This comprehensive inspection took place on 20 August 2018 and was unannounced, which meant that nobody at the service knew we would be visiting. The last comprehensive inspection took place in July 2017 when we identified three breaches of regulation. This was because there was a system in place to receive record and respond to complaints made by people who used the service or others, however this was not being used. Also, systems or processes did not operate effectively to assess, monitor and improve the quality and safety of the service and staff were not provided with appropriate supervision and appraisal as is necessary to enable them to carry out their duties. The service was rated as ‘requires improvement’.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do to improve the key questions safe, effective, responsive and well led, to at least ‘good’.

At this inspection we checked if improvements had been made. We found the registered provider had made improvements but not addressed all the concerns raised at our last inspection and the service continues to be rated ‘requires improvement.’ This is the fourth time the service has been rated ‘requires improvement.’

You can read the report from our last inspections, by selecting the 'all reports' link for 'Stoneacre Lodge' on our website at www.cqc.org.uk.

Stoneacre Lodge is a 'care home' that provides care for up to 31 people. 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.

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.

The management team were unsure about their responsibilities in notifying relevant people in relation to accidents, incidents and safeguarding. We found some potential safeguarding concerns, which had been recorded as accidents but not notified to us or reported to the safeguarding authority. We did not have concerns that these accidents had caused a detrimental effect on people’s health and wellbeing. However, this meant concerns may not be investigated in line with current safeguarding protocols, which could place people at risk.

People received their medicines at the right time and in the right way to meet their needs. However, we found a discrepancy in the stock amount of one medicine and found two staff had not always signed when controlled drugs were administered. These concerns had not been identified on the managers weekly audit of medicines.

Staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

Staff were not provided with appropriate supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. Also, there was no clear system in place to record staff training. Which meant the registered provider and registered manager could not be assured all staff had completed the required training.

Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people's care when necessary.

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 support this practice.

Staff knew the people they were supporting and provided a personalised service. Support plans were in place detailing how people wished to be supported and people were involved in making decisio

This inspection took place on 31 July 2017 and was unannounced. This means prior to the inspection people were not aware we were inspecting the service on that day.

Stoneacre Lodge is a care home that provides care for up to 31 older people, some of whom were living with dementia. The home is located in the village of Dunsville, near Doncaster. On the day of our inspection there were 27 people living in the home.

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.

Our last inspection at Stoneacre Lodge took place on 30 November 2016. The home was rated as Requires Improvement. We found the home to be in breach of regulations for safe care and treatment and fit and proper persons employed. Requirement actions 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 improvements had been made relating to fit and proper persons employed. However there were still improvements needed in relation to regulation 12, safe care and treatment. Sufficient improvements had not been made to meet all regulations.

The registered provider had a policy and procedure in place for the safe management of medicines. Staff were not always working in accordance with this policy which could put people at risk of not being kept safe and well.

There was a risk staffing levels could be insufficient for people’s needs to be met in a timely manner. This was because the registered provider or registered manager did not use a dependency tool to assess the number of staff required against the dependency levels of people who used the service.

Checks of the fire systems and fire fighting equipment were not always carried out at the frequency requested by the registered provider.

We received positive feedback from people who used the service and their relatives. People we spoke with told us they felt safe and relatives also said the home provided safe care.

Staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

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

People said they enjoyed the meals provided to them and there was plenty of choice. People could choose to eat their meals either in the dining room or their own room. At lunchtime staff were busy which meant some people had to wait to be assisted to eat.

Staff and people who used the service were mutually respectful. People were seen enjoying the company of staff and staff spoke with people in a polite and caring way. We saw staff advising and supporting people in a way that maintained their privacy and dignity.

The registered provider had a complaints policy and procedure; however written records of complaints and concerns received were not kept.

A limited programme of social activities was in place and people who used the service wanted to be involved in more social activities and outings. An additional activity worker had been recruited and was due to start at the home within the next few weeks.

Staff said communication in the home was very good and they felt able to talk to the managers' and make suggestions. There were meetings for people who used the service, relatives and staff where they could share ideas and good practice.

People and their relatives had been asked their opinion of the quality of the service via surveys and by the regular meetings with the managers.

We identified the current audit systems were not robust enough to effectively assess, identify and ac

This unannounced inspection took place on 30 November 2016.

We previously carried out an unannounced inspection at this home on 8, 9 June 2016, where we identified shortfalls in the standard of care. These included shortfalls in the management of medication, induction of new staff and the on-going training of staff members employed and quality assurance systems. Following this inspection, we asked the provider to take action to make improvements.

