This inspection took place on 29 and 30 January 2018. We made an unannounced visit on 23 January 2018. However as our inspection commenced we were advised the service needed to close due to an outbreak of infection. We therefore announced further visits.

Boroughbridge Manor and Lodge is a ‘care home’. People in care homes receive accommodation and 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. The service supports older people some of whom may be living with dementia and can accommodate up to 77 people.

At the time of our inspection 75 people were living at the service. The service is a large building and people are accommodated over three floors. Each floor is a named unit which has a unit manager who reports to the deputy and registered manager. Each floor had a dining room, seating area and kitchen facilities.

There was a registered manager in post who assisted us throughout the inspection. The registered manager began managing the service in October 2017. 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.

Night staffing levels had not consistently met the provider’s own assessment of minimum numbers required. Staffing levels have been reviewed since our inspection to provide the minimum number of night staff together with a redeployment of staff during the day to ensure people with the most complex needs received the support they required.

A fire risk assessment had highlighted actions required to ensure the people who used the service were safe in the event of a fire. Not all of the high risk actions had been completed within the specified timeframe. Since our visits the registered manager has informed us of the progress they have made towards the completion of this work.

Audits were being undertaken by both the registered manager and provider. We identified that timescales for actions required as a result of the audits had not been consistently completed.

The registered manager was in the process of embedding quality assurance processes and was aware of areas to focus on first.

Medicines arrangements were managed safely and health and safety checks were completed.

Staff appropriately recorded and monitored accidents and incidents. We spoke with the registered manager about considering individual patterns and trends in order to address and reduce any potential risks.

Staff understood how to safeguard people from abuse. They received safeguarding training and were aware of signs of abuse and the process to report concerns. The provider had a safeguarding procedure in place and had taken appropriate steps when there were concerns for the safety or welfare of a person who used the service.

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 place in the service supported this practice.

We received mainly positive feedback about the quality of the food and the registered manager listened and responded to people’s feedback. We observed people’s mealtime experience and found while there were some areas for further development overall this was a positive experience.

People were supported to access medical professionals and their health needs were monitored and responded to. We received very positive feedback from healthcare professionals about the service who reported a joint working approach to supporting people.

The needs of people living with dementia had been considered in the design and decoration of the environment.

We observed staff were caring in their interactions with people. They

This inspection took place on 17 November 2015 and was unannounced. We last inspected this service on 18 and 19 March 2015 where we identified breaches relating to:

Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which related to staff failing to carry out person centred care.

Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2014 which related to obtaining and acting in accordance with the consent of service users in relation to the care and treatment provided for them in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards.

Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2014, which related to the arrangements in place to ensure that staff were appropriately trained and supervised to deliver safe care and support to people.

This inspection took place on 17 November 2015 and was unannounced. This meant the staff and provider did not know we would be visiting. This inspection was a re-rating inspection carried out to provide a new rating for the service under the Care Act 2014 and to see if the registered provider and registered manager had made the improvements we required during our last inspection on 18 and 19 March 2015.

The provider sent us an action plan telling us about the actions to be taken and that the improvements would be completed by June 2015.

During this inspection we found the provider was no longer in breach of regulations and had made significant improvement to the service and the care people received.

Boroughbridge Manor and Lodge Care Home is a residential care home for older people, some of whom are living with dementia. The home can accommodate up to 76 people over three floors and is located in the town of Boroughbridge. The registered provider is Boroughbridge Manor Limited. There were 64 people living at the home.

The service had a registered manager in place. They had been in post since February 2015 and registered with the Care Quality Commission since 6 August 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us they felt safe. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They received appropriate safeguarding training and there were policies and procedures to support them in their role.

Risk assessments were completed so that risks to people could be minimised whilst still supporting people to remain independent. The service had systems in place for recording and analysing incidents and accidents so that action could be taken to reduce risk to people’s safety.

Medication was managed safely and people received their prescribed medication on time. Staff had information about how to support people with their medicines.

