This comprehensive inspection took place on 5 June 2018 and was unannounced. At the last comprehensive inspection in March 2017, the service was rated Requires Improvement and we found a breach of regulation. People did not receive person centred care that met their needs. We asked the registered provider to complete an action plan to show what they would do and by when to improve the areas identified to at least Good. At this inspection we found the service had improved and we have rated it as Good. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Lockermarsh’ on our website at www.cqc.org.uk’

Lockermarsh 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. The service can accommodate up to 24 people in a converted and extended property.

The service had a registered manager in post at the time of 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 who used the service told us they felt safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm and risks to people were assessed and monitored.

There were good systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staffing levels were maintained to ensure that people's care and support needs continued to be met safely and there were safe recruitment processes in place.

People received their medicines as prescribed. Although, we found some documentation could be improved, this was addressed immediately by the registered manager.

The service was clean and maintained. The registered manager had a maintenance and renewal plan in place and the registered manager had identified areas that could be improved further.

A nutritious, varied and balanced diet was provided and people’s dietary needs and choices were met. Although we found documentation could be improved.

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. People received appropriate healthcare support.

We observed people had good relationships with the staff. Without exception all people we spoke with told us the staff were kind, considerate and caring. Staff respected people’s privacy and dignity and promoted their independence. People were also supported in decisions regarding their end of life wishes.

There was a varied and appropriate activity programme; we saw people enjoying activities and activities were arranged so people could have access to the community.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

The service was promoting an open and inclusive culture to encourage communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

We saw that the operations manager and the registered manager had improved systems to maintain effective monitoring and auditing to ensure the quality and safety of the service was continued to be improved and that systems were embedded into practice.

We saw that people who used the service and their relatives were involved in the development of the home and could contribute ideas.

Further information is in the

The inspection took place on 14 March 2017 and was unannounced. The last comprehensive inspection at the home took place in May 2016, when a breach of legal requirements was identified. The service was rated overall requires improvements. The provider sent us an action plan outlining how they would meet the breach. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Lockermarsh Residential Home’ on our website at www.cqc.org.uk.

Lockermarsh Residential Home is situated close to Thorne town centre, within easy reach of local amenities. The home provides accommodation and personal care for up to 24 people. It is a detached, listed building. Accommodation is on two floors and there is a passenger lift. The communal areas are located on the ground floor, including lounges and dining room. The gardens are easily accessible for people who use the service.

The service had a registered manager in post at the time of 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.

Risks associated with people’s care had been identified but instructions on how to minimise risks occurring were not always included in care records.

Staff were not always aware of infection control procedures within the home.

The provider had a safe and effective system in place for employing new staff. Staff confirmed that they had received an induction when they commenced employment.

Medicines were managed in a safe way. We found that medicines were stored correctly and that medication records had been completed accurately. On the day of our inspection we observed medicines being administered and we raised some concerns with the registered manager regarding this. The registered manager dealt with this immediately.

We observed staff interacting with people and we found that people’s needs were met in a timely manner. However, staff appeared task orientated at times.

Training was provided to staff to ensure they were kept up to date with their knowledge. Staff we spoke with felt supported by the registered manager and told us they received supervision n a regular basis. Supervision was one to one sessions with their line manager.

The service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager fully understood her responsibilities in meeting these requirements.

People were supported to eat and drink sufficient to maintain a healthy, balanced diet. During our inspection we observed snacks and drinks being served in addition to the meals provided.

People were supported to maintain good health and have access to healthcare services. We looked at care plans and found that people were referred to health services when their needs changed, but this was not always followed up.

Staff interacted well with people who used the service and respected their privacy. People’s choices and preferences were respected and people were treated with dignity. Staff engaged well with people’s family members and welcomed them when they visited the home.

We looked at care plans and found that they did not always reflect people’s current needs. Evaluations had been completed monthly but the care plans were not always updated to reflect any changes.

There was a lack of social stimulation in the home. There was no dedicated activity co-ordinator which meant that individual hobbies and interests were not taken into account and activities to meet people’s specific social needs did not take place.

The provider had a complaints procedure in place and we saw a record of concerns which captured issues that people had raised. We saw that the registered manager had taken appropria

This inspection took place on 26 April 2016 and was unannounced. This was the third rated inspection for this service and at the last inspection in November 2015 the service had been rated Inadequate. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Lockermarsh’ on our website at www.cqc.org.uk’

Lockermarsh Residential Home is a care home providing accommodation for older people who require personal care including people living with dementia. The home can accommodate up to 24 people over two floors which are accessed by a passenger lift. The service is situated in Thorne north of Doncaster.

The home had a registered manager. They had been in post since October 2015 and registered in March 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

During this inspection we looked to see if improvements had been made since our last inspection in November 2015. We found substantial improvements had been made across all aspects of the service and it was evident further improvements are in the process or are planned to be implemented.

We found that people had care and support plans in place and care records reflected the care they required. The plans had been reviewed and updated when people’s needs had changed. People’s risk assessments had also been reviewed to ensure their safety.

