This was an announced inspection carried out on 22 August and 5 October 2017.

We last inspected Harrogate Lodge in December 2016 when the home was rated 'Requires Improvement' overall. The key question 'Safe' was rated Inadequate. We identified two breaches of regulations. We found that medicines administration was not always safe. Medicines were signed for without checks being made to ensure they were taken. Medicines were left with people and stocks of medicines did not always match records. We also found some fire doors were propped open, meaning people were not adequately protected against the risks of fire. People were not fully protected from the risks of unsafe care or treatment because accurate records were not maintained. As a result, we issued two warning notices for regulation 12 (Safe care and treatment) and regulation 17 (Good governance) to the provider telling them they must improve.

Following our December 2016 inspection, the provider sent us an action plan detailing the changes and improvements they intended to make to improve the quality of service provided to people living at the home. We took this into account when planning this inspection to ensure these actions had been completed. At this inspection, we found the provider had made all the required improvements and addressed all our concerns that had been highlighted last time we visited the home.

Harrogate Lodge Care Home is a care home with nursing and is registered to provide accommodation for up to 50 persons who require nursing or personal care. It is situated in the Chapel Allerton area of Leeds, close to local amenities.

There was a manager in post when we inspected. They had been in post since June 2017, and had applied for registration with the Care Quality Commission (CQC). 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 using the service told us they felt safe. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

Staff and people we spoke with said staffing levels were sufficient to meet their requirements. We also looked at recruitment processes and found that staff had been recruited safely. All staff received an induction when they started working at the home. Staff received regular supervision and appraisal. Staff also received all the necessary training relevant to their roles.

There was a range of quality audits in place completed by both the manager and provider. These were up to date and completed on a daily, weekly and monthly basis. All of the people we spoke with told us they felt the service was well-led and that they felt listened to and could approach management with concerns. Staff told us they enjoyed working at the home and enjoyed their jobs.

All of the people we spoke with during the inspection made positive comments about the care and support provided. People told us they felt staff treated them with dignity and respect and promoted their independence where possible. People felt the home was responsive to their needs. Each person had their own care plan, which was person centred and included their choices and personal preferences.

People were offered a variety of meal options, such as three choices at lunch. They told us they enjoyed their meals and had ample portions. Risk assessments were completed regularly to monitor people against the risks of malnutrition.

The manager ensured staff had training about the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Where people were deprived of their liberty to safeguard them, we found up-to-date records were in place to support decisions made by people. The registered manager and staff

We carried out an inspection of Harrogate Lodge on 5 and 8 December 2016. On both occasions our visit was unannounced. At our last inspection in May 2015 we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit an action plan to show how they intended to make the necessary improvement. On this inspection we found the provider was still in breach of this regulation, and we identified a further breach.

Harrogate Lodge Care Home is a care home with nursing and is registered to provide accommodation for up to 50 persons who require nursing or personal care. It is situated in the Chapel Allerton area of Leeds, close to local amenities.

There was a manager in post when we inspected. They had been in post for a fortnight, and had applied for registration with the Care Quality Commission (CQC).

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 identified a number of errors of administering and recording of medicines. Some people had not had medicines which had been signed for, medicines were left with people by a nurse who did not stay to witness whether they had taken them, stocks did not always balance with records and we had concerns about the competency of nurses supplied by an agency. Audits of medicines records had not identified errors with stocks. We recommended the provider carry out more robust checks of agency nurse competence to administer medicines before allowing them to work unsupervised in the home.

We found some fire doors had been propped open, an action which would have prevented them operating to preserve the safety of people if there had been a fire.

There were no concerns related to infection control identified during the inspection, however we noted that some paintwork was worn down to bare wood, which would have reduced the effectiveness of cleaning activities.

We found risks associated with people’s care and support was well documented across all relevant areas.

Recruitment of staff was carried out safely with appropriate background checks being made. Staff understood the principles of safeguarding and whistle-blowing, and knew when and how to report any concerns. There were sufficient staff on duty to meet people’s care and support needs.

Staff told us they received a thorough induction and ongoing support including training and supervision, which meant they were able to provide effective care and support to people.

We found the provider had a good approach to assessing people’s capacity to make specific decisions and providing appropriate support to people who lacked capacity. Staff had good knowledge of how to support people who may lack capacity, and the provider managed Deprivation of Liberty Safeguards appropriately.

