Bruce Lodge

About the service

Bruce Lodge is a care home which provides accommodation and personal care for older people, some of whom live with dementia, and was supporting 64 people at the time of inspection. The service can support up to 66 people. Part of the home was currently providing short-term, care placements for people who have been discharged from hospital but not yet ready to return home. People had their own bedrooms and access to various communal areas and secure outside gardens.

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

Staff had undergone safe recruitment checks prior to working at the home. Medicines were mostly managed safely. Risks to people's health, safety and well-being had been identified through assessments and care plans provided staff with the relevant information and guidance to help support people safely. We have made a recommendation about safe storage of thickeners.

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. People at risk of malnutrition were supported to help ensure they had a good level of nutritional intake. We have made a recommendation to ensure people have access to water at all times. Referrals to other agencies were made when needed and this helped people access the healthcare they needed. People were supported by staff who had received training and supervision.

People told us staff were caring, kind and treated them well. We mostly observed staff treating people with respect and encouraging them to be independent and make decisions about their care when they were able to. Staff respected people's right to privacy, dignity and confidentiality.

Care plans included information about people’s backgrounds and diversity to guide staff about what was important to them. We have made a recommendation about people’s staff gender preferences for care.

The registered manager had good links with other organisations and built relationships with key people such as the local authority and health protection teams. Statutory notifications were submitted as required. We found there were still some improvements to be made to the oversight of the quality and safety of the service and we have made a recommendation about this.

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 21 December 2021)

At our last inspection we recommended that the provider ensures there are enough staff to meet people's needs. At this inspection we found they had made improvements. At our last inspection we recommended that the provider ensures people are safely supported to take their medicines. At this inspection we found they had made improvements.

Why we inspected

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.

The inspection was prompted in part due to concerns received about laundry management, person-centred care and lack of activities. A decision was made for us to inspect and examine those risks.

Recommendations

We have made one recommendation about safe storage of thickener, one recommendation about the accessibility of water and one recommendation about people’s gender preferences for care. We have also made a recommendation about robust quality monitoring systems.

Follow up

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

Bruce Lodge is a care home which provides accommodation and personal care for older people, some of whom live with dementia, and was supporting 39 people at the time of inspection. A new unit had been built, and once this unit was open, the service can support up to 67 people. People had their own bedrooms and access to various communal areas and secure outside garden.

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

People’s needs and risk were assessed but records were not always consistent and detailed. People felt safe but there was not always enough staff to meet their needs quickly. We have made a recommendation about staffing levels. People had their medicines as needed, but records lacked detail about how to support people with medicines that they needed occasionally, or which were given covertly hidden in food or drink. We have made a recommendation about the management of some medicines. Work was ongoing to ensure lessons were learnt from accidents, incidents and safeguarding concerns.

There was a new registered manager and operational management team in post. They completed a variety of checks to ensure the quality of the service and were working through a range of actions as part of the service improvement plans. People spoke positively about the registered manager and felt able to raise concerns with them. The registered manager worked with other health care services to ensure people’s needs were met and they were committed to driving improvement within the home.

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 good (published 17 June 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the management of falls. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

Follow up

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

Bruce Lodge is a care home which provides accommodation and personal care for up to 47 older people, some of whom live with dementia and/or mental health issues. The home is based in Stockport, Greater Manchester.

People’s experience of using this service:

Staff had undertaken appropriate safeguarding training and knew how to raise a concern. Any concerns were raised appropriately with the local safeguarding team, documented and followed up as needed.

The service held electronic health and safety records and relevant certificates were in place and up to date.

Individual risk assessments were completed and held within individual electronic care files. Accidents and incidents were documented and followed up as required.

Recruitment systems were robust and there were sufficient staff on the day of the inspection to meet the needs of the people who used the service.

Medicines systems were safe. Staff had infection control training and appropriate personal protective equipment (PPE) was worn when carrying out personal care support.

Care files were person-centred and included people’s personal histories. Staff were knowledgeable about people’s preferences. The electronic care record system used by the service helped ensure all information was live. The system flagged up tasks to be done and any alerts for staff to be aware of and staff were able to update the system instantly from hand-held devices.

New staff undertook a company induction programme and further training and refresher courses were on-going.

People’s specific dietary needs and risks with regard to nutrition and hydration, were documented, along with individual preferences and choices. People said they enjoyed the food and choices were offered at each meal.

The environment was pleasant and there was plenty of space for people to walk around as they wished. The service had received planning permission to build a 20 bed extension and building work was on-going at the time of the inspection. This was being managed effectively and causing minimal disruption to the running of the home.

The service was working within the legal requirements of The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People said they were well looked after. Staff were observed to talk to residents with respect and attention, often touching them on the shoulder or hand. Individual communication needs were recorded within care files.

People who used the service and their families were fully involved in the support plan process. People’s dignity and privacy was respected by staff.

There was a range of activities and outings offered to people to take part in. Relatives were encouraged to participate in activities and outings if they wished to be involved.

