The inspection was carried out on 22 November 2018 and was unannounced. This meant the provider and staff did not know we would be visiting. The service was previously inspected in November 2017 and we identified three continued breaches of regulations. The registered provider had not managed risks to ensure people’s safety, was not meeting the requirements of The Mental Capacity Act 2005 and there was ineffective governance in place to improve the quality of the service. he service was rated Requires Improvement. At this inspection we found the service had improved although remained requires improvement overall.

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

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.

West Melton Lodge 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 service provides accommodation for up to 32 people in one adapted building. At the time of our visit there were 17 people using the service.

Medication procedures were in place for staff to follow and medicines were ordered, stored and administered safely. However, staff did not always document administration of as and when medication in line with the registered provider’s procedures, although they were administered as prescribed.

The service was predominantly clean; however, some areas were not well maintained so were not able to be effectively cleaned. The environment was also not dementia friendly. We also identified that due to some people’s mobility limitations they could not access the communal areas of the building which were accessed using a stair lift. The alternative was to access the different levels through an outdoor walkway which was not practical in poor weather.

The provider had improved the governance framework and quality monitoring completed had identified areas for improvement. However, the monitoring had not identified all of the issues that required improvement that we had picked up as part of the inspection.

The provider had safeguarding procedures and staff were aware of the procedures to follow to safeguard people from abuse.

There were dependency tools in each person care plan to determine how many care hours were required to meet their needs. However, the registered manager did not have an overview to show total hours. However, the registered provider has provided this since our inspection.

Risks were identified and managed so that people avoided injury or harm.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found the requirements of the act were being met. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People received adequate nutrition and hydration to maintain their health and wellbeing.

Staff recruitment processes were robust. We found all the required pre-employment checks had been carried out. Staff received supervision and an annual appraisal of their performance. Staff told us they felt supported in their role.

We found staff approached people in a kindly manner and were respectful. People and their relatives told us staff were

The inspection was carried out on 30 October 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. The service was previously inspected on 14 March 2017 and was rated Inadequate and placed in special measures, with six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read the report from our last inspections, by selecting the 'all reports' link for 'West Melton Lodge' on our website at www.cqc.org.uk.

The service did not 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. However, the registered provider had appointed a new manager who commenced on 1 August 2017 and they had submitted an application to CQC to register.

At this inspection we found improvements. The new regional manager and the provider had followed the action plan submitted following our last inspection. Although at this inspection we identified three continued breaches, these had not adversely impacted on people who use the service and were mainly due to new systems that are still being embedding into practice. The service has been removed from special measures although further improvements must be made and sustained over time to ensure they meet the fundamental standards of safety and quality.

West Melton Lodge is in West Melton village, which is between Rotherham and Barnsley. The home is registered to provide accommodation for 32 older people. Accommodation is on two floors accessed by a passenger lift, although some rooms are only accessed by using stairs. There are several lounges and dining areas throughout the home. The bedrooms vary in size and some have en-suite lavatories. The home has gardens and there is a car park to the front of the property.

The provider had safeguarding procedures and staff were aware of the procedures. Staff had received training and people were protected from abuse.

At the time of our inspection we found there were sufficient staff on duty to meet people’s needs. However, staff told us this was because the occupancy was low, so they could manage.

Risks to people had been identified, but we found these were not always followed or reviewed to reflect current needs. Systems were in place for the safe management of medicines. However, we identified a number of errors that meant systems had not always been followed to ensure people received medications as prescribed.

The service was predominantly clean. However, some areas were not clean and the environment was not well maintained, therefore it could not be effectively cleaned.

We found that the recruitment of staff followed procedures. However, although three references had been sought for one member of staff they were not from a previous employer. Staff supervision took place and staff told us they felt supported by the new manager. Staff received training that ensured they had the competencies and skills to meet the needs of people who used the service.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some records were well completed and clearly documented the decision being made. However, we found some people’s best interests were not always documented. If they were documented they did not always involve all relevant people and did not clearly detail the outcome. Decisions being made were sometimes very general and not specific.