We undertook this inspection to check that they had followed their plan and to confirm that they now meet legal requirements. We found that the provider had not made sufficient improvements and remained in breach of the legal requirements.

Stoneacre Lodge is required to 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. At the time of our inspection there was a home manager who was registered with the Care Quality Commission.

Stoneacre Lodge is a 31-bed residential home situated in the village of Dunsville approximately four miles from Doncaster town centre. The home has quiet sitting areas and a large lounge area which looks out on to the front garden and car park. It has off road car parking facilities available. On the day of our inspection there were 28 people living in the home.

People told us that they felt safe living at Stoneacre Lodge and staff we spoke with were aware of how to identify and report abuse.

There were continued shortfalls in the way that medicines were managed. We found that there was a lack of information of when medicines which could spoil had been opened. Stocks of medicines available did not always tally with administration records.

We saw that some recruitment checks had been made, but we could not always evidence that recruitment procedures were robustly followed and that applicants were checked for their suitability, skills and experience.

Staff told us that they received suitable training, although records showed not all staff had undertaken safeguarding training.

We found the provider ensured they acted in accordance with the requirements of the Mental Capacity Act (MCA).

People were complimentary about the support that they received from staff. They told us that staff were kind and caring.

Care records did not always reflect the support that people needed therefore staff could not always understand how to care for the person appropriately. Not all care plans were up to date to reflect changes to people's needs. Daily charts were not always completed fully.

People knew how to complain and told us they would feel able to speak to staff about any concerns.

There were some systems in place to monitor the quality and safety of the service. However, some of the quality assurance systems that the provider had in place were not frequent and did not identify the concerns that were identified on this inspection.

The staff spoke positively about the manager, who they said was approachable and supportive.

The inspection took place on 8 and 9 June 2016 and was unannounced on the first day, which meant no one related to the home knew we would be inspecting the service. The care home was previously inspected in July 2014, when no breaches of legal requirements were identified.

Stoneacre Lodge is a care home that provides care for up to 31 older people, some of whom are living with dementia;, the home does not provide nursing care. The home is a two storey building located in the village of Dunsville, near Doncaster. There is a stair lift to the first floor bedrooms.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

At the time of the inspection 29 people were living at the home. We spoke with twelve people who used the service about their experiences, as well as three visitors. Everyone we spoke with told us they were happy with the service provided and the way care and support was delivered by staff.

People told us they felt the home was a safe place to live and work. We saw there were systems in place to protect people from the risk of harm. Staff we spoke with were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made.

A structured recruitment process was in place to help make sure staff were suitable to work with vulnerable people. However, we found some elements of the process had not been consistently followed.

There were enough staff available to meet people’s needs and many staff had worked at the home for a number of years. This helped to provide people with consistent care.

The service had a medication policy outlining the safe storage and handling of medicines, but we found this had not always been followed. We found shortfalls in relation to the recording and storing of medicines, which could mean people did not receive their medication correctly.

Relatives said they thought staff had the appropriate skills to meet people’s needs. However, we found ancillary staff had not received an induction to the home and their job role and training records were incomplete. Therefore they did not demonstrate that all staff had received essential training.

The service was not fully meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Records showed that most staff had received basic training in this topic and the management team had, or were enhancing their knowledge and skills in these subjects. However, not all the people who used the service had been assessed to determine if a DoLS application was required, and care plans did not always clearly record decisions made in people’s best interest. The deputy manager told us they were liaising with the local authority to address this issue.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. The people we spoke with said they were happy with the meals provided and we saw they were involved in choosing what they wanted to eat. On the day we visited the dining rooms were relaxed and people who used the service were given time to eat their meal at their own pace.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support.

People’s needs had been assessed before they moved into the home. Although people told us they had been involved in these initial assessments and planning their care, this was not always reflected in the care files we sampled.

We found most people had a clear care plan that outlined their needs, risks associated with their care and their preferences. However, on the first day of our inspection we found one person did not have a care plan in place. Although this had not had any adverse impac

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?

Care and treatment was planned and delivered in a way that ensured people’s safety and welfare. Records were in place to monitor any specific areas where people were more at risk and explained what action staff needed to take to protect them.

The home was clean and fresh throughout. Two visitors we spoke with particularly commented about the cleanliness and lack of odours at the home. We also saw there were effective systems in place to reduce the risk and spread of infection.

Improvements had been made to the general décor and furnishing at the home and an action plan was in place to address areas still needing attention.

