The inspection was unannounced, and took place on 7 November 2018. The home was last inspected in September 2017 where concerns were identified in relation to governance, consent, and a failure to display CQC ratings and make required notifications to CQC. The home was rated “requires improvement” at that inspection.

The S.T.A.R Foundation 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 home is located close to the town centre of Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to many amenities and public transport links. The home accommodates up to 60 people with support needs including dementia, physical disabilities and mental health conditions. At the time of the inspection 60 people were using the service. The home comprises three discrete units, each consisting of separate “pods” of four en suite bedrooms with a kitchen/diner and living area, as well as central communal facilities, including a large lounge area, a therapy pool and a sensory room. The home is known locally as Astrum House.

The service had registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that staff went about their day to day duties treating people with respect and dignity. We observed a genuine warmth when staff spoke with people and staff told us that treating people respectfully was the most important part of their job.

The home environment was designed to meet the needs of the people living there, with a range of facilities including a hydrotherapy pool. The home had an activities coordinator who devised a varied activities programme, including activities both within the home and within the local community.

Medicines were stored and handled safely. Where people were at risk of harm, or presented a risk to others, there were appropriate risk assessments in place to ensure staff kept people safe.

Recruitment procedures were sufficiently robust to ensure people’s safety.

We looked at the arrangements for complying with the Mental Capacity Act, and found that although on the whole this was adhered to, improvements were required in the way consent was obtained and recorded.

Mealtimes were observed to be comfortable and pleasant experiences for people. People told us the food available was always good.

The management team were accessible and were familiar to people using the service. The provider had a system in place for auditing the quality of the service, although we identified improvements could be made to this. There were arrangements for obtaining and acting on feedback from people using the service and their friends and relatives.

The inspection was unannounced, and took place on 13 and 14 September 2017. The home was last inspected in July 2015, where the home was rated “Good” overall.

The S.T.A.R Foundation is a 60 bed service providing residential and nursing care to people with a range of support needs including physical disability, mental health support needs, learning disability and dementia. It is known locally as Astrum House.

The home is located close to the town centre of Rotherham, South Yorkshire. It is in its own grounds in a quiet, residential area, but close to many ameneties and public transport links. The home comprises three discrete units, each consisting of separate “pods” of four en suite bedrooms with a kitchen/diner and living area. In addition there are central communal facilities, including a large lounge area, a therapy pool where people could access hydrotherapy treatments, and a sensory room”

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 and associated Regulations about how the service is run.

We found that people received care which was tailored to their individual needs, and upheld their dignity and privacy. There were plentiful activities both within the home and within the wider community. People using the service praised the activities available to them.

Staff were well trained in relation to keeping people safe from the risks of harm or abuse, and spoke with knowledge about this. Medicines were stored and handled safely.

Recruitment procedures and audit procedures were sufficiently robust to ensure people’s safety.

There were up to date and thorough risk assessments relating to issues where people were at risk of harm, or presented a risk to others, and we saw evidence that staff were adhering to them.

We found that improvements were required in the way consent was obtained and recorded.

Mealtimes were observed to be comfortable and pleasant experiences for people, and people told us they enjoyed their food.

Staff told us they received a good standard of training which enabled them to better carry out their roles.

The management team were accessible and were familiar to people using the service. The provider had a thorough system in place for monitoring the quality of service people received.

The provider was failing to comply with legislation in relation to the requirement to display their CQC rating on their website, as well as in the requirement to notify CQC about certain key incidents within the home.

Our inspection looked at three of our five questions; 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?

At our last inspection on 9 April 2014 we found safeguarding policies and procedures had not always been followed when issues of concern had been highlighted. This included alleged abuse not being reported to the appropriate external services.

At this visit we found the provider had addressed the shortfalls we identified at our last inspection. Safeguarding policy and procedure had been followed and all staff had attended further training in this subject. This had helped to make sure staff reported concerns promptly and appropriate agencies were alerted in a timely manner.

People we spoke with told us they felt safe living at the home. Their experiences were also captured through information received from the provider and the council, checking records and speaking with staff.

Since our last visit the care planning system had been improved and care records now reflected people’s needs, and any risks associated with their care, in more detail. The care records we checked contained more in depth guidance about actions staff may need to take to minimise risks and manage incidents.

Is the service effective?

