Enter and view: Athenaeum Care Home

Healthwatch Barnet carried out an announced Enter and View visit to Athenaeum Care Home in Whetstone on 11 October 2023. The home provides residential, dementia and respite care for older adults and was rated Good by the Care Quality Commission across all domains. During the visit, Healthwatch spoke with two residents, three relatives and friends, five staff members and the manager.

Overall, residents and relatives reported positive experiences of the home and described staff as friendly, attentive, caring and approachable. Residents said they were treated with respect, could choose when to get up and go to bed, and were able to decide where they wished to eat their meals. Relatives felt that residents received personalised care and praised the manager as genuine, responsive and committed to residents’ wellbeing.

The home was generally viewed as clean, tidy and well maintained. Residents appreciated the peaceful environment and access to the garden, while relatives described the home as organised and welcoming. However, Healthwatch noted that some corridors were narrow and that signage and décor could be improved to better support people living with dementia by making navigation easier and the environment more visually stimulating. 

Residents were satisfied with the activities programme, which included exercise sessions, music, singing, social activities and access to the garden. Healthwatch observed activities that were well attended and positively received by residents. Staff were also reported to spend time socialising with residents and encouraging participation. Nevertheless, most residents and relatives were unaware of opportunities for organised outings outside the home and felt there could be more external trips and community activities.

Feedback about food was positive. Residents said they generally enjoyed the meals and appreciated having choices. Relatives felt that food quality was good, and some reported noticeable improvements in residents’ health after admission. Healthwatch observed a well-organised mealtime with staff supporting residents appropriately and respecting dietary and cultural preferences.

Clinical care was viewed positively. Residents said they felt comfortable raising health concerns with staff and believed staff monitored their wellbeing closely. The home had regular GP support from a local practice, access to district nursing and multidisciplinary teams, and systems for monitoring health concerns such as nutrition, hydration and pressure sore risks. However, one relative felt that charges for staff escorts to medical appointments were expensive.

Staff morale appeared high. Employees described the home as friendly, supportive and well organised, with good staff retention and minimal use of agency workers. Training compliance was reported to be above 90%, and staff were generally positive about the support they received from management. However, some confusion existed about supervision and appraisal arrangements, and Healthwatch found that some staff struggled to clearly explain safeguarding responsibilities despite having completed training. Staff also raised concerns about the condition and size of the staff kitchen and break facilities. 

The most significant concern identified in the report related to Deprivation of Liberty Safeguards (DoLS). Healthwatch was informed that the home routinely applied for DoLS authorisations for all residents. Healthwatch considered this approach inconsistent with national guidance, which states that each case should be assessed individually rather than applying blanket restrictions. Concerns were also raised that residents without DoLS authorisations were not given the front-door access code and would need staff assistance, including paid escorts in some circumstances, if they wished to leave the home. Healthwatch emphasised that there was no indication that staff had negative intentions, but concluded that the home's DoLS policies, training and practice required urgent review.

The report also highlighted concerns about healthcare system issues beyond the home’s direct control. Staff described cases where residents had been discharged from hospital with insufficient information about their needs, leading to inappropriate placements and distress. In one example, a resident with significant mental health needs was reportedly discharged to the home despite it not being equipped to meet those needs. Relatives also expressed concerns about local authority decisions that had placed residents far from their families and support networks.

Residents and relatives generally felt comfortable raising concerns and reported that management was responsive to feedback. Examples included resolving issues with clothing and replacing furniture when concerns were raised. However, Healthwatch found the organisation’s complaints procedure difficult to locate on the provider’s website and recommended making it more accessible. 

Healthwatch made several recommendations. The most important was a comprehensive review of DoLS policies, staff training and practices in partnership with local authorities and supervisory bodies. Other recommendations included strengthening safeguarding training, improving clarity about staff supervision and appraisals, making the environment more dementia friendly, developing more opportunities for outside trips, increasing awareness of resident and relatives’ meetings, making the complaints process easier to find, and improving staff facilities. The provider accepted the recommendations and committed to reviewing practices in these areas. 

Overall, Healthwatch concluded that Athenaeum Care Home provided caring, person-centred support in a clean and friendly environment, with positive feedback about staff, management, activities and day-to-day care. However, significant concerns regarding the management of Deprivation of Liberty Safeguards and some aspects of governance meant that improvements were required to ensure residents’ rights and freedoms were consistently protected.