Archived: Bannatyne Lodge Care Home

We spoke with 15 people who used the service, two people's relatives, three members of staff, the manager and Area Quality Assurance Manager. We also looked at five people's records and observed how people were cared for.

Three people we spoke with talked positively about the service. People told us "I like it here, I am well cared for". Another person told us "I am treated very well, the staff are lovely." One person's relative told us " I have no concerns regarding my relatives care, we are very happy."

Thirteen people we spoke with did not talk positively about the service and made comments such as "I don't want to get anyone into trouble by saying anything." Another person told us "I don't like it here, it's awful."

We spoke to people in private to establish further their concerns but people were reluctant to talk to us, some people stating they were "frightened" of the consequences of speaking out.

We looked at the areas of concern identified at previous inspections and found people were not treated with dignity and respect, people did not have their care appropriately planned and delivered, people were not protected from the risks of abuse and standards relating to infection control and cleanliness had not improved.

We found some action had been taken to improve infection control arrangements. We looked around all of the communal bathrooms and saw they were clear of people's personal toiletries. We saw there was liquid soap in all of the dispensers.

We saw the laundry was clean behind the machines and a replacement bin and ironing board cover were in place. The manager told us hoist slings had been ordered for each person who required one. We saw most of these were in use but a small number had been returned to the supplier as they had issued incorrect types.

However, we also found a number of areas of concern.

We looked in both of the sluice rooms. We found both were unlocked. The sluice on the ground floor contained some toilet seat raisers which were observed to have yellow/orange stains on the underside. We saw these were stored on the shelf above the sluice disinfector machine, alongside clean equipment. We saw the pedal on the waste bin did not operate the lid; therefore it would need to be operated by hand. There was also some equipment (suction machine) being stored on the floor next to the disinfector.

We found the sluice on the first floor was malodorous and also contained toilet seat raisers stained with faeces. We saw the bin was overflowing and the lid was on the floor.

We saw skips of soiled laundry were stored in the corridors. People who used the service were observed walking in these areas. We also saw the hand washing sink in the laundry was blocked by piles of soiled laundry.

We saw one of the bathrooms did not have a bin in place and we found the toilet was leaking. One of the toilet rooms was being used for hairdressing. The manager told us people who used the service had requested a hair washing sink. This had been installed but the toilet and clinical waste bin remained in place. We observed hairs on the soil pipe and the underside of the hair washing sink was stained.

We looked in several bedrooms. We saw some areas such as dado rails, tops of picture frames, lampshades and tops of wardrobes were dusty. Some of the en-suite bathrooms did not have bins in place. We observed continence aids and dressings were stored on the floors of some of the en-suite bathrooms. We saw the ceiling in one of the en-suite bathrooms was stained from a previous leak. During our observations in the afternoon we saw some bedding in one of the bedrooms had brown faeces marks on it. One of the rooms which we had looked at during an inspection in July had some brown splash marks on the wall. When we looked at the room during this inspection we saw the marks were still there.

We spoke with some people who used the service about their bedrooms. One person said 'They came in and cleaned the ornaments after you came the last time but they haven't done it since.'

We looked at the daily cleaning schedules in the bedrooms and saw they had been signed to say the rooms had been cleaned either on the day of the inspection or the previous day.

We looked in a storage cupboard on the ground floor. We saw this was full of mattresses. One mattress fell out as it was immediately behind the door. We saw the cover and the mattress itself were heavily stained and malodorous. The manager agreed to dispose of this mattress immediately. We looked at the mattresses in two of the vacant bedrooms. We found one mattress cover was stained, but had a clean foam mattress inside. Both covers had strong malodours. The manager told us rooms were cleaned before they were allocated to someone else.

We looked at several radiators around the home. We saw many were unclean and had debris, such as hair, within the fittings. We observed some seat arms in the first floor lounge were engrained with dirt. The manager told us they were in the process of ordering new chairs for the lounges. We looked at some fans, in both communal areas and bedrooms. We saw the fan blades were dusty. This meant if the radiators or fans were switched on the dust particles could spread around the room and increase the risk of cross infection.