A well balanced diet that met people’s nutritional needs was provided.

We found staff approached people in a kindly manner. They were kind, considerate and caring. We saw most staff respected people and maintained their dignity. Although we observed some

This inspection took place on 14 March 2017. The home was previously inspected in November 2016, and at the time was rated requires improvement with two breaches of regulations. Previously the service had been rated Inadequate in February 2016. We brought this inspection forward due to concerns we had about the service and to check if improvements had been made. You can read the report from our last inspections, by selecting the 'all reports' link for ‘West Melton Lodge’ on our website at www.cqc.org.uk’

West Melton Lodge is in West Melton village, which is between Rotherham and Barnsley. The home is registered to provide accommodation for 32 older people. Accommodation is on two floors and a passenger lift is provided. There are several lounges and dining areas throughout the home. The bedrooms vary in size and some have en-suite lavatories. The home has landscaped gardens and there is a car park to the front of the property.

There was not a registered manager for the service in post at the time of the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had left the same week as our inspection in November 2016; they were moved to another location owned by the provider. A manager who was previously registered at this location but left in 2016 was reappointed and commenced in November 2016. They had submitted an application to register with CQC.

The provider had systems in place to protect people from abuse and staff were aware of the procedures to follow. However, we identified these had not always been followed. People had not been protected and we made a safeguarding referrals to the local authority following our inspection.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines but these were not always followed.

People were assessed and risks to their safety and welfare had been identified. However, we found care was not always delivered in a way to manage these risks to ensure people’s safety.

We found there was adequate staff on duty to be able to meet people’s needs at the time of our inspection. However, from speaking with staff and people who used the service it was not clear if adequate staff were on duty in the evenings. We also identified from observations ineffective deployment and direction of staff meant people were not always appropriately supported.

We saw that appropriate pre-employment checks had been carried out to ensure staff were of good character and suitable to work with vulnerable adults.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with told us they had been requesting additional training as they were struggling to understand how this impacted on people they supported. People who used the service had been assessed to determine if a DoLS application was required. However, we found best interest decisions were not always made and where people had conditions as part of their DoLS authorisations had not always been met.

A well balanced diet that met people’s nutritional needs was provided. However, we found people were not always supported appropriately to be able to eat and drink. We found best practice guidance was not always followed for people living with dementia in respect of aids for eating and adaptations to the environment.

Staff told us they had undertaken training to give them the skills and knowledge to carry out their roles. However, we found training was not up to date and staff

This inspection took place on 1 November 2016 and was unannounced. This was the second rated inspection for this service and at the last inspection in February 2016 the service had been rated Inadequate and was placed into Special Measures. You can read the report from our last inspections, by selecting the 'all reports' link for ‘West Melton Lodge’ on our website at www.cqc.org.uk’

West Melton Lodge is in West Melton village, which is between Rotherham and Barnsley. The home is registered to provide accommodation for 32 older people. Accommodation is on two floors and a passenger lift is provided. There are several lounges and dining areas throughout the home. The bedrooms vary in size and some have en-suite lavatories. The home has landscaped gardens and there is a car park to the front of the property.

The home had a registered manager. They had been in post since November 2015 and registered in June 2016. 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.

During this inspection we looked to see if improvements had been made since our last inspection in February 2016. We found improvements had been made across all aspects of the service and it was evident further improvements were in the process or were planned to be implemented. However, these improvements had been implemented by the registered manager and following our inspection they were moved to another service owned by the same provider. The systems in place to maintain the improvements had not been embedded into practice as they were new. We will carry out a further inspection of the service to ensure that improvements continue to be made and these have been embedded into practice and sustained over time.

We found that people had care and support plans in place and care records reflected the care they required. The plans had been reviewed and updated when people’s needs had changed. People’s risk assessments had also been reviewed to ensure their safety.