There was a complaints policy and people were encouraged to raise any concerns. Complaints were responded to appropriately.

People’s wishes for when they were nearing the end of their lives, if they were able to express them, were documented within their care files.

The registered manager, deputy managers and provider had good oversight of the home. Staff felt well supported by management and there were regular staff meetings, supervisions and appraisals.

A number of regular audits and checks took place at the home. These audits were all up to date and action plans were implemented and completed for any issues identified.

The service had good relationships with the wider community as well as other professionals and agencies.

Rating at last inspection:

At the previous inspection published on 20 April 2018 the service was rated Requires Improvement in safe, effective, responsive and well-led and good in caring. This meant the overall rating for the service was Requires Improvement. This was due to a lack of fire drills and insufficient information to safely evacuate people, some issues with topical medicines records and some audits which had failed to identify issues. At this inspection we found improvements in all these areas.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. Inspection timescales are based on the rating awarded at the last inspection and any information and intelligence received since we inspected. As the previous inspection was Requires Improvement, this meant we needed to re-inspect within approximately 12 months of this date.

Follow up:

We did not identify any concerns at this inspection. Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for services rated Good

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

At the last inspection on 22 September 2016, the service was rated as requires improvement. We found two breaches of the regulations, as improvements were needed in the management of medicines, fire safety and the registered provider had not ensured good governance in the home.

Bruce Lodge is a purpose built care home situated in Stockport. The service provides care and accommodation for up to 47 older people, some of whom were living with dementia. At the time of our inspection 39 people were living at the home, with two people were receiving a day care service.

The home has four units, called Bluebell, Rose, Sunflower and Fern, which people can move freely between. The service has communal lounges, dining rooms and bathing facilities available. Accommodation is provided over two floors which can be accessed by a passenger lift. To the front of the building is a large secure landscaped garden and car parking is available. People in care homes receive accommodation and nursing and/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.

A registered manager was in place at the home. 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. We explained to the current registered manager that the previous registered manager of the home was still registered for Bruce Lodge. We were provided assurances that the provider would ensure an application to de-register the previous manager would take place.

The provider had not taken reasonable actions to ensure the safety of the premises. During our tour of the home we noted several potential safety hazards. For example, we found the sluice room on the ground floor was unlocked which stored hazardous substances, such as cleaning products. The premises had not been made secure to minimise the risk of people unintentionally touching or drinking the hazardous substances with the potential of causing themselves harm.

The management of medicines had improved which meant people would get the medicines that they required. Records in regards to medicines were accurate and there were care plans which provided staff with information to ensure that the right medication was given to the right person at the right time. However, we found the room temperature in the ground floor clinic was exceeding 25 degrees centigrade. Manufacturers advise that medicines are stored at a temperature below 25 degrees centigrade. If the temperature is above this medicines can lose their efficacy. The registered manager told us they were considering installing an extractor fan to circulate the air more and reduce the temperature in the room. We found there were no plans, or 'when required' (PRN) protocols in place to inform staff when and how they should administer people medicines that were not required routinely. We signposted the registered manager to review the NICE guidance on 'Managing Medicines in Care Homes' as this provides recommendations for good practice on the systems and processes for managing medicines in care homes.

We examined staff training records which demonstrated that training relevant to their job roles was provided. The provider recognised they needed to adapt the training programme delivered to staff with the introduction of classroom dementia awareness training, which was due to be provided to the staff team to help staff gain a better understanding of supporting people living with dementia.

People told us that they were well cared for and in a kind manner. Staff knew the people they were supporting well and understood their requirements for care. We found that people were treated with dignity and respect. People were supported and involved in planning and making decisions about their care.

During our inspection we saw staff were attentive and responded to people who might need assistance in a timely way. There were sufficient numbers of staff on duty to provide people with the support they needed. However, we noted on occasions staff were not always visibly present in communal lounges for short periods of time. We have provided this feedback to the registered manager and area lead during the inspection.

The provider was not always acting in accordance with the Mental Capacity Act 2005. We found the provider had not always submitted deprivation of liberty safeguards (DoLS) applications for all people living at the home. We found 10 DoLS had not been applied for in a timely manner. This meant people were at risk of their liberty being restricted unlawfully.

Some staff when asked were not confident about their duties and responsibilities in relation to the MCA 2005 and DoLS. The registered manager advised us that she would arrange further staff training to help make sure staff confidence was increased in this topic.

The Care Quality Commission had not been sent all the required statutory notifications relating to the outcome of some the Deprivation of Liberty Safeguards (DoLS) that had been made to the authorising authority in a timely manner. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

People's social needs were met. This was because staff were encouraged to interact meaningfully with people and recorded their interactions.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the registered manager.

Care plans were based on the needs identified within the assessment, however we found four care plans did not have a dementia specific care plan in place, and therefore it did not reflect the current needs of these three people.

Whilst some improvements have been made to the registered provider's governance and auditing systems these were still not robust to ensure the safety of people was maintained. The registered provider had failed to ensure that the home had improved or sustained improvement in some identified areas.