We saw people were usually asked for consent before any care interventions took place, and found the provider supported people to access other healthcare professionals when this was needed.

People told us they enjoyed the food served, and we saw mealtimes were unrushed. Alternatives were made available when people did not want meals from the menu.

Staff had good relationships with people who used the service, and we found care was planned and delivered in a person-centred way. This was achieved by including people in the writing of their care plans.

Complaints were well managed, and we saw the provider received a range of compliments from relatives of people who used the service.

There was a programme of audit in place, however we found this was not always effective in relation to checks on medicines. Staff said they felt supported by the manager and enjoyed working in the service. They had opportunity to att

The inspection was carried out by an individual inspector. We looked at five specific questions; Was the service safe? Was the service effective? Was the service caring? Was the service responsive? Was the service well led?

Was the service safe?

We spoke with six people who used the service. They all told us they were happy with the care and support they received. One person told us “It’s nice and comfortable here”. Another told us “I am happy enough here, people are very caring”.

We saw evidence staff received regular training in safeguarding vulnerable adults and the service had an up to date safeguarding policy. This meant they were able to protect people from the risk of harm.

Staff had regular training on a variety of subjects and the staff we spoke with told us they felt the training was important as it helped them keep their skills and knowledge up to date. They told us they would like to have further training in specific areas such as wound management and tissue viability. The deputy manager told us training in tissue viability had been scheduled for staff.

Was the service effective?

People had an assessment of their care needs prior to admission into the home. Once they had settled into the home, a further assessment of need was carried out and care records were developed. The resulting care records were then reviewed at regular intervals. This ensured people were having their needs assessed on a regular basis.

The service used advocacy services if people needed it; this meant that, when required, people could access additional support.

The manager set the staff rota and ensured there were the right mix of skills on each shift. This meant people were being cared for by staff that were qualified and experienced. The staff we spoke with told us they had concerns regarding the level of staff sickness at weekends. The deputy manager told us this had been addressed by the manager. The service provider did not routinely use agency staff to cover vacancies amongst care staff. They only used agency staff to cover vacancies amongst qualified staff.

Was the service caring?

We saw interaction between staff and people who used the service was warm and respectful. The staff we spoke with told us they had known a lot of the people for a very long time and had developed a good relationship with people. This meant they had a good understanding of people’s care needs.

People were supported by staff who were kind and attentive. We saw care staff showed patience and gave encouragement when supporting people. Some people commented “Staff are very kind and caring”. However other people told us some care staff were better than others and they felt the care was not always consistent.

We saw people’s preferences, interests and diverse needs had been recorded in their care plan. There was evidence people’s religious and cultural beliefs were being met.

Was the service responsive?

People took part in a range of activities organised by the activities co-ordinator. Visiting relatives told us the activity co-ordinator had made a big difference within the home.

People told us they knew what to do if they weren’t happy with the service. We looked at how complaints had been dealt with within the home. We saw complaints had been responded to in a timely fashion.

Was the service well led?

The service was going through a period of refurbishment which was coming to an end. The staff we spoke with felt the refurbishment had made a difference to the environment. A new manager and deputy manager was in post. There was a voluntary embargo on new referrals and the local health authority had stopped placing people in the home. The service had a difficult relationship with some local General Practitioners and other external agencies. These issues were being addressed by the management team.

The relatives we spoke with told us they had seen a positive change in the way the home was managed. They felt the new manager was approachable and appreciated the time they spent with people who used the service.

Staff were clear about their roles and responsibilities and felt able to talk to the manager if they had any concerns. The manager took an active part in managing the home and the team felt they were as much a part of the team as the care staff.

The people we spoke with told us they could talk to the manager if they had any concerns. We spoke with some visitors to the home and they felt that the home was well managed. They too felt able to talk to the manager if they had any concerns.

On the day of our inspection there was no Registered Manager, however a new Manager is in place and is in the process of applying for registered Manager Status. We spoke with six people and asked them about their consent to care and treatment. Comments included, "I get asked if I would like to have a shave", "I am always involved with decisions concerning my care" and "I'm happy here and they have my best interest at heart; they take notice of what I want."

People told us they were happy with the care provided. Comments included, “Staff are very good and put residents first”, “Staff are brilliant, they value the residents, and are very friendly and genuine.”" A visitor said, “Everyone at home is very happy with Mums care.”

