Athorpe Lodge

Athorpe Lodge is a purpose-built care home close to the centre of Dinnington. It provides accommodation for up to 94 people in four units. The care provided is for people who require nursing or personal care. Some people living at the service were living with dementia. At the time of our inspection there were 86 people using the service.

The home also provided accommodation for people who were medically fit for hospital discharge but required addition support and therapy prior to moving back to their own homes.

People’s experience of using this service

People were safeguarded from the risks associated with abuse. Risks associated with people's care were assessed and plans were in place and followed to minimise them. During our inspection we observed there were enough staff available to meet people’s needs. Staff we spoke with confirmed they had been recruited safely. People's medicines were managed in a safe way and people received their medicines as prescribed. Accidents and incidents were monitored and well analysed and we saw evidence of lessons learned.

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.

Staff were knowledgeable and had received appropriate training and support. People received a balanced diet which met their individual needs. People were offered choice, and this was respected. People were supported by staff who were kind and caring and who maintained their dignity and respect.

Care plans we looked at reflected people's individual needs and preferences. The provider had a complaints procedure which was appropriately followed, and people and their relatives felt able to raise issues if needed. People's end of life wishes were documented.

Audits were in place to ensure the service was monitored appropriately. Feedback about the registered manager was positive and staff felt well supported.

People were involved in the service and opportunities to give feedback were in place.

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

Rating at last inspection

The last rating for this service was requires improvement (published 19 June 2018). There was also an inspection on 8 April 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 and well led, to at least Good.

At this inspection we checked if improvements had been made. We found that the registered provider had not addressed all the concerns raised at our last inspection and the service was rated Requires Improvement. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Athorpe Lodge’ on our website at www.cqc.org.uk.

Athorpe Lodge 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.

Athorpe Lodge provides care for up to 94 people over four units. The service provides support for people living with dementia, personal and nursing care. All bedrooms are single occupancy with en-suite facilities.

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.’

Some staff told us there were not enough staff to ensure people’s needs were met in a timely way. However, this was only referred to on one unit. We looked at care records and found they contained limited information regarding risk management. Important information was missing from risk assessments, such as the loop configuration required when moving people using the hoist. Systems were in place to manage medicines safely, however, these were not always followed. Some areas of the environment had been missed in the cleaning process.

Staff had the skills and knowledge to deliver effective care. A balanced nutritious diet was provided for people. However, appropriate support for people’s dietary needs varied between the different units. People had access to healthcare professionals and staff predominantly followed their advice.

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. The service was compliant with the Mental Capacity Act 2005.

During our inspection we found staff interacted well with people who used the service. Staff were kind and caring in their manner.

We looked at care records belonging to people who used the service and found evidence that staff were responsive to people’s needs. However, we identified two people’s needs were not met appropriately. We saw evidence of end of life care plans which met people’s needs and preferences.

The registered provider had systems in place to monitor the quality of the service. However, these needed to be fully implemented and embedded into practice. Residents and relatives meetings took place and people felt they had a voice. However, there had not been a recent quality survey completed. This would have given people an opportunity to comment anonymously about the service if they wanted to.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. All three breaches were continued from our previous inspection. You can see what action we told the registered provider to take at the back of the full version of the report.

Athorpe Lodge is a care home situated close to the centre of Dinnington. It provides accommodation for up to 90 people. The home is divided into six units; three providing nursing care (Balmoral, Buckingham and Sandringham) and three providing residential care (Hampton Court 1, Hampton Court 2 and Clarence).

At the time of our inspection there was a registered manager in post. 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. However, the registered manager was also registered at another service.

The provider had recently recruited a second manager who had been appointed to assist with the clinical aspect of the service. This person was in the process of registering with the Care Quality Commission. Throughout this report this person is referred to as the acting manager. It is the provider’s intention to operate the service using two registered managers due to the size and complexity of the home.

People who used the service, and their relatives we spoke with, told us they were happy with how the care staff provided the care and support. They spoke positively about the staff and told us they were very caring. However, they told us the home was always very short staffed and that more staff were required as they had to wait to receive care and support and at times this was up to 45 minutes.

During our inspection we observed people had to wait at times for assistance and staff were not always present in communal areas to ensure people’s safety. Staff told us at there was not enough staff to be able to meet people’s needs. Staff we spoke with were aware they struggled to give person centred care, due to low staffing levels and felt very frustrated this was the case.

Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety. However, we found these were not always followed.

Medicines were not always managed safely. We saw that temperatures of fridges used for medicines, were not constantly recorded. We also identified some concerns with the storage, recording and administration of medicines.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There was a designated staff member who was responsible for the management of the DoLS and they had a good understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required.

The meals provided were well presented, nutritious and appetising. However, we observed staff did not always give appropriate support with meals to people who used the service. In particular we found people did not receive adequate hydration to meet their needs.

We spoke with staff and found they knew people well. They were aware of people’s needs and their different preferences, but did not have time to meet these needs effectively. We looked at staff training records and they reflected that most staff had received training. However, updates were required to maintain the provider’s expectations.

We looked at care files, although peoples choices were documented the care we saw delivered did not always reflect people’s care and support needs choices or preferences. We observed staff at times were task orientated and care provided was not person centred.