People were protected against the risk of abuse. Staff we spoke with were aware of procedures to follow and understood whistleblowing procedures.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. People we spoke with told us they enjoyed the food. However the meal time experience could be further improved to fully meet the needs of people living with dementia. The registered manager had identified this through the home’s monitoring systems and areas for improvement were planned in this area.

People were kept safe at the home. We found that staff had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.

Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, we identified some errors that meant these were not always followed.

There were robust recruitment procedures in place; staff had received formal supervision and an annual appraisal. Staff received training to be able to fulfil their roles and responsibilities.

Staff told us they felt supported and valued by the registered manager. They said they felt confident that they could raise any concerns with them and felt that they were listened to. Relatives told us they were happy to raise any concerns directly with the registered manager and told us they could see the improvements they had made since they had been in post.

There were systems in place to monitor the quality of the service provided. We saw these were completed and were effective. Improvements to the service continue to be identified and planned; these will need to be closely monitored by the Registered Manager and provider so that these become fully embedded into practice and ensure they are sustained.

This inspection took place on 3 December 2014 and was unannounced. The home was previously inspected in July 2014 when we found breaches of Regulations 9, 10, 12, 13 and 14 of the Health and Social Care Act 2008 (Regulated Activities) 2010. We found at our inspection in July 2014 that people’s care and nutritional needs were not met, appropriate medication procedures were not followed, the home was not kept clean and the systems for monitoring the quality of the service were not completed. Following that inspection the registered manager sent us an action plan to tell us what improvements they were going to make.

Lockermarsh Residential Home is a care home providing accommodation for older people who require personal care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 24 people over two floors. The floors are accessed by a passenger lift. The service is situated in Thorne north of Doncaster.

At the time of our inspection there were 19 people living in the home. Eighteen people were in the home and one person was in hospital. People and relatives we spoke with were generally happy with the service and praised the staff very highly.

The home has 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.

During this inspection we looked to see if improvements had been made since our last inspection in July 2014. We found most of the breaches were now being met. However, there were still some minor improvements required in Regulation 13, in relation to medication protocols for administering medication that was prescribed, as and when required, for example pain relief. We also identified that the registered manager had made significant improvements in regard to regulation 10 assessing and monitoring the quality of service provision. However they had not always identified risks. We found this did not have a negative impact on people using the service. The registered manager was aware that continued improvements were required and was committed to ensuring these were implemented.

We also identified two further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that people’s care records did not always fully reflect the care they required although we saw these people received the care they required as staff knew them well. We also found that some staff did not understand the legal requirements of the Mental Capacity Act (2005) Code of Practice although we did see that training for staff was planned. 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 Mental Capacity Act Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive people of, or restrict their liberty. For one person we observed that they may have been deprived of their liberty. This had not been considered by the registered manager however after our inspection we received confirmation that an application had been submitted to the supervisory body.

Although people’s needs had been identified, and from our observations, we found people’s needs were met by staff who knew them well, we found some care records were not fully up to date. The registered manager told us they had identified that care records required further improvement and intended to implement new care files, which they told us would ensure people’s needs were identified and that staff followed them.

The registered manager had implemented some new systems for monitoring people’s needs but we found these were not fully completed by staff. The registered manager also told us more new monitoring systems were being implemented in January 2015.

The registered manager had commenced monitoring the quality of the service, and had identified there was improvement required. For example infection control had improved significantly since our last inspection.

There were effective systems in place to make sure people were kept safe. Staff had a good knowledge about safeguarding people from abuse and neglect, and up to date risk assessments were in place. Staff were recruited safely and all staff had completed an induction. Staff had received formal supervision although this was due again at the time of our visit. Staff had an up to date annual appraisal.

The registered manager told us they had received no formal complaints since our last inspection, but was aware of how to respond if required. People we spoke with did not raise any complaints or concerns about living at the home. Relatives we spoke with told us they were very happy with the care provided and had no concerns to raise.

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

Our inspection looked at 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, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed people being treated with respect and staff maintained people’s dignity. People told us that the staff were good and one relative told us, “My relative is well looked after.” Another relative said, “The (the staff) keep me informed of any changes in my relatives’ health.”

We found adequate quality monitoring systems were not in place. This did not ensure risks to people were identified and reduced. We found many areas that required improvement.

Appropriate arrangements for the recording, safe keeping and safe administration of medicines were not always followed, putting people at risk of not receiving medication as prescribed.

Staff supervisions and appraisals had not been kept up to date. Many staff had not had supervision for two years.

During our visit we observed there were not effective systems in place to reduce the risk and spread of infection. Many areas were not maintained to an appropriate standard of cleanliness.

Is the service effective?

Most people’s health and care needs were reviewed, and if people were able they were involved in the reviews.

Audits and quality monitoring had not been carried out. These meant shortfalls had not been identified or rectified. There were not effective systems in place to ensure service improvement.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

We spent time observing lunch in the dining room. We saw the experience was not inclusive or supportive. People were left without staff support. Although the cook did come into the dining room and ask people if they would like seconds.

Is the service responsive?