People were satisfied with staffing levels. One person said, “If I pull the bell they come straight away.” Another person said, “The staff are in and out of (relative’s) bedroom all the time.”

We found the provider requested feedback from people who used the service, relatives and staff, and took action to address any concerns.

We found records were up to date and securely held.

The service cares for and supports people with a wide range of needs. Some people who used the service were able to share their views whilst others had complex needs and were not able to tell us about their experiences. The people we spoke with told us they were happy with the care and support they received. They made the following comments:

“They will always let me know what’s going on and then leave it up to me.”

“I’m very pleased with the staff. They are dedicated, cheerful, good humoured, very hard working, helpful and kind.”

“They are very friendly and willing to help.”

“I’m very happy with the care. Others are also receiving a good standard of care; I can overhear and am impressed by their patience. They guide people through an emotional crisis. ”

“We’re well looked after. They sort me out from my eyes to my feet.”

“Everywhere is always clean and tidy, and it’s nice and warm. They come in and check my room is ok.”

“Staff are always very willing to help out when I need it. I get up when it suits me and go to bed when it suits me.

“If I use my buzzer I never wait long.”

We spoke with four visitors who were all complimentary about the staff. They made the following comments:

“They have very good staff indeed and very patient.”

“We have been involved in making decisions all the way.”

“They help with anything. They do all the checks. We’ve looked at the records and they are always filling them in.”

Staff told us people received good care and were treated with respect and given choice. One member of staff said, “Absolutely no doubt whatsoever people are treated with respect.” Another member of staff said, “People get good care. We do make sure they are well looked after.” Another member of staff said, “We have a brilliant staff team and everyone gives 100%. If we’re not sure we ask the nurses and they’re always willing to help out.”

Two visitors and most of the staff told us that at times there were not enough staff. The regional manager was aware that staffing levels had been a problem and had started addressing this.

This was an unannounced inspection carried out on the 13 May 2015. At the last inspection in October 2014 we found the provider had breached nine regulations associated with the Health and Social Care Act 2008.

We found proper steps to ensure that each person was protected against the risks of receiving care or treatment that was inappropriate or unsafe had not been taken. Care records were not up to date and were complex and difficult to follow. There were not always effective systems in place to manage, monitor and improve the quality of the service provided. The management team had failed to protect people from inappropriate or unsafe care and treatment as effective analysis of accidents, incidents and audits had not been carried out. There were not suitable arrangements in place to ensure staff were appropriately supported in relation to their responsibilities to enable them to deliver care safely and to an appropriate standard.

We also found that people were not always protected against the risks associated with medicines and appropriate arrangements were not in place to manage medicines. We saw that suitable arrangements were not in place to ensure people were safeguarded from abuse and that there were not sufficient staff to make sure people’s needs were properly met. We found that applications for the Deprivation of Liberty Safeguards (DoLS) had not been carried out and it was not clear if people were at risk of having their liberty deprived or their rights to make decisions respected. From the records we looked at we were not able to see if complaints had been responded to appropriately or any lessons learnt implemented and we found the registered person did not notify the Care Quality Commission without delay of incidents.

We told the provider they needed to take action and we received a report in January 2015 setting out the action they would take to meet the regulations. At this inspection we found improvements had been made with regard to these breaches. However, we found other areas where improvements were needed.

Harrogate Lodge Care Home is a care home with nursing and is registered to provide accommodation for up to 50 people. At the time of our inspection there were 22 people living at the home.

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 and associated Regulations about how the service is run.

At this inspection we found overall that appropriate arrangements were in place to manage the medicines of people who used the service. However, we found the records relating to some people’s medication administration and some ‘as and when’ required medications were not accurately completed. This could lead to people’s needs being missed or overlooked. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People were cared for by sufficient numbers of suitably trained staff. We saw staff now received the training and support required to meet people’s needs. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions to enhance their capacity and where people did not have the capacity were aware that decisions had to be made in their best interests.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People participated in a range of activities and enjoyed a balanced healthy diet. Mealtime experiences in the home were good and people received the support they needed.

Staff were aware of how to support people to raise concerns and complaints and we saw the provider learnt from complaints and suggestions and made improvements to the service.

There were overall, effective systems in place to monitor and improve the quality of the service provided.