Staff recruitment practices helped ensure that people were protected from unsafe care. There were enough qualified and skilled staff at the service. Staff had received relevant training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Staff had received further guidance and training with regard to current good practice for supporting people living with dementia. They were able to speak more confidently about the issues and how this had impacted on their practice and improved the well-being for people they cared for.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions.

People had their nutritional needs met. People were offered a varied diet and were provided with sufficient drinks and snacks. People who required special diets were catered for.

People’s needs were regularly assessed, monitored and reviewed to make sure the care met people’s individual needs. Care plans we looked at were person centred, descriptive, and contained specific information about how staff should support people. People had good access to health care services and the service was committed to working in partnership with healthcare professionals.

People told us that they were well cared for and happy with the support they received. We found staff approached people in a caring manner and people’s privacy and dignity was respected.

People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.

People were involved in activities they liked and were linked to previous life experience, interests and hobbies. Visitors were made welcome to the home and people were supported to maintain relationships with their friends and relatives.

The provider completed a range of audits in order to monitor and improve service delivery. Where improvements were needed or lessons learnt, action was taken.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found.

Is the service safe?

People were treated with dignity and respect by the staff. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Systems were in place to ensure that managers and staff learnt from incidents such as accidents. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act (MCA), 2005 and Deprivation of Liberty Safeguards (DoLS). All staff had received training on when a DoLS application should be made and how to submit one. Documentation was available in people's care files to support this.

Staff had received training in all mandatory areas. Staff recruitment procedures were thorough and in accordance with the provider's policy. Staffing levels and experience were based on the individual needs of each person living in the care home. Policies and procedures were in place to make sure unsafe practices were identified so that people could feel protected.

People were being cared for in an environment that was safe, clean and hygienic. Equipment had been well maintained and serviced regularly.

Is the service effective?

People's dietary, mobility and equipment needs had been identifies in care plans. People's needs were taken into account with signage and the layout of the care home, enabling people to move around freely and safely. The building had been sensitively adapted to meet the needs of people with physical impairments.

Staff had the skills and knowledge to meet people's needs. Managers gave effective support to staff including induction training, supervision and appraisal. This was supported by an extensive training programme. The home worked effectively with other agencies and health care services, to ensure a co-ordinated approach to people's care was achieved.

People's end of life care needs had been documented, discussed with people and their families and regularly reviewed and their changing needs had been noticed. Access to palliative care services was provided.

Is the service caring?

People living in the care home were supported by kind and attentive staff. They were cared for sensitively and given encouragement. People's preferences, interests and needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People were involved in a range of activities in and outside the service on a regular basis.

The complaints procedure was understood by staff. The manager was exploring ways of encouraging greater involvement from relatives in the way care was delivered.

Is the service well led?

There was a quality assurance process in place. Records showed that any remedial action needed was actioned promptly. This enabled the quality of service to continually improve. Staff told us they were clear about their roles and responsibilities. All of the staff we spoke to felt they were strongly supported by the managers.

During our visit the expert-by-experience talked to eight people who lived at the home and one relative. The inspector also talked to three relatives, six members of staff, the local doctor and a visiting social care professional.

People told us that staff were polite and respectful. We saw staff treating people respectfully and involving people in their care. People generally looked well cared for and had their care needs met. Comments made to us included “They (the carers) are very good to them, lovely with people”, “They genuinely care”, “The home is very, very good” and “Quite content”.

We saw that people were provided with choices of food and drink throughout the day. The food was well presented and looked appealing. Staff provided people with assistance and gave encouragement where this was needed. Systems were in place to monitor people’s weight and make sure that action was taken if people started to loose weight.

The home was being staffed by an appropriate number of people and the manager was satisfied that staffing levels were sufficient to meet peoples needs. However, a number of people we spoke with felt that staffing levels could be improved and we have suggested the provider keeps this under review.

The home was kept clean and appropriate systems were in place to ensure cleanliness and infection control. There were also regular checks taking place to ensure that the service was being run well and that people were happy with their care.

We carried out this responsive review because we had received information that raised concerns about staffing levels at the service.

