Bradstowe Lodge

Bradstowe Lodge is a residential care home providing accommodation for people requiring personal care to up to 27 people. The service provides support to older people in one large adapted building. At the time of our inspection there were 22 people using the service.

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

People told us staff working at Bradstowe Lodge were “all lovely”, “interested in me” and “everyone is kind and thoughtful”. People felt comfortable living at the home and a person told us, “This is my home now.” We found improvements had been made at the service, but further improvements were needed to comply with regulations and ensure people always received a good service.

Checks and audits had improved but action had not always been planned to address shortfalls found. People’s records were not always complete. Detailed guidance was not available to staff about how to mitigate risks to people and provide their care in the way they wanted.

People were involved in planning changes at the service and the provider acted on feedback received from people and staff. Staff offered people choices in all areas of their life and respected decisions they made. People told us they were supported to remain independent and had enough to do during the day.

Risks to people had been identified and staff had the skills and knowledge to keep people safe. Staff had been recruited safely, completed an induction and received further training around people’s needs. Medicines were managed safely and people received their medicines as prescribed. Lessons had been learnt when things went wrong and action had been taken to reduce the risk of them from happening again. People were confident to make complaints but had not felt they needed to.

People told us they felt safe at the service. Staff knew how to identify and report any safety concerns. Staff had assessed people’s needs before they began using the service. Any changes in people’s health were identified promptly and they were referred to health care professionals. People were supported to be comfortable at the end of their lives. People had enough to eat and told us the food was “extremely good”.

The service was clean, and staff followed safe infection control processes. The building had been adapted to people’s needs and people were encouraged to decorate their bedrooms as they wished.

A new manager was leading the service, they were experienced and staff told us they were approachable and supportive.

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 6 October 2022). We took enforcement action against the provider and applied a condition to their registration requiring them tell us each month the action they had taken to improve the service. At this inspection we found some improvements had been made, but the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 19 May 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to accurate and complete records and acting on shortfalls found at this inspection. Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Bradstowe Lodge is a residential care home providing accommodation for people requiring personal care to up to 27 people. The service provides support to older people in one large adapted building. At the time of our inspection there were 26 people using the service.

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

People told us they felt safe living at the service. However, the service had not improved since the last inspection, there was no effective system to monitor and improve the service. The audits completed had not identified shortfalls found at this inspection. Action had not been taken to act on the recommendations from the previous inspection including the inclusion of signs to help people find their way around the service.

Potential risks to people’s health and welfare had not been consistently assessed. There was not always guidance for staff to keep people as safe as possible and mitigate the risk.

Each person had a care plan, however, they did not contain information about people’s choices and preferences including their end of life preferences. People had met with staff before moving into the service to check their needs could be met. Assessments of people’s needs had not been consistently completed using assessment tools in line with current good practice guidance.

Medicines were not managed safely. Medicine records were not always accurate, there was not always guidance for staff to administer medicines safely. People were asked for their feedback about the service, however, their suggestions were not always acted upon.

Staff had been recruited safely. There were enough staff to meet people’s needs and they had received appropriate training to meet people’s needs. The registered manager and staff understood their responsibilities to keep people safe from abuse and discrimination.

People were supported to eat a balanced diet. People were referred to health professionals when people’s needs changed and were supported to attend healthcare appointments.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 July 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. At our last inspection we recommended that signs were used within the service and care plans should meet current guidance. At this inspection we found these recommendations had not been met. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We inspected based on the last rating of the service.

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 COVID-19 and other infection outbreaks effectively.

We carried out an unannounced comprehensive inspection of this service on 20 May 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and staff recruitment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bradstowe 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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Bradstowe Lodge is a residential care home that provides personal care to up to 27 people aged 65 and over at the time of the inspection there were 22 people living at the service. Some people were living with dementia. Two people were cared for in bed.

People’s experience of using this service:

People had choice over their care and support and their choice, dignity and privacy was respected by staff. People told us staff were kind and caring and treated them well. Comments included, “The staff are ever so kind and friendly here” and “The staff are so friendly it feels like family and feels like I’ve known them all my life.” People's religious needs were met.

The service had not been testing and checking that water temperatures for people using the showers were at safe levels. Staff had only recorded bath water temperatures. This meant people were at risk of scalding. Risk assessments did not always have all the information staff needed to keep people safe. Medicines were not always managed in a safe way. Medicines were not always stored at the correct temperature to ensure their efficiency. Some people were prescribed topical creams and lotion; records were not always clear about whether prescribed creams have been administered. Most people were in receipt of as and when required (PRN) medicines. PRN protocols were not in place for most people to detail why they needed the medicine and what the maximum dosages were. This meant that staff working with people may not have all the information they need to identify why the person takes that particular medicine and how they communicate the need for it.

Staff had not always been recruited safely. Staff files contained unexplained gaps in their employment history.

Most people had access to a range of different activities throughout the week. People told us that they took part in these and that they were enjoyable. However, activities were not provided for people who were cared for in bed. Although care plans were in place to describe the care and support people needed, they did not always include some important information individual to the person. We made a recommendation about this.