There were enough qualified, skilled and experienced staff to meet people’s needs. We spoke with five people who used the service and six visitors. They told us they felt that in the main there was sufficient staff on duty to meet people’s needs. One person told us, “There is the odd time when all the staff are busy, but usually it’s okay.”

Is the service effective?

People’s health and care needs were assessed on a regular basis. People who used the service, and the visitors we spoke with, confirmed they had been asked about the care and support people needed. However, care plans had not been signed by them to acknowledge they agreed with the planned care.

The care plans we checked identified people’s care needs and preferences in good detail and we saw they had been evaluated and updated as required.

Staff comments, and the records we sampled, showed they had access to a varied training programme that helped them meet the needs of the people they supported.

Is the service caring?

People were supported by friendly, caring and approachable staff. We saw staff interacting with people in a positive manner. They encouraged them to be as independent as they were able to be while providing support as needed. One person told us, “They (care staff) care about us. They are always asking if we are all right, you can’t ask for anything more.”

People looked well-presented and cared for. The people we spoke with all said they were happy with the care provided and complimented the staff for the way they delivered care.

Staff we spoke with demonstrated a good knowledge of the people they cared for and could tell us about their preferences and individual care needs as recorded in the care plans we checked.

Is the service responsive?

Care records demonstrated that when there had been changes in people’s needs outside agencies had been involved to make sure they received the correct care and support. For example we saw assessments had been completed to make sure people were eating and drinking enough. Where people needed additional support timely referrals had been made to the GP or other healthcare professionals.

Records showed people had access to a variety of social activities. The home employed an activities co-ordinator and we saw outside entertainment was also arranged.

The home had a complaints procedure which was available to people using and visiting the service. The manager told us one complaint had been recorded since our last inspection and this had been resolved satisfactorily. We also saw thank you cards were displayed complimenting staff for the care and support they had provided.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People’s comments indicated they were happy with how staff supported them and the home’s facilities.

Is the service well-led?

There was a quality assurance system in place to assess if the home was operating correctly. This included surveys and internal and external audits. We saw action plans were in place to address any areas that needed improving and progress was being made to address these.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to inform and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

The last time we inspected this service we found that people's care plans had not been reviewed and updated on a regular basis. This meant that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate records were not maintained.

At this inspection we found that the provider had made sure the issue was addressed and that people were now better protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People were protected from the risks of inadequate nutrition and dehydration. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work. There was an effective complaints system available and comments and complaints people made were responded to appropriately.

We spoke to seven people who used the service. They spoke positively about the care and support they received. They told us they were well looked after and liked living at the home. We spoke with two people’s relatives at the time of the inspection and one person’s relative by telephone. They told us that they visited every day. They said the care was of a very good standard.

However, we found that people's care plans and risk assessment had not been reviewed and updated regularly to reflect their changing needs. Care staff relied on daily records and handovers to make sure that they were kept up to date with people's needs and this meant that people were not protected from the risks of unsafe or inappropriate care and treatment.

We carried out an unannounced inspection of Stoneacre Lodge in July 2012. At that inspection we found the provider was not compliant in Outcome 9, Management of medicines and Outcome 21, Records. We made compliance actions, which required the provider to make improvements in these areas.

We undertook this visit to review the provider’s compliance with the compliance actions. At this inspection we found that improvements had been made and people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We also found that improvements had been made with regards to the written records, which had been updated and reflected people’s needs, so that people were protected from the risks of unsafe or inappropriate care and treatment.

There were 24 people living in the home at the time of our inspection. We spoke with six people who used the service to gain their opinion of the service. They told us they liked living in the home and were happy with the care they received. They said they could make choices and decisions about their care. One person said there were opportunities to go out if they wanted to and there were lots of activities on offer. Comments included:

"I couldn’t wish to be in a better place."

"We get very well fed here."

"It's nice here, the staff are lovely."

“I get my breakfast in my room because that’s where I want it.”

"I think this is an excellent home."

“The care is very good.”

“The food is excellent and we always have choices.”

We also spoke with two people’s relatives. They were happy with the standard of care their relatives received.

We spoke with people who used the service at our last visit in September 2011 and they told us they were very happy with the service.

This follow up visit was to view the progress of the service in improving their record keeping, infection control practices and staff training programme. Therefore we did not speak with people who used the service during this visit.

People we spoke with said they were involved in the decisions about their care and staff were good at communicating with their relatives. People told us they enjoyed activities in the home and chose these on a daily basis.

People said that staff supported them to be as independent as possible and that they felt safe in the service.