People were protected against the risk of abuse. Staff we spoke with were aware of procedures to follow and understood whistleblowing procedures.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. People we spoke with told us the food was always good.

We found the registered manager had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.

Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, we identified some improvements could be made.

There were robust recruitment procedures in place. Staff had received some formal supervision but this was not in line with the provider’s policy. The registered manager told us they had completed some annual appraisals and were organising others and they would be completed by the end of the year. Staff told us they felt well supported by the registered manager. Staff received training to be able to fulfil their roles and responsibilities. However not all training had been completed by staff.

The registered manager had implemented new systems to monitor the quality of the service provided. We saw these were completed and were effective. Improvements to the service continue to be identified and planned; these will need to be closely monitored by the registered manager so that these become fully embedded into practice and ensure they are sustained. However, these improvements were driven by the registered manager and she has been moved following our inspection to another service. The provider will need to ensure that a manager who is registered with the Commission continues to develop the systems to monitor the quality a

West Melton Lodge is in West Melton village, which is between Rotherham and Barnsley. The home is registered to provide accommodation for 32 older people. Accommodation is on two floors and a passenger lift is provided. There are several lounges and dining areas throughout the home. The bedrooms vary in size and some have en-suite lavatories. The home has landscaped gardens and there is a car park to the front of the property.

This inspection took place on 2 and 3 February 2016 and was unannounced on the first day. At the time of the inspection 25 people were living in the home. The service was last inspected in September 2014 and no breaches of legal requirements were identified.

There was no registered manager at the time of the 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 2008 and associated Regulations about how the service is run. The provider had appointed a new manager, who had started work a few days before Christmas. The manager told us they were preparing to apply to become registered.

We received mixed feedback from people living in the home and their visiting relatives, although most of the feedback was very complimentary regarding how nice the staff were, and about the care that people received. We found several areas for concern, as some risks to people’s health, safety and welfare were not appropriately managed. This included poor cleanliness and infection prevention and control in the home. The environment was not in a good state of repair or well decorated in some areas, and that there were physical hazards, such as trip hazards and security risks. Therefore, people were not always cared for in a hygienic and safe environment.

We saw that people’s health care needs were not always accurately assessed and risks, such as risks associated with use of the stairs and the use of bedrails were not always recognised. In some cases, support and advice had not been sought from healthcare professionals. In one case the person’s care plan was not being followed. This meant that people’s care was not well planned or delivered consistently. In some cases, this put people at risk and meant they were not having their individual care needs met. Additionally, the records staff kept about the care they delivered to people were not checked, leaving people at risk of not having their current, individual needs met.

There were few activities. The level of staffing support available did not adequately provide for people’s social and intellectual needs, and allow people sufficient freedom to go out into their local community.

Staff told us they received training, which helped them to carry out their role. However, not all staff had a good understanding of the Mental Capacity Act 2005. There were a number of people who lived in the home who were living with dementia, but not all staff had a good understanding of working positively with people living with dementia. Staff confirmed that they received supervision sessions with their manager.

The Mental Capacity Act (2005) (MCA) has been introduced as extra safeguards, in law, to protect people’s rights and make sure that the care or treatment they receive is in their best interests. The service was not meeting the requirements of the MCA (2005) for people who may lack capacity to make decisions. For example, people’s mental capacity was not assessed when particular decisions had been made. Additionally, some decisions made did not support people’s rights.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the necessary DoLS applications had been made.

There were 14 people living with dementia who lived in the home, and although some work h

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 protected against the risks associated with the unsafe use and management of medicines.

We observed people were treated with respect and staff maintained people’s dignity.

Is the service effective?

The provider had an effective system to regularly assess and monitor the quality of service that people received. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted upon.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

People we spoke with told us they were well looked after, One person told us, “It is lovely here we are well looked after.” Another person said, “I like it here it is a nice home.”