There were systems in place to check the quality of the service. However, these systems were not always robust, they had not identified the concerns we raised in relation to risk management, medicines management and safe recruitment practice.

The design and layout of the service met most people's needs. People knew where their rooms were. However, some people lived with dementia and experienced episodes of confusion. We observed there were no way marking signs to help people and their visitors find their way around the service or out to garden. Communal rooms such as lounges, dining rooms, bathrooms and toilets did not display accessible signs. This is an area for improvement.

People felt safe living at Bradstowe Lodge. Staff had the knowledge and training to protect people from abuse and avoidable harm. The provider's safeguarding policy required updating to ensure it gave staff clear information in line with the local authorities' policies and procedures. This is an area for improvement.

People received care, support and treatment when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly they were referred to a fall's clinic. The service worked closely with the GP.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

The Service was rated Good at the last on 30 September 2016 (the report was published on 17 November 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Bradstowe Lodge is owned and run by a charitable organisation. It provides accommodation and personal care support for up to 27 older people. It is situated on the seafront of Broadstairs and has coastal views. At the time of the inspection there were 26 people living at the service.

A registered manager was in post. 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. The day to day running of the service was managed and overseen by the registered manager with the support of a deputy manager and a head of care. They were all present during the inspection.

People said they felt safe living at the service. Risks to people were identified and assessed and guidance was provided for staff to follow to reduce risks to people. People received their medicines safely and on time.

Staff knew about abuse and knew what to do if they suspected any incidents of abuse. Staff were aware of the whistle blowing policy and the ability to take concerns to agencies outside of the service. Staff were confident that any concerns they raised with the management team would be investigated to ensure people were kept safe.

The registered manager followed the provider’s recruitment policy to make sure that staff were of good character. Staff completed regular training, had one to one meetings and annual appraisals to discuss their personal development. There were consistent numbers of staff deployed, day and night, to meet people’s needs. Contingency plans were in place to cover a shortage of staff in an emergency.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. Staff knew the importance of giving people choices and gaining their consent.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. There was no-one living at Bradstowe Lodge with an authorised DoLS.

People enjoyed a choice of healthy, home-cooked, food and told us they had enough to eat and drink. People’s health was assessed and monitored and staff took prompt action when they noticed any changes or a decline in health. Staff worked closely with health professionals, such as community nurses and GPs, and followed any guidance given to them to ensure people received safe and effective care.

People told us they were happy living at the service and that their privacy and dignity were respected. Staff spoke with people in a patient, kind, caring and compassionate way. People were involved in the planning of their care and support and told us care was provided in the way they chose. Each person had a descriptive care plan which had been written with them and their relatives. People’s religious and cultural needs were recorded and respected.

People knew how to complain and told us they had no complaints about the quality of service or the support they received from the staff team. The provider had a complaints policy and procedure, a copy was given to each person at the service.

People’s friends and family could visit when they wanted and there were no restrictions on the time of day. Staff spent time with people on a one to one basis. There was a range of activities which people told us they enjoyed. People were encouraged and supported to maintain as much independence as possible.

People, staff and health professionals felt the service was well-led. There was effective and regular auditing and monitoring. People, relatives and health professionals were asked their views on the quality of the service provided. The registered manager regularly met with people, their families and staff to encourage them to input into the day to day running of Bradstowe Lodge.

Staff understood the culture and values of the service – ‘Putting people first’, ‘Integrity’, ‘Impartiality and genuine concern for individuals’ and ‘Ensuring that the desired outcomes are person centred specific to people’s individual needs’.

The provider had submitted notifications to CQC in a timely manner and in line with CQC guidelines.

We last inspected Bradstowe Lodge in January 2014 when no concerns were identified.

People told us that they 'felt listened to, respected and well cared for'. One person said that they were 'always asked' before any support was provided. People had few if any grumbles, and a person explained that 'the manager is often around, always available to speak with; they do not just sit in the office you know'. We observed that staff spent time listening and speaking with people too. We asked several people if life was like this all the time. All people and the relative said what we saw was no different on any other day of the week. One person said 'staff have a great sense of humour'. Another person said the quality of the activities and events was 'always top notch'.

We found that people had thorough assessments before moving to the home, and that their care was well planned. Staff were delivering care in a kind and thoughtful way based on individual preferences.

The environment was purpose built to meet the people's needs. It was extremely clean and well maintained. All steps to reduce the chance of infection spreading had been considered and put into action.

Medicines were managed safely and the district nursing team were consulted for additional support for care, welfare and palliative care medicine matters.

People said that they were satisfied with the service and that they were happy living at Bradstowe Lodge. People said 'The food is quite good. They (staff) come round and ask what you would like. They offer different things,'

'The food is good and yes we do get a choice. I like most things but I could have something else if I asked,'

'We get spoiled, the food is very good' and 'I am having scampi today as I am not too keen on fish.'

People said that the staff were kind and caring. People told us 'I like the staff, they are all pleasant' and 'I am very well looked after.'