At our last inspection we found that periodical reviews of people’s care package involving social workers had not been documented in one of the files we looked at. Therefore it was not possible to assess when their last review had taken place and if any changes were needed. At this visit we saw the electronic care planning system had been fully implemented and visits were now routinely recorded.

At our last visit we also found that although staff had in the main received adequate professional development and an annual appraisal of their work, regular support sessions had not taken place. At this visit records and staff comments indicated these sessions were now being provided consistently.

Is the service well-led?

At the time of our last inspection there was no registered manager at the service. Since then a new manager has been appointed and successfully registered with C.Q.C.

At our last visit there was a quality assurance system in place, but it had not been constantly managed and maintained. At this visit we found the manager, clinical lead nurse and the compliance team were working together to monitor all aspects of the system.

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?

People were treated with respect and dignity by the staff. We also saw the service had a dignity champion on each unit to promote best practice in this topic. People using the service said staff respected their privacy and dignity. One person told us how staff listened to what they wanted and acted on their preferences.

People told us they felt safe living at the home. However, we found safeguarding policies and procedures had not always been followed when issues of concern had been highlighted. This included alleged abuse not being reported to the appropriate external services.

We found most staff had received training in relation to safeguarding vulnerable people from abuse, but appropriate action had not always been taken. We saw the provider had arranged for further training on this subject to take place with additional guidance on how to raise concerns outside the home.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. However, these were not consistently followed. For example identified concerns had not always been appropriately reported and action taken. We also found care records had not always been completed comprehensively so lacked the information staff may need to minimise risks and manage incidents.

There were systems in place to make sure people received their medications safely and we saw staff had completed training in this subject.

We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to safeguarding people and risk management.

Is the service effective?

We saw people had access to advocates if they could not speak for themselves or needed additional support.

People who used the service and a visitor we spoke with said they were involved in writing plans of care, but the plans we saw were not always in a format people could easily understand.

Evaluations of care had taken place monthly. A nurse told us how they sat with people to discuss their plans of care and amended them as needed. However periodical reviews of people’s care package involving social workers had not been documented in one of the files we looked at. Therefore it was not possible to assess when their last review had taken place and if any changes were needed.

Staff had received appropriate professional development. The staff we spoke with felt they had access to a varied training programme that helped them meet the needs of the people they supported. We saw staff had received an annual appraisal of their work which included a training and development plan. However, staff support sessions had not been carried out on a regular basis.

Is the service caring?

People were supported by kind, caring and patient staff. We saw staff interacting with people positively and encouraging them to be as independent as they were able. People’s comments indicated they received the care and support they needed and they were happy with how staff supported them.

People’s preferences, interests and individual needs were recorded in the care plans we checked.

The provider had used meetings and surveys to gain people’s views. When we asked people if there was anything they would like to improve the majority could not think of anything. Other people outlined minor things they felt would make their unit better, such as a snooker table.

Is the service responsive?

People told us they were encouraged to be involved in social activities, attend day centres and carry out day to day living skills, such as cooking, making their bed and doing their laundry.

People told us they knew how to make a complaint if they needed to. When we looked at complaint records we saw action taken had been recorded.

Is the service well-led?

At the time of our inspection there was no registered manager at the service. The provider told us a new manager had been appointed and they would be starting in May 2014. Due to inconsistencies identified at the home, management responsibilities for overseeing it had been reorganised for the interim to make sure the service operated effectively.

There was a quality assurance system in place, but not all areas have been consistently managed and maintained. The provider had taken action to address this by allocating certain aspects of the system to specific staff. We saw they were also working through an action plan developed with Rotherham council to address shortfalls found at the service.

We have asked the provider to tell us how they will make improvements and meet the requirements of law in relation to having an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others

People’s comments indicated they received the care and support they needed and they were happy with how staff delivered their care. One person said, “I was really poorly when I came here and now I am living independently. I do my own shopping and cook my meals.”

People received a well-balanced diet and were involved in choosing what they ate. The people we spoke with said they were happy with the meals provided. Staff promoted healthy eating and checked people were eating and drinking properly.

We saw there were effective systems in place to reduce the risk and spread of infection.

There were systems in place to make sure people received their medications safely and we saw staff had completed training in this subject.

Background checks had been carried out on staff before they started to work at the home to make sure they were suitable to work with vulnerable people.

There were enough qualified, skilled and experienced staff to meet people's needs. We observed staff were able to meet people's needs in a timely and unhurried way. One person told us, “The staff are always there to help.”