Is the service responsive?

The manager had identified concerns during routine audits and had implemented systems to ensure improvements.

Is the service well-led?

The registered manager was registered with CQC earlier in 2014. Since their appointment they have implemented improvements and followed through on the actions to ensure compliance actions were met.

The staff we spoke with said they worked well as a team and things had improved in the last few months. They told us the manager was approachable, listened and took action if required.

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?

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 found inadequate quality monitoring systems were in place. This did not ensure the risks to people were identified and reduced, to be able to continually improve.

We found that medicines were not always recorded or administered safely and appropriately. Care workers did not always support people using the service to take and use their medicines appropriately.

Is the service effective?

People’s health and care needs were reviewed, and they were involved in the reviews.

Audits and reviews had taken place, however when shortfalls were identified no action was taken. We found the same issues had been identified each month since September 2013.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people. One person we spoke with told us, “I love it here I came on respite but wanted to stay, the staff are great.”

We observed the lunch time meal the experience was inclusive, calm, supportive and enjoyed by people who used the service. People were given choices and their preferences were respected. Staff gave appropriate sensitive support when required. People told us the food was very good and that the meals were a good time to talk to people and have a laugh and a joke.

Is the service responsive?

The manager was new in post and had identified a number of areas that required improving; however these at the time of our inspection had not been addressed.

Is the service well-led?

A new manager was appointed in October 2013 and has just completed the registration process with us.

People we spoke with told us they liked living at the service. They told us the staff were good and looked after them. We also spoke with relatives and they said that the service was very good and staff kept them informed of any issues or changes to their relative’s health.

People also told us that staff treated them with respect, listened to them, gave them choices, made them feel safe and supported them. One person told us. “If I have any concerns I talk to staff and things are always sorted out.

Evidence showed people were protected from the risk of infection because appropriate guidance had been followed.

There were effective recruitment and selection processes in place and staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed.

There was an effective system to regularly assess and monitor the quality of service that people received. There was a complaints policy that took account of complaints and comments to improve the service.

People’s personal records including medical records were not always accurate or fit for purpose. The acting manager had identified this and told us they were going to implement a new format to ensure records were accurate.

People we spoke with told us they liked living at West Melton Lodge. One person told us, “The staff help you, and are lovely.”

Another person told us, “Every member of staff is fantastic, look after people very well and work very hard.” However two people we spoke with told us they would like more activities as they at times were bored just watching television.

People told us that staff treated them with respect, listened to them, gave them choices and supported them.

People were not always cared for in a clean, hygienic environment. People’s bedrooms and communal areas were found to be clean with no offensive odours, although some areas of the service were not well maintained or kept clean. These included the laundry and sluice facilities. The systems in place to reduce the risk and spread of infection were not always effective. The manager and provider had identified this and were putting measures in place to address the shortfalls.

Staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed. However some training required updating this included first aid and adult safeguarding. The manager had organised dates for staff to attend in January and February 2013.

There was an effective system to regularly assess and monitor the quality of service that people received. There was a complaints policy that took account of complaints and comments to improve the service.

We have not spoken directly with people who used the service in assessing this essential standard.

People using the service told us they were happy with the care provided and were involved in decisions about their care and welfare needs. One person told us they were able to choose what time they got up and went to bed and if they wanted to join in the events of the day. Another person told us there were not many activities but liked what was on. Two people told us they had not read their care plan but that was their choice.

Two people using the service told us their dignity and privacy was respected by staff.

People using the service told us they were happy living at the home and they were well looked after. We spoke with three people who told us “I am very happy and they look after me”, “I am happy living here” and “They look after me well”. Staff were described as pretty good and nice.

People told us that they felt safe at the home and they would tell staff or the manager if they were worried about anything.

One person using the service told us the organisation was not as good as it could be. They were waiting for a manager to be appointed as there was no one to raise concerns with.