Archived: Bedrock Lodge

This inspection was unannounced and took place on 13, 14 and 16 February 2017.

We carried out inspections of three of the provider’s locations from 13 to 17 February 2017. These locations are; Bedrock Lodge, Bedrock Mews and Bedrock Court. The reports of all three inspections can be viewed on our website. The provider’s main offices are at Bedrock Lodge. We found many aspects of the service provided at the locations to be similar. This is because the policies, procedures, systems and processes used by the provider were consistent across all three locations. In addition, a number of staff worked across all three locations and, until recently the service users from each location attended Bedrock lodge during the day. As a result, each of the three reports contains some information that is similar.

Bedrock Lodge was placed in ‘special measures’ by CQC as a result of our inspection on 27, 28 and 29 September 2016.

Following this inspection, the overall rating is ‘Inadequate’. This means that it remains in ‘special measures’. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Full information about CQC's regulatory response to these concerns will be added to reports after any representations and appeals have been concluded.

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 2008 and associated Regulations about how the service is run. The registered manager of Bedrock Lodge was also the registered provider. The registered manager was not available when we visited. They had been absent from 3 January 2017.

Following the inspection in September 2016 the provider had made arrangements for a ‘turnaround team’ to oversee the management of the service from November 2016. This had involved the provider commissioning experienced health and social care staff to be available on a day-to-day basis and co-ordinate the management of the service in addition to an independent project manager. They oversaw the senior person from the ‘turnaround team’ and an acting manager directly employed by the provider, who managed an assistant manager, senior care staff and support workers.

After the inspection in September 2016 some improvements had been made to ensure that people’s immediate safety was considered and action taken. Immediate actions included, finding alternative placements for people whose needs were not being met, people from the provider’s other two locations ceasing using Bedrock Lodge for day care and staffing levels increasing at night.

Additional improvements were identified and referred to throughout this report. However we were concerned the improvements we saw would not be sustained following the withdrawal of the ‘turnaround team’. Staff employed directly by the provider and, members of the ‘turnaround team’ themselves were unclear how much longer this arrangement would be in place. We wrote to the provider and asked them to provide us with further information detailing their plans for any withdrawal of this additional input. The response we received was vague and they told us a date for withdrawal had not been decided and that plans were yet to be agreed. This raises concerns and, we could not be satisfied, that the improvements we found would be sustained and that subsequent improvements required would be achieved. The inspection history of the service shows repeated concerns regarding keeping people safe and the leadership and management of the service.

Staff told us they were concerned any improvements would be reversed when the ‘turnaround team’ were no longer in charge and the provider took control. Some senior staff told us they felt they were able to withstand attempts to do this; others felt it unlikely they would be able to do so.

Since the inspection in September 2016, there have been 11 new individual safeguarding concerns raised with the local authority relating to people living at Bedrock Lodge and 35 in total across all three of the provider’s locations. The concerns about the service were still considered a risk by the local authority and other agencies, and the service continues to be placed in an organisational safeguarding process.

There had been a slight improvement in identifying risks and providing staff with guidance on keeping people safe. However, staff awareness of these were not consistently good and some risks had not been thoroughly planned for. Measures to ensure the prevention and control of infection were not sufficiently applied.

Staff still lacked the skills and abilities to provide effective care and support. Staff did not always have a good understanding of the principles of the Mental Capacity Act (MCA) 2005 or best interest decision making. However, people told us they were now able to make more day-to-day choices and decisions. Relevant health and social care professionals were now more involved in ensuring people’s needs were met. However on occasions staff compromised this process through their lack of knowledge and understanding.

At the inspection in September 2016 we found the provider/registered manager and staff had failed to recognise where certain practices compromised people’s dignity and respect. We also reported that the service was, in many ways, demeaning to people and did not contribute towards them being viewed as valued individuals. Although improvements had been made, people were still not always treated with dignity and respect. The improvements made had been led by the ‘turnaround team’. People told us they felt they were better cared for and more able to exercise their independence. However further progress will be required to take this forward as the structure and delivery of the service is still more likely to foster dependence than independence, because of the way the service has been previously led and managed.

People still gave the impression of feeling they were required to fit into the service rather than the service being designed and delivered around their needs. In addition, the service had failed to continually assess and support people in ensuring the service was still a suitable place for people to live. The provider/registered manager had failed in their responsibility to engage with commissioners who funded people’s placements to ensure that placements were still appropriate.

The impact on people due to the lack of support and planning to ensure smooth transitions was unsatisfactory. For people who had moved the experience had been disorganised and potentially traumatic. The attitude of staff to other professionals was not always positive. They did not see the professionals’ support as helpful and in people’s best interests. Although the ‘turnaround team’ had tried to change this attitude, it was still evident with some staff.

Although staff were making efforts to provide activities that were person centred and supported choice and personal preferences, their attempts were compromised by the provider/registered manager, and this reinforced our previous concerns around the control they exercised.