We saw records were accurate and fit for purpose. They were kept securely and could be located promptly when needed.

We were unable to gain the verbal views of some people but other people spoke to us about their experiences of living at the home. We also watched how staff provided care and support to people.

The people we spoke with told us they were happy with the care and support they received and felt the home was a safe place to live. We saw they were offered choice and staff listened to what they wanted and respected their opinions. One person told us, “They are the best in the whole world.” Another person said, “They do things the way I want them doing and always consult me.”

When we asked people if there were any improvements they would like to see no-one could think of anything they would change.

The people we spoke with praised the staff and said they were friendly and helpful. They told us there were enough staff on duty to meet their needs and they were good at their job. One person commented, “Everyone is fun, even the night staff have a joke with you, they are all good at their job.”

People told us they had no complaints but would feel confident taking any concerns to the manager or any of the staff.

People told us how much they appreciated living in the home. A person told us, “I don’t think there is anywhere better to be. Privacy, dignity and confidentiality are maintained.” Another person said, “I am comfortable in here and I like it here because I can get to sleep.” Another person said, “There is not a bad thing about it. I appreciate everything about it. I can definitely stop here for life.”

A relative told us, “We were given a guided tour; my relative’s, and my needs, were considered. Now they all address him by his name, and ask if he is all right. He is settled here and I am so, so happy.” Another relative we spoke with said, “To our family it has made a big difference. The little things matter, like plenty of drinks, and they don’t rush meals, they serve a main meal and pudding. They change him straight away. He is happy here.

People we spoke with told us they felt safe in the home. We spoke with people and their relatives about staff that worked with them. A person told us, “There are nice staff here.” Another person said, “The staff are all friendly.” A relative said to us, “There is a continuity of staff, and nurses are good.”

The inspection took place on 20 and 21 July 2015 and was unannounced on the first day. We last inspected the service in February 2014 when it was found to be meeting with the regulations we assessed.

The S.T.A.R. Foundation Nursing Home, which is also known as Astrum House, is located close to the centre of Rotherham. It caters for up to 60 people over the age of 18 years old whose needs include mental health, physical disabilities and/or a learning disability. Accommodation is provided on three wings which are divided into units, each having four en-suite bedrooms and communal living areas.

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 and associated Regulations about how the service is run.

People we spoke with told us they felt safe living in the home. Throughout our inspection we saw staff encouraged people to be as independent as possible while taking into consideration their wishes and any risks associated with their care. People’s comments, and our observations, indicated people using the service received appropriate support from staff who knew them well.

People received their medications in a safe and timely way from staff who had been trained to carry out this role. However, records pertaining to medication were not always robustly completed.

There was enough skilled and experienced staff on duty to meet people’s needs. We saw there was a recruitment system in place that helped the employer make safer recruitment decisions when employing new staff. New staff had received a structured induction and essential training at the beginning of their employment. The majority of staff had received timely refresher training to update their knowledge and skills. Where this had not taken place the registered manager had identified shortfalls and was arranging further training.

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

The Deprivation of Liberty Safeguards were only used when it was considered to be in the person’s best interest. This legislation is used to protect people who might not be able to make informed decisions on their own. The registered manager demonstrated a good awareness of their role in protecting people’s rights and recording decisions made in their best interest.

We saw people received a well-balanced diet and were involved in choosing what they ate. People’s comments indicated they were happy with the meals provided. We saw specialist dietary needs had been assessed and catered for.

We found people’s needs had been assessed before they moved into the home and they had been involved in formulating their care plans. Care records reflected people’s needs and preferences so staff had guidance about how to support them. Care plans had been regularly evaluated to ensure they were meeting each person’s needs, while supporting them to reach their aims and objectives.

A varied programme was in place to enable people to join in regular activities and stimulation, both in-house and in the community. This included therapeutic activities such as physiotherapy, hydrotherapy and sensory programmes. People told us they enjoyed the activities they took part in, which they felt enhanced and improved their lives and abilities.

The provider had a complaints policy to guide people on how to raise concerns. There was a structured system in place for recording the detail and outcome of any concerns raised.

People had been consulted about the service they or their relative received, but the outcomes of surveys had not always been analysed and shared with people using and visiting the service.

An audit system had been used to check if company policies had been followed and the premises were safe and well maintained. Where improvements were needed action had been taken, but action plans had not been put in place to evidence how these had been addressed.