Archived: Beacon Hill Lodge

Updated 19 October 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 28, 29 and 30 July 2015 and was unannounced. The inspection team consisted of one inspector, a specialist professional advisor, whose specialism was in nursing older people and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We did not receive the completed PIR from the provider because the provider used the incorrect email address. After the inspection the provider gave us a hard copy of the PIR. We looked at previous inspection reports and notifications received by CQC. Notifications are information we receive from the service when significant events happen, like a death or a serious injury. Before our inspection we had information from the local authority safeguarding team.

During our inspection we spoke at length with 14 people and briefly with six people. We spoke to seven people’s relatives and the staff on duty at the service. We looked at the care and support that people received. We looked at people’s bedrooms, with their permission; we looked at care records and associated risk assessments for six people. We observed medicines being administered and inspected medicine administration records (MAR). We looked at management records including three staff recruitment files, training and support records and health and safety checks for the building. We observed the support provided to people in the lounges.

A new member of the provider’s senior management team was visiting the service for the first time on the first day of our inspection. They were present at the service during the whole of the inspection.

We last inspected Beacon Hill Lodge in June 2014. At that time we found that the registered provider and registered manager were complying with the regulations.

Updated 19 October 2015

This inspection was carried out on 28, 29 and 30 July 2015 and was unannounced.

Beacon Hill Lodge provides accommodation and personal and nursing care for up to 30 older people and to people living with dementia. The service is a large, converted property. Accommodation is arranged over three floors. A shaft lift is available to assist people to get to the upper floors. The service has 20 single and five double bedrooms, which people can choose to share. There were 23 people living at the service at the time of our inspection. Accommodation is provided for four staff on the top floor of the building.

A registered manager had not been working at the service since April 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run. A new manager began working at the service in June 2015 but was not registered with CQC.

The service lacked leadership and direction. There was a lack of leadership and oversight by the provider and this had impacted on all areas of the service. Some staff had resigned and the remaining staff were demotivated. People, their families and staff had not been asked about the quality of the service they received and were not involved in the way the service operated. Processes were not in operation to continually improve the service.

A system to make sure there were enough staff available to meet peoples’ needs at all times was not in operation. The manager had used agency staff to increase staffing levels on the second day of our inspection. Staff did not have time to spend with people and people received little interaction from staff during the day. Staff were unclear about their roles and responsibilities.

Staff recruitment systems were in place. Adequate information about staff had not been obtained to make sure staff did not pose a risk to people and had the right skills and knowledge to meet their needs. Disclosure and Barring Service (DBS) criminal records checks had been completed.

Staff were not supported to provide good quality care. The provider and manager did not know what training staff had completed and what skills and experience they had. Checks had not been completed on the competency of staff to complete their role. A training plan was not in place to keep staff skills and knowledge up to date. Staff did not have the opportunity to meet with a senior staff member on a regular basis to discuss their role and practice and any concerns they had.

Staff knew the possible signs of abuse and who to report any concerns to. Guidance was not available to staff, including new or agency staff, about the provider’s safeguarding or whistleblowing processes. Equipment and plans were not in place to evacuate the building in an emergency. Risk to people’s health and wellbeing had not been fully assessed, and action had not been taken to keep people as safe as possible. Some moving and handling equipment had not been safety checked and areas of the building and equipment were not clean. Accidents and incidents were not continually reviewed to identify and address patterns or common themes.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Staff were unclear about their responsibilities under Deprivation of Liberty Safeguards (DoLS). The provider did not have arrangements in place, as the managing authority, to check if people were at risk of being deprived of their liberty and apply for DoLS authorisations. Care for people who had DoLS authorisations had not been planned to keep people safe and to ensure restrictions were kept to a minimum. Some people were at risk of being restrained because staff had failed to check that using equipment, such as bedrails, was the least restrictive way of keeping people safe. Some people were not encouraged and supported to get out of bed. Systems were not in operation to obtain consent from people or those who were legally able to make decisions on their behalf. The provider had failed to act in accordance with the Mental Capacity Act 2005.

Information and guidance was not provided to care staff to make sure they provided the care people needed in the way they preferred. People and their relatives had not been involved in planning and reviewing their care. People were not supported to remain as independent as they could be. Care was not planned to make sure that people received consistent care and treatment, including wound and catheter care. People who had lost weight had not been referred to appropriate health care professionals for advice and support.

People did not always get their medicines at the correct time. People’s medicines were not stored in a clean environment or disposed of when they were no longer required.

Meals times were not social occasions at Beacon Hill Lodge and people were not supported to get out of bed to eat or to sit together at tables. We found that people often had to wait for their meal and there were long gaps between courses. People told us that they enjoyed the food but did not know what they were eating. People had not been involved in planning the menus. Food was prepared to meet some people’s specialist dietary needs.

Staff were not sure how to offer people choices in ways that people understood. Some staff were unable to understand what people were saying to them because English was not their first language. People told us they could not understand some staff as they had strong foreign accents. We observed that staff did not always respond appropriately to peoples’ requests.

People were not always treated with dignity and respect. People who used net underwear with their incontinence products did not received their own underwear back from the laundry. People were referred to as room numbers and tasks by staff and were not treated as individuals.

People’s privacy was not maintained. Staff, including the manager, did not knock on people’s bedroom doors before walking in and did not ask their permission to enter their rooms. People’s records were not held securely and information about them was accessible to other people and visitors to the service.

Information had not been obtained about people’s preferences and personal histories. People were not supported to continue with interests and hobbies they enjoyed. People told us they were bored and wanted things to do and people to chat to. People were not supported to build relationships with staff or other people using the service. Staff did not chat to people about people who were important to them or things that mattered to them.

An effective complaints system was not in place and was not accessible to everyone. People and their relatives had made complaints about the service but these had not been investigated and people had not received a satisfactory response.

The provider and manager were not aware of the shortfalls in the quality of the service we found at the inspection, and had not completed regular checks of the quality of the service provided. The provider had not obtained information from people and staff about their experiences of the care.

Records were kept about the care people received and about the day to day running of the service. Some records, including medicine administration records, were not accurate and did not provide staff with the information they needed to assess people’s needs and plan their care.

The registered provider had not notified the Care Quality Commission of significant events that had happened at the service. During our inspection the provider made a commitment not to admit any new people into the service until the concerns around staff and their knowledge and skills and other concerns had been resolved.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 met with the provider on 30 July 2015 and again on 23 September 2015. We had several telephone discussions with the provider about what they intended to do to improve the service. We asked the provider to send us evidence, urgently, about the immediate action they would take to ensure peoples’ safety and well-being. The provider sent us an action plan and evidence of the immediate action they had taken. They have sent us regular updates to the action plan and further supporting evidence. We considered everything the provider sent us and will follow this up at the next inspection. After the inspection, the provider informed CQC that they planned to close the service for refurbishment.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we have asked the provider to take at the end of this report.