Bell Lodge

Updated 28 April 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak.

Inspection team

The inspection was completed by one inspector.

Service and service type

Bell 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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

Bell Lodge had a COVID-19 outbreak which affected the staffing and levels of care they were able to complete.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We were unable to speak to people who used the service due to the outbreak of COVID-19 and people were being moved to alterative placements. We spoke with four members of staff including the registered manager, assistant manager and care workers.

We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at equipment information, fire procedures, staff training and quality assurance records.

Updated 28 April 2021

About the service

Bell Lodge is a residential care home providing personal care for up to 15 people with dementia

physical disabilities and/or sensory impairments. At the time of inspection there were 11 people being supported at the service.

People’s experience of using this service and what we found

Risk to people’s safety and health were not always identified, assessed and managed appropriately. People did not have all the appropriate risk assessments in place to keep them safe. Their records did not identify how risks were managed. Repositioning charts, safety checks and food and fluid charts were not in place for people who required them.

The provider did not have effective systems and processes in place to ensure oversight of the service. The environment required improvements to keep people safe

Infection control required improvement. We saw a number of poor practices including the unsafe disposal of used personal protective equipment (PPE). Areas of the service did not have cleaning schedules in place, and we found gaps in the recorded cleaning schedules.

Medicine management required improvement. We found information missing on people’s medicine administration records. We could not be assured people received their prescribed medicines. Protocols were not consistently in place to ensure staff knew when to give a ‘as required’ medicine.

Unexplained bruising and injuries were not consistently logged or investigated to ensure they did not happen again or make improvements in peoples care and treatment.

Records were not kept up to date. We found gaps in multiple records, some records were difficult to understand, and the handwriting was not clear.

Due to COVID-19 people were not supported by staff who knew them or had all the relevant information available to understand their needs. The provider had not completed a comprehensive contingency plan in case of staff shortages and relied heavily on agency staff within the home.

People did not always receive person centred care. We were not assured that the provider had sought health care support for people in a timely manner.

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 17 October 2020) and there was a breach of regulation 17; Good Governance. The provider do not completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to staffing levels, safe care of people and management oversight. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. However, due to the COVID-19 outbreak and people being moved out of service we did not inspect the other key questions and this impacted on gathering information for the key question caring. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bell Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care, medicines, infection control, staffing and oversight of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.