We looked in the linen cupboard. We found some of the pillows and chair cushions stored on the shelves were stained. We saw three wheelchairs which were unclean. The manager told us they were waiting for two of the wheelchairs to be collected by the local wheelchair services. The other wheelchair was labelled with the name of a person using the service. The provider's infection control policy stated that 'if a wheelchair is dirty in the interim period it must be cleaned.' This meant that the wheelchairs should have been cleaned in between the scheduled cleans if they were dirty.

During the inspection we looked around the dining room. We saw the ceiling fan and picture frames were dusty. We observed an open bin next to the kitchen entrance and a fruit bowl. We saw some bottles of sauce stored in one of the cupboards. The bottles were stained and not labelled or dated. We found the menus on the display board and the menu folder were soiled with food particles. We looked at some of the tables and chairs and saw some were soiled with dirt and food particles. We saw one of the curtains had splash marks on it. The manager told us they had been cleaned a few days previously so it was a recent spillage.

We asked the manager about the monitoring and audit arrangements. They told us they carried out a daily infection control audit. We looked at the audits from the previous four weeks. The records did not refer to any of the issues we identified during our inspection. The audits listed the communal areas; there were no records of which, if any, bedrooms were checked.

We saw the regional manager carried out a monthly 'home environment' check. We looked at the records from the checks carried out in August and September 2013. The checklists referred to the need for some new armchairs in the lounge areas. The audit carried out in September 2013 also referred to the observation of some dust; this was attributed to some building work nearby. The audits were followed up by a memo from the regional manager to the home manager. We saw the memos for both August and September 2013 stated 'checklist completed, no issues identified'.

The monitoring and audit arrangements in place did not identify many of the areas of concern which were found during our inspection. This demonstrates that the systems in place were not robust.

All providers of health and social care have to comply with the Code of Practice for health and social care on the prevention and control of infections, and related guidance. We found that criterion 2 of this code, which requires the provider to maintain a clean and appropriate environment, was not being met.

We observed how staff asked people for consent. For example, one person was sitting in the dining room and staff asked if they wanted help to eat their meal. One relative of a person who used the service said, 'They always explain what's happening and ask if it's OK.' Another person said, 'The nurse always asks if it's OK before she takes my blood.'

During our inspection we saw one person was not transferred from their chair to a wheelchair in line with their care plan.

People appeared happy with the care provided. Comments included, 'My (relative's name) gets on really well with the staff', 'They look after us well', 'I like it the way it is' and 'The staff are top of the class and six pints over.'

We saw several areas of the home were unclean , including some communal areas and bedrooms.

We spoke with seven people who used the service. Most people were happy with the staffing levels. One person said, 'Yes I think there's enough staff.'

We asked people what they would do if they had a concern. One person said, 'The staff are approachable, if there was a problem I would go to them and then the manager if necessary.'

People were happy with the care provided. Comments included 'They are very caring here", 'I think it's great' and 'They understand my needs'. One relative said 'Some staff are alright but others aren't, they sometimes don't handle people very well'.

During our inspection we looked around the home. This was to see if it was kept clean and cross infection minimised. The majority of areas within the home were clean. We looked at equipment such as hoists and shower chairs that were provided to help meet people's mobility needs. We saw this equipment was clean. However, we also saw areas which were not clean and some practices which increased the risk of cross infection.

When we visited the home, we looked at the medication records held on behalf of people who lived there. We also observed the nurse and senior carer administering medications at lunchtime. We saw they spent time with each individual, explained what the medication was for then recorded it in that person's file.

We saw there was a detailed complaints policy in place. There was a copy on display in the reception area and in the Service User guide. This meant people were kept informed about how to raise any complaints or concerns they might have.