This is the second consecutive time the service has been rated Requires Improvement.

We found three 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 this report.

Bruce Lodge is a purpose build care home situated in Stockport. The service can provider care and accommodation for up to 47 older people. At the time of our inspection 46 people were living at the service. The service has communal lounges, dining rooms and bathing facilities available. Accommodation is provided over two floors which can be accessed by a lift. To the front of the building is a large secure landscaped garden and car parking is available.

The service had a registered manager in place. 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.

Emergency procedures were in place for staff to follow and personal emergency plans were in place for everyone, however these lacked details. Fire drills had not taken place; discussion on what to do in the event of a fire had taken place but these were not practical fire drills.

Medicines were not always managed appropriately. The registered provider had policies and procedures in place to ensure that medicines were handled safely. Medication administration records were completed fully to show when oral medicines had been administered and disposed of. People we spoke with confirmed they received their oral medicines when they needed them. However, topical medication, such as creams, was not always recorded when it had been administered and we saw gaps in these records.

People and their relatives told us they felt safe. Risk assessments were in place for people who needed these. Risk assessments had been regularly reviewed and updated when required.

Accidents and incidents were monitored to identify any patterns and appropriate actions were taken to reduce the risks.

Staff we spoke with understood the procedure they needed to follow if they suspected abuse might be taking place and the registered provider had a policy in place to minimise the risk of abuse occurring.

Certificates were in place to ensure the safety of the service and the equipment. Maintenance and fire checks had been carried out regularly.

A recruitment process was followed to reduce the risk of unsuitable staff being employed. All new staff completed a thorough induction process with the registered provider.

Staff performance was monitored and recorded through a regular system of supervisions and appraisal. Staff had received training to support them to carry out their roles safely.

People were supported to maintain their health. People spoke positively about the food and drink provided at the service. Staff understood the procedures they needed to follow if people became at risk of malnutrition or dehydration.

Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and knew what action they would take if they suspected a person lacked capacity. We saw that documentation was in place to show best interest decisions being made appropriately.

Each person was involved with a range of health professionals and this had been documented within each person's care records. From speaking with staff we could see that they had a good relationship with health professionals involved in people’s care. People’s care records contained evidence of appropriate referrals to professionals such as falls team, SALT and tissue viability nurses.

The service was clean and neutrally decorated throughout but was adapted to support people living with a dementia. People were able to bring their own furniture and personalise their bedrooms.

People spoke highly of the service and the staff. People said they were treated with dignity and respect.

People, and where appropriate their relatives, were actively involved in care planning and decision making. This was evident in signed care plans and consent forms. Information on advocacy was available.

Care plans detailed people’s needs, wishes and preferences and some were person-centred, however some areas of the care plans lacked person centred information. Care plans had been regularly reviewed and we saw evidence that relatives had been invited to these reviews. Relatives we spoke with confirmed this.

The service did not currently have an Activity Lifestyle Facilitator who managed activities, but there were plans to recruit a person for this position. Staff spent time preparing and conducting activities with people and we saw a variety of activities on offer. Some people felt activities could be improved and more stimulation was needed.

The service had a clear process for handling complaints. There had been two complaints received in the past twelve months which had been managed appropriately. People we spoke with confirmed they knew how to make a complaint.

Staff told us they enjoyed working at the service, felt supported by the management and were confident any concerns would be dealt with appropriately. We could see from our observations and speaking with people that the registered manager had a visible presence at the service.

Quality assurance audits were completed by the registered manager and action plans were generated. However, effective monitoring systems were not in place and the issues we found during inspection had not been identified such as care plans were not always person centred, activities were not accurately recorded and practical fire drills had not taken place.

Feedback was sought from people, relatives, and staff. ‘Comment cards’ were regularly given to people and relatives to complete. The manager told us this information was evaluated and action plans produced where needed.

Staff worked with various healthcare and social care agencies and sough professional advice to ensure that people's individual needs were being met.

The registered manager understood their role and responsibilities and was able to describe when they would be required to submit notifications to CQC.

We looked at the care files of eight people living at Bruce Lodge. We found examples of people being involved in the planning of their care. We saw information was written in a style which encouraged them to be involved in decision making about their own care and support.

We saw safety checks were in place to protect people from the risks associated with the storage, preparation and cooking of food. These checks included ensuring food had been stored within the recommended temperature ranges.

Families told us they felt confident their relatives were safe. They said "we come most days and would know if something was not right, we are able to visit anytime, it is very open here, people are well looked after".

People told us they were happy with the way they were supported. We observed staff and people's interactions throughout the inspection. Relationships were positive and respectful.

We saw regular supervisions were taking place and staff said they felt supported.

The people we spoke with told us the staff were very kind, patient and carried out a very good job in caring for their relatives. They told us they felt there were enough staff around.

They also told us they had no concerns about the care they received and would speak to the Registered Manager if they had any concerns.