Since the ‘turnaround team’ commenced in November 2016 they had needed to prioritise the most urgent areas for improvement in order to keep people safe. Some of the actions they had taken had improved the quality of service people received. This was particularly around improving their day to day lifestyle. People were making far more choices about everyday matters, for example, what time they got up, when they went to bed, what they did during the day, what they ate and drank and when they received meals. They had worked extensively with permanent staff members on role modelling, coaching and introducing best practice.

People told us they felt safer. Staff had a better understanding of how to recognise the possibility of abuse and report concerns appropriately. Staffing levels at night had increased. The management of medicines had improved and people benefitted from revised individual protocols for the administration of these. Some positive changes to the environment had also been made.

Staff had received some additional training to meet people’s needs. We did see staff treating people in a more caring manner. People’s care records were written in a more objective and positive manner. The turnaround team had tried to build better working relationships with other agencies and to educate staff on the importance of this in order to enhance people’s health and well-being.

We found, and have reported on, breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.

This inspection was unannounced and took place on 27, 28 and 29 September 2016.

The grounds of Bedrock Lodge contain a small holding and teaching rooms. This functioned as the day service base for people living at Bedrock Lodge and, two other homes a short distance away, also registered with the provider. We inspected these two other locations at the same time as Bedrock Lodge. Our reports of those inspections should be read in conjunction with this report. In this report we have described the care people received at Bedrock Lodge. This includes people living there but also the care provided to others attending Bedrock Lodge as part of their day care activities. The two other locations registered with the provider are; Bedrock Court and Bedrock Mews. You can read the report of our inspection of each of these locations on our website at www.cqc.org.uk.

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 2008 and associated Regulations about how the service is run. The registered manager of Bedrock Lodge was also the registered provider.

We identified serious concerns during this inspection. We wrote to the provider outlining the most urgent of these and told them to provide us with a report of actions they would take to address these.

The provider/registered manager and staff had failed to recognise where certain practices compromised people’s dignity and respect. We could not be satisfied that promoting dignity and respect was fully understood. We found some of the terminology written in a people’s care records was subjective in nature and reflected a personal opinion from staff. The tone of the accounts did not reflect a sense of compassion or sympathy and, evidenced a lack of knowledge and understanding of people’s needs. Interactions with people using the service seemed at times abrupt and dismissive. There was a lack of evidence to support that staff were there for the benefit of the people they were supporting. The service was, in many ways, demeaning to people and did not contribute towards them being viewed as valued individuals.

People did not receive a service that was safe. Staff did not have a good understanding of how to recognise the possibility of abuse and report concerns appropriately. Risk assessments had not resulted in sufficiently detailed plans to keep people safe. Staff were not aware of the contents of risk assessments and management plans. There was not enough staff at night to ensure people were safe. Records regarding the administration of medicines were not maintained correctly. Checks had not always been carried out to ensure staff were safe to work with vulnerable people. The building and environment was not always safe from hazards.

The service did not provide effective care and support. Staff had not received the training required to effectively meet people’s needs. The registered manager and staff did not have a good understanding of the Mental Capacity Act (MCA) 2005. People were not encouraged to make choices and decisions. The involvement of other health and social care professionals was not sought and, as a consequence people’s needs were not always met. People did not have access to hot drinks or snacks when they wanted them.

Staff did not treat people in a caring manner. People’s relationships with family and friends were not always supported. People’s independence was not promoted. People were expected to conform to the ‘house rules’.

The service was not responsive to people’s needs. People were required to fit into the service rather than the service being designed and delivered around their needs. There was little or no choice about the type of activity people did during the day or how they wanted to live their life on a daily basis. The service did not encourage people to express their views and opinions and, when they did, action was not always taken.

The service was not well-led. The culture of the service was not empowering and person centred. The service provided was institutional, dictated by routine, with a rigid hierarchy. Quality systems were not operated effectively. People’s views were not used to make improvements. The provider/registered manager had not worked positively with other health and social care professionals.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found a number of breaches 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 the report.

We found the home to be clean and that people were protected from the risk of infection because appropriate guidance had been provided for staff. Staff followed daily cleaning schedules and supported people with their hygiene.

People were supported safely by staff who had been trained in administering medicines. Information had been well documented about the sort of medicines people took, and the times they were given had been recorded.

Appropriate checks were undertaken before staff began work. There were some references that were not in staff files although we saw that these had been followed up.

We looked at various records including menus. These showed that people were offered a choice of varied and sufficient food and drink that was monitored individually. Other records had been maintained and kept up to date including those associated with all aspects of people's care and their health and safety.

We looked at documents relating to people's care and treatment. These included care plans, daily records, and risk assessments. People had been asked for their consent before they received care or treatment.

Although there were measures in place to help prevent abuse from occurring, the provider had not responded appropriately to all allegations. Incidents of aggression between people living at the home had not always been referred to the local authority safeguarding team.

Systems in place to assess and monitor aspects of the quality of service that people received had not always been effective. Although people's views about their care had been sought the outcome had not been fed back or the issues raised followed up.

People knew how and to whom they could complain and complaints were investigated appropriately.

Records had not always been maintained accurately or reviewed so that people were protected from the risks of unsafe or inappropriate care and treatment.