Overall we judged that the provider is compliant with this outcome area and is generally providing enough qualified, skilled and experienced staff to meet people’s needs. All six staff we spoke with told us that staffing had improved at the service and that the management were recruiting new staff and making sure enough staff were on duty, including using agency staff if needed. Staff comments included ‘they (staffing levels) are better than they were’, ‘they have recruited quite a few more and are using agency’, ‘this weeks been great, fully staffed on all shifts’, ‘now it’s a bit better, getting the right number of staff on duty’ and ‘numbers have improved.’ Staff rotas confirmed that there were usually enough staff on duty.

However, there were areas for improvement that need the provider’s consideration. Staff deployment and shift patterns do not always fully meet the needs of the people using the service. For example, staff had been taken off the floor to attend training, but had not been replaced. And staff levels on the top floor did not always recognise the dependency of the people who use the service. Although we did not find evidence of these issues having a negative impact on people during this visit, they have the potential to place people who use the service at risk if they are not addressed.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people had complex needs, which meant they were not able to give us their views of the service.

We spoke to eight people who use the service who were able to tell us about their experiences. They told us “it’s a home from home”, “staff are all really nice” and “I’m happy to spend the rest of my days here”.

We also spoke to the relatives of three people who use the service. The majority of feedback was very positive. People told us that staff were “ever so good”, and that they had “visited dozens of homes before deciding on this one”. However, relatives also commented that there had been a number of staff changes recently and that it was “hard to keep track”.

We spoke to two of the home’s care staff and the home manager. Staff told us that they were well trained and supported by management and thought that the home provided a good service.

While we were visiting the home we had the opportunity to talk to a social care professional who works for the Local Authority. They told us that staff were very pleasant with people who use the service and that care records were reasonably up to date and informative.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed staff interacting well with people and providing care and support in kind and friendly ways. For example, staff members kneeled or sat down to be on the same level as the person whilst chatting, and people were encouraged to sing and dance to music. When medication was given to people staff explained what they were doing and what the medicine was for.

This inspection took place on 18 and 19 March 2015 and was unannounced. We last carried out an inspection on 19 June 2014 where we found the home was meeting all the regulations we inspected.

Boroughbridge Manor and Lodge is a residential care home for older people, some of whom are living with dementia. The home can accommodate up to 76 people over three floors and is located in the town of Boroughbridge. The registered provider is Avery Boroughbridge Limited.

There was a manager in charge of the home who had only recently commenced in post but had not yet submitted their application to be registered to the Care Quality Commission. 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.

A new care planning process was being implemented which had resulted in a lack of, or inconsistent information recorded about how people’s needs were to be met. Specific areas of risk had not been assessed and addressed appropriately and this placed people at risk of harm.

Although there appeared to be sufficient staff available, their deployment and additional responsibilities were not well organised. This meant the number of staff available to provide direct care and support was reduced and this impacted on people’s care

Staff had received training with regard to safeguarding adults and they were able to tell us what they would do if they suspected abuse had taken place.

People received their medicines at the times they needed them. The systems in place meant medicines were administered and recorded properly.

Some staff had received training with regard to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. However we found some areas of practice did not take into account people’s mental capacity and best interests.

There was a staff training programme in place, however, further training was required to ensure staff had the specialist skills and knowledge to provide care for people living with dementia.

People had their nutritional needs met. People were offered a varied diet and were provided with sufficient drinks and snacks. People who required special diets were catered for.

People had good access to health care services and the service was committed to working in partnership with healthcare professionals.

People told us that they were well cared for and happy with the support they received. We found staff approached people in a caring manner. We found that most of the time people’s privacy and dignity was respected. However we observed some incidents where people’s dignity was not respected and these were reported to the manager.

A lack of robust care planning impacted on people’s health and wellbeing. Care plans lacked information or contained contradictory information for staff to provide care and support in manner which responded to the person’s needs consistently.

People knew how to make a complaint if they were unhappy and all the people we spoke with told us that they felt that they could talk with any of the staff if they had a concern or were worried about anything.

People and their relatives completed an annual survey. This enabled the provider to address any shortfalls identified through feedback to improve the service.

Changes to management arrangements had impacted on the service provided. There were good auditing and monitoring systems in place to identify where improvements were required and the service had an action plan to address these.