fittings are worn and tired. The provider has plans to totally refurbish the home in 2015.

On the day of our inspection there were 20 people living in the home. This was an unannounced inspection.

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.

We last inspected Lindhurst Lodge on 21 July 2014 and found staff were not being properly trained, supervised and appraised. We also found there was not an effective system to assess and monitor the quality of the service. We asked the provider to take action to make improvements and this action had been completed.

At this inspection we found a medicine prescribed for a person had not been given for more than one week because information about the medicine had not been transferred over at the beginning of the monthly medicines cycle. This meant medicine records were not maintained appropriately.

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

The healthcare professionals we contacted prior to this inspection told us the new management team at the home were improving the service and they did not have any significant concerns.

People told us they were well cared for in this home. People said, “the staff here are brilliant,” “they are such lovely people,” “they are all good. There’s not a bad one at all” and “these carers look after me very well. I’ve no complaints.” Many people who lived in the home were from the local area and were able to remain in contact with their family and friends and still felt part of the community.

Relatives told us, “we don’t feel we have to come every day now because we know [family member] is safe and well cared for. That’s worth a lot to us” and “my [family member] was a resident in Lindhurst Lodge before they sadly passed away last year and they cared for them very well, particularly at the end of their days, we had no complaints as family.”

We saw staff advising and supporting people in a way that maintained their privacy and dignity. People told us their views and experiences were taken into account in the way the service was delivered.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions for themselves.

We saw people participated in a range of daily activities many of which were meaningful and promoted their independence in and outside the service.

People were encouraged to maintain a healthy lifestyle which included being provided with nutritious meals and being supported to attend healthcare appointments. People told us the food was “good” “delicious” and “just right.”

Staff said the training provided them with the skills and knowledge they needed to do their jobs. Care staff understood their role and what was expected of them. They were happy in their work, motivated and confident in the way the service was managed.

An adult social care inspector carried out this inspection. At the time of this inspection Lindhurst Lodge was providing care and support to 21 people, some of whom had a diagnosis of dementia. We spoke with eight people living at the home, and three visiting relatives to obtain their views of the support provided. In addition, we spoke with the area manager and five members of staff about their roles and responsibilities.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed interactions between staff and people who lived at the home that were respectful and friendly. People were relaxed in the company of staff.

People we spoke with who lived at the home told us they felt safe living there. One person said, “It’s as safe as your own house here.” One relative said “It’s such a relief to know that [family member] is safe and being well cared for. It’s a weight off my mind.”

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

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their lives.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Although no applications had been submitted relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded.

The service had completed enhanced Disclosure and Barring Service (DBS) checks, formerly known as Criminal Records Bureau (CRB) checks for all staff working at the home. This helped to protect people who were receiving a service.

Is the service effective?

We found people were provided with nutritious food. Some people required specialised diets for health or personal reasons and these were provided.

People told us they liked the food. Comments included: “It’s all home cooked and always good. You never go hungry,” “The food is good. You can eat as much as you like” and “I’ve got no complaints about the food. It’s all good.”

During our visit, we found people were provided with the support they needed. We found staff knew people well and were aware of their individual preferences.

Care files we checked confirmed that initial assessments had been carried out by staff before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. Specialist mobility and equipment needs had been identified in care plans where required.

We looked at the staff training matrix and found significant gaps in the training provided. When we looked at staff files we found certificates for training staff had completed which was not recorded on the training matrix. This meant there remained some gaps in staff training, but until a full audit of this was completed it was not possible to assess what the gaps were. Also staff had not been provided with a yearly appraisal. This meant there was a risk staff were not properly trained and their competency appraised.

We have asked the provider to tell us what they are going to do to ensure persons employed are receiving appropriate training and appraisal.

Is the service caring?

We observed warm and respectful interactions between staff and people who used the service as well as some good humoured banter. We found staff treated people in a kind manner.

People we spoke with who lived at the home told us they were happy living there. Comments included: “I like it here. I’ve been here a while and it’s home for me,” “It’s a good place. The staff are nice and friendly and the food’s good too,” “I’ve not been here long, but I do like it here. People are friendly,” “I’m quite happy here. No complaints from me” and “I’m just here for respite (short term) care but I’d recommend it to anyone.”

One relative told us, “The staff are all really good with [family member]. They are happy here. They all know me and I know all of them, which is nice.”

Is the service responsive?

Staff told us the care and support provided was flexible to the person’s needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed. For example one relative told us, “My family member prefers a late breakfast and often doesn’t eat at lunchtime but then they eat well at tea time and that suits them.”

Several people, particularly men, told us there was not a lot for them to do during the day. Three people told us they did not like activities such as bingo or quizzes or music. One person said, “There’s not much going on for me, so I watch TV most days. It does get a bit boring sometimes.” One person told us they preferred to stay in their bedroom all day and preferred to socialise out of the care home.

We observed one person who used the service preferred to spend some of their time sitting on the floor. We noted that this person was not always in the view of care staff. We saw other people had to manoeuvre their walking frames around this person at times in narrow corridors. This meant there was a risk of people using the service falling. This had not been identified and action taken to ensure their safety and welfare.