The provider employed an activity co-ordinator and had recently appointed a second one to provide activities and social stimulation within the home.

The provider had a complaints procedure and people felt they could raise concerns. However, they didn’t always feel that staff had time to discuss issues. We looked at the complaints record and found that concerns had been addressed in line with the provider’s policy.

We saw that audits had taken place to establish whether the policies and procedure were being followed and to identify any areas of improvement. We saw that some concerns we highlighted as part of the inspection had not been adequately addressed.

The provider held residents and relatives meetings. However, people were only informed about the recent meeting at the last minute. We spoke with people and their relatives and most knew that a new manager had been appointed. However, people commented that they had never met them. This person had been in post approximately six weeks at the time of our inspection.

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.

Due to the complex needs of the people using the service we were unable to gain some people's views. Therefore we used a number of different methods to help us understand their experiences. This included observing how staff supported people, speaking with staff and visitors, and checking records.

Is the service safe?

We saw people using the service were treated with respect and dignity by the staff who supported them. Care and support was delivered in a safe way by staff who had received appropriate training.

The company had policies and procedures in place to help protect people who used the service from abuse. We found the majority of staff had received training in relation to safeguarding vulnerable people from abuse and further training was planned.

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

We saw there were enough qualified, skilled and experienced staff on duty to meet people's needs in a timely way. The manager told us the number of staff required to meet the needs of the people living on each unit was under constant review.

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

Is the service effective?

People's health and care needs were assessed on a regular basis. People who used the service and their relatives had been involved in writing plans of care and these were reviewed and updated regularly.

Staff had received appropriate professional development. The staff we spoke with felt they had access to a comprehensive induction and a varied training programme that helped them meet the needs of the people they supported. We saw staff had received regular support sessions and plans were in place for an annual appraisal of their work to be completed.

Is the service caring?

People were supported by friendly, caring and helpful staff. We saw staff interacted with people in a positive way. The people we spoke with, including two visitors, spoke positively about the care and support provided. One person said, 'My family visit most days and the staff are very kind.' A visitor commented, 'I couldn't look after mum any better myself.'

Care files contained detailed information about people's needs and preferences. We saw care and support had been provided in accordance with people's wishes.

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 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.

People who used and visited the service knew how to make a complaint if they needed to. People told us they had no concerns but said they would feel confident raising any issues with the staff.

Is the service well-led?

At the time of the inspection there was no registered manager. However, an acting manager was in post and they had submitted an application to become the registered manager at the home.

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 shortfalls found 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.

At this visit we found the provider had addressed the shortfalls we identified at our last inspection. We saw there were enough qualified, skilled and experienced staff to meet people's needs. More staff had been recruited and action had been taken to make sure unplanned staff shortfalls were covered. People's comments, our observations, and the records we checked, indicated there was consistently enough staff on duty to meet people's needs in a timely manner.

We saw records were accurate and fit for purpose. Care records had been reviewed and updated to make sure they reflected people's current needs. We also saw monitoring tools had been completed on a regular basis. Records were kept securely and could be located promptly when needed.

We were unable to gain the views of the people who were living on the unit due to their complex needs. Therefore we observed how support was provided and spoke with visitors and staff to help us understand their experiences.

The four visitors we spoke with told us they were happy with the care and support staff provided. A visitor said, 'I am happy. They keep him clean and shaved.' Another visitor commented, 'The home has improved vastly, I would recommend it to anyone, but there is not enough staff.'

Staff comments and the records we checked indicated there was not always enough staff on duty to meet people's needs. This meant that people had not always received their planned care in a timely manner. We were told people's needs were usually met but staff seemed rushed. A visitor told us, 'People coming in seem to need a lot of attention and I feel they haven't enough staff to meet his needs and see to the people in bed.'

People's personal records were not accurate or fit for purpose. Although each person had a care plan in place they were not all up to date. We also found shortfalls in monitoring and assessment documentation.

We spoke with nine people who used the service, six visitors and six people providing services from outside the home. 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 feel that we are lucky. It's not regimented, it's just like home. I can come and see him when I want and they keep me informed about what's happening.'

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

The premises were in a good state of repair, clean and fresh. People told us they were happy with their rooms and the general facilities provided.

There were enough qualified, skilled and experienced staff to meet people's needs. People told us staff were able to meet their needs in a timely way.

There were systems in place to gain peoples views and check if staff were following company policies.

People told us they had no complaints but we saw a complaints procedure was available to people who used and visited the service.

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. If anyone was unable to give consent systems were in place to consult other people to make sure things were carried out in their best interest.

People's comments indicated they received the care and support they needed and they were happy with how staff delivered care. One person said, 'If I want something I can always ask and they do their best.'

People had access to a varied activities programme which they said they enjoyed.

People received well balanced meals that provided variety and choice. Staff promoted healthy eating and checked people were eating and drinking properly.

We saw the home provided specialist equipment to meet people's needs and keep them safe. There was a system in place to make sure equipment was satisfactorily maintained.

Background checks had been carried out on staff before they started to work at the home. This included ensuring staff underwent a Criminal Records Bureau (CRB) check.

We saw the complaints procedure was available to people who used and visited the service. People told us they felt comfortable taking any concerns to the manager.