The manager told us they were providing care to people living with dementia and wanted to specialise in this area. We identified the environment did not meet the ‘best practice’ in design to meet the needs of the people who used the service. All areas were decorated in the same light colours; no landmarks were present and no signage to enable people to find toilets, bathrooms or bedrooms. The service had not identified what environmental improvements could be made to improve the quality of life for people living with dementia.

Is the service well-led?

There was a registered manager in post.

Relatives we spoke with told us staff kept them informed of any changes in the health or wellbeing of their relatives. However, they told us there were no resident or relative meetings held to discuss any issues or concerns. But they did say if they had any concerns they would approach the manager or deputy.

We spoke in some depth with the seven people who used the service and two visiting relatives during this inspection.

People told us before they received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People experienced care, treatment and support that met their needs and protected their rights.

People were provided with a choice of suitable and nutritious food and drink. Everyone we spoke with said the food was good.

We found that appropriate arrangements were in place in relation to obtaining, recording and the disposal of medicines.

There were effective recruitment and selection processes in place and appropriate checks had been undertaken before staff began work in the home.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. Everyone we spoke with said they knew how to complain.

We visited the service because we had received some concerns about the quality of the care from an anonymous source. However, we did not identify any concerns at our inspection. In addition, no-one raised any concerns with us during our inspection. 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 lived in the home. They all told us that they liked living in the home. They said they received good care. Comments included: "I have absolutely nothing to complain about." and "They look after you properly here."

People told us they were free to make their own choices. They told us about various activities that they enjoyed. One person said they would like the opportunity to go out for walks more often, but were clear that they were very happy in all other respects

People told us that they were involved in residents’ meetings and that their feedback was listened to and acted upon by the manager.

People using the service told us they were happy with the care provided and were involved in decisions about their care and welfare needs. One person told us they were able to choose what time they got up and went to bed and if they wanted to go out for the day. Another person told us they chose to help with preparation of the lunchtime meal. Two people told us they had not read their care plan but that was their choice.

We spoke with five relatives during our inspection who told us they had not been involved in the development of their relatives care plan, but this had been their choice. However, they also told us they were able to make changes to their relatives care if they wished. They also told us their relative’s dignity was respected and confidentiality was always maintained.

People using the service told us they were happy living at the home and they were well looked after. One person told us ‘I have no grumbles it’s alright here’, and two people told us they liked living at the home. Staff were described as very nice and easy to talk to.

We spoke with five relatives who confirmed they would talk to the manager if they had any concerns. One relative told us ‘Mum is safe’. People told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything.

This inspection took place on 27 October and 2 November 2105 and was unannounced on the first day. The home was previously inspected in December 2014 when we found breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) 2010. Following that inspection the registered manager sent us an action plan to tell us what improvements they were going to make. They told us the improvements would be completed by the end of September 2015.

Lockermarsh Residential Home is a care home providing accommodation for older people who require personal care. It also accommodates people who have a diagnosis of dementia. It can accommodate up to 24 people over two floors. The floors are accessed by a passenger lift. The service is situated in Thorne north of Doncaster. At the time of our inspection there were 16 people living in the home.

The home did not have 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. The registered manager had left in August 2015. The provider had appointed a new manager who had commenced in post on 28 September 2015. They had only been in post four weeks at the time of our inspection. They had however, commenced the process to register with the CQC.

During this inspection we looked to see if improvements had been made since our last inspection in December 2014. We found improvements although implemented had not been sustained.

We identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that people had care and support plans in place, however, care records did not always fully reflect the care they required. The plans had not been reviewed or updated when people’s needs had changed. People’s risk assessments had also not been reviewed or updated to ensure their safety.

People were not always protected against the risk of abuse. The provider had not always followed clear safeguarding policies and procedures. Staff we spoke with were aware of procedures to follow but did not fully understand whistleblowing procedures.

There were not always enough staff to meet people’s needs. People who lived at the home and relatives told us they did not think there was enough staff on duty to meet their needs. We also found there was lack of activities and stimulation during the day. People told us there was not much to do during their day as staff were busy.

Staff were recruited safely, however it was not clear if staff had received an induction and we found training and supervision was out of date.

Infection prevention and control had improved. However, due to changes in the management structure since our last visit there was a decline in monitoring the environment and implementing infection control measures.

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines.

The new manager understood the legal requirements of the Mental Capacity Act (2005) Code of Practice. 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. However, care staff we spoke with were not always knowledgeable about this legislation and how it impacted on people they supported.

A well balanced diet that met people’s nutritional needs was provided. However, we found people were not supported to be able to eat and drink sufficient to ensure they received adequate nutrition. People had lost weight and no action had been taken.

Staff told us they felt supported by the new manager. They said they felt confident that they could raise any concerns with the manager and felt that they were listened to. Relatives told us they were happy to raise any concerns directly with the manager.

We found the systems in place to monitor and improve the quality of the service were ineffective. The operations manager and the provider told us that they visited the home once or twice a month to monitor quality. We saw the reports did not clearly detail what action was required, who was responsible for implementing it or any timescales for completion. We also saw the audits did not cover all aspects of the service provision.

We found seven breaches of The Health and social care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider, and will report on this at a later date.

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.