There were no outstanding complaints about the service. People who used the service said if they had any worries they would take their concerns to a member of staff or to the managers’. One person said, “You can talk to anyone here. I know they’d sort anything out for you.”

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People who used the service and their relatives said they could not recall being asked to attend residents’ or relatives’ meetings. The area manager said a relative meeting had been arranged but no one had turned up. We saw the poster that had been on display in the home advertising this.

Information collated by CQC evidenced that the service had not reported the death of any person who used the service since April 2013. It is a legal requirement for services to inform CQC about the death of a person who uses the service. If services do not inform CQC they are at risk of receiving a fine or being prosecuted.

The service carried out a yearly ‘Quality Assurance Survey’. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends, staff and healthcare professionals. This showed people had the opportunity to put their views across.

The area manager explained the systems in place to assess and monitor the quality of service provision. The area manager said audits were completed each month and covered many areas, for example, infection control, environment, medication, food hygiene and care plans. We checked the audits and found they had not been completed since March 2014.

We have asked the provider to tell us what they are going to do to ensure the quality of the service is monitored so that any risks relating to the health, safety and welfare of people are identified and managed.

People that we were able to communicate with told us that overall they were happy living at the home and satisfied with the care and support they were receiving. Their comments included, "I’m very happy here," "I have everything I need," and "the staff are very good."

Records checked showed that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

During the inspection we spent time sitting with people in the communal areas of the home. We found that care and support was offered appropriately to people.

Each person living at the home had a care plan. We found that the information in these was detailed and complete.

We spoke with two relatives who were visiting the home and they confirmed that they were satisfied with the care provided.

We found that the home was clean and tidy and that there were sufficient resources available to prevent and control infections.

Our conversations with people, relatives and staff, together with observations on the day of our inspection evidenced that there were sufficient staff available to meet people’s needs.

The provider had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care the service provided. People who used the service and their representatives were asked for their views about their care and treatment.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. Their comments included, "This is a nice place to be." "It's okay here." "I'm happy." And "The staff are very good and they spoil me."

During the inspection we spent time sitting with people in the communal areas of the home. This meant we were able to observe people's experiences of living in the home. We found that care and support was offered appropriately to people. We found that staff were skilled, in recognising the diversity, values and human rights of people who use the service.

Each person living at the home had a care plan. We found that the information in these was variable. Some care plans seen were not fully completed and up to date. This meant that the delivery of care to people may not be safe, effective and appropriate.

When we spoke with staff we found that they had not completed any updated or refresher training in safeguarding adults since 2010. This meant that they were unsure how to respond and raise concerns appropriately.

We found that the service had not carried out a needs analysis as the basis for deciding sufficient staffing levels. This meant that there were some days when staffing numbers were not sufficient to ensure consistency of care.

The home had an effective complaints system available. We found that comments and complaints people made were responded to appropriately.

A number of people who live at Lindhirst Lodge have conditions that mean they have difficulty talking with people and therefore have varied methods of communication. Some people were able to express their views clearly, others were not able to verbally communicate with us. Due to people’s communication needs, during the site visit we sat with people in communal areas and observed them closely. This meant we were able to ascertain whether their needs were met.

Throughout the observation we saw all staff treat people with respect and courtesy.

During our observation period there appeared to be sufficient numbers of staff to meet the needs of people who use the service.

We saw occasions where staff interactions with people could have been handled more appropriately.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. People’s comments included:

“I like it here”.

“The staff look after me well”.

“I can’t grumble, I have everything I need”.

A number of people who lived at Lindhurst Lodge had conditions that meant they had difficulty talking with people and therefore had varied methods of communication. Some people were able to express their views clearly, others were not able to verbally communicate with us. Due to people’s communication needs, during the site visit we sat with people in communal areas and observed them closely. This meant we were able to ascertain whether their needs were met.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving.

Relatives said that they were satisfied with the support provided to their loved ones and were always made to feel welcome at the home when they visited.

Health and social care professionals told us that they were satisfied with the level of care, staff provided to people. They said that the new manager was doing a fantastic job and this was helping to improve the standard of care and support provided to people.

We observed that staff treated people with dignity and respect. However improvements were necessary during meal times, so that people’s dining experience was enhanced. People were not always given choices and meal times was treated by staff as a task rather than an activity that would compliment people’s daily life.

We were concerned that there was not always a trained member of staff on duty, during the night, to administer medication. This was addressed by the manager on the day of the site visit. She confirmed that immediate action would be taken to resolve this.

Over the last 12 month’s there had been five incidents that had been investigated under safeguarding procedures. This was to make sure people living at the service were safe. All these issues were now resolved. Following safeguarding meetings, actions were given to the provider to address the concerns. The safeguarding team told us they were satisfied that the provider had taken the necessary action and that people living in the home were safe.

Work was underway to improve the information in people’s care plans. However further work was needed to ensure that care plans reflected people’s current health and welfare needs. We saw that some care plans were not fully completed and some information was out of date.

Health care professionals, relatives and people all told us that they felt the environment at Lindhurst Lodge needed upgrading. Some decorating and repair work had already commenced, however the home needed a significant upgrade so that the environment was appealing and fresh.