Bell Lodge

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.

Bell Lodge is a residential care home providing accommodation for persons who require nursing or personal care. The care home accommodates up to 15 people in one adapted building. At the time of our inspection there were 11 people using the service.

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

People’s experience of using this service and what we found There was a lack of managerial oversight of the service, its systems and processes to ensure people’s care met the regulatory requirements. Quality assurance systems were not always effective at identifying any areas of concern for example, environmental audits had not highlighted issues in relation to fire safety.

People’s risk management plans had not always been updated when people’s needs changed and some risks to people had not always been mitigated with detailed risk assessments. Records management was disorganised, and key documents could not be found easily.

There was a lack of leadership and no responsible person when the provider was not at the service. For example, the registered manager did not know how to access many documents because they were not sure where the provider held them.

Care plans were not user friendly and lacked person centred information. Personalised outcomes for people were not recorded in their plans of care. Outcomes or advice from health professionals was not always recorded or referred to within the care plans.

No satisfaction surveys to seek people’s feedback on the care received had been sent out for over 12 months. There was no evidence that previous feedback from people had been used to drive improvements at the service.

The provider did not have a robust system in place to plan, monitor and record staff training or track staff supervisions.

Policies and procedures needed to reviewed and updated so they reflected current legislation and best practice. The fire risk assessment in place also referred to old legislation and needed to be updated.

Some people received medicine which were administered ‘as and when required’ (PRN). There were no protocols in place to advise staff when people should be supported to receive these medicines. We have made a recommendation about the management of some medicines.

Staff recruitment procedures needed to be strengthened to ensure only suitable people were employed to work at the service.

Systems in place for the prevention and control of infection need to reflect up to date legislation and current best practice. We have made a recommendation about the prevention and control of infections.

Some areas of the environment were in need of repair and refurbishment.

At the time of our inspection the service was not providing end of life care to people. There was no end of life policy in place to guide staff and most staff had not completed any end of life training. The provider told us this was planned for the future.

People told us they felt safe living at the service and staff understood what abuse was and how to report it. There were sufficient numbers of staff to meet people’s needs.

People's care needs were assessed before they went to live at the service, to ensure their needs could be fully met. Staff received an induction when they first commenced work at the service and on-going training.

People were supported to eat and drink enough to maintain their health and well-being. Staff supported people to live healthier lives and access healthcare services.

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. We saw throughout our inspection that staff always asked people for their consent before they undertook any tasks.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service very well and had built up kind and compassionate relationships with them. People told us they were always given choices about their day to day routines and were involved in their care.

People's privacy and dignity was always maintained, and staff consistently treated people with respect.

People were encouraged to take part in a variety of activities and interests of their choice and some accessed the local community regularly.

There was a complaints procedure in place and systems in place to deal with complaints effectively, however this needed to included details of how the complainant could contact the Local Government Ombudsman (LGO) if they were not happy with the outcome of their complaint.

Rating at last inspection

The last rating for this service was Good (published 22 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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 have identified one breach in relation to the governance of the service.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

People continued to receive safe care. Staff were appropriately recruited and there were enough staff to provide care and support to meet people’s needs. People were consistently protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on going professional development that they required to carry out their roles. People were supported to maintain good health and nutrition.

People developed positive relationships with the staff who were caring and treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.

The service had a positive ethos and an open culture. The registered manager was a positive role model in the home. People and relatives told us that they had confidence in the manager’s ability to provide consistently high quality managerial oversight and leadership to the home.

We spoke with two relatives of people that used the service. One relative told us 'It's a great service. We wouldn't want mum to be anywhere else'. Another relative told us 'It's just brilliant'.

We spoke with a staff member who told us that they felt well supported and that they received regular supervision.

We found that people's preferences were recorded in their care plans and that care plans and risk assessments were regularly reviewed. We found that there were appropriate arrangements in place to manage medication.

We had concerns about how frequently staff were receiving training.

Staff members told us that they enjoyed their work and because it was a small home they got to know the people who live there well.

We found that care plans and risk assessments were in place and being regularly reviewed. We found that staff had received appropriate pre-employments checks. However, we found concerns about medication and records.