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Bamfield Lodge Requires improvement

Reports


Inspection carried out on 29 August 2018

During a routine inspection

Bamfield Lodge is a care home. People in care homes receive accommodation and nursing 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.

Bamfield Lodge provides accommodation with nursing and personal care for up to 60 people. At the time of our inspection 47 people were living in the home. The home comprises four units over three floors. Crocus, on the ground floor, provides personal care, Bluebell and Daffodil on the first floor provide nursing care and Snowdrop on the second floor provides care for people living with dementia.

At the last inspection on 26 September 2017 the service was rated Requires Improvement. We found repeated breaches of the regulations relating to management of medicines, risk management and quality assurance systems. We imposed a condition on the provider’s registration. We also found a breach of the regulation relating to staff supervision and training and we issued a requirement action. Following the inspection, the provider was required to send us an action plan each month telling us how they were making the required improvements.

We carried out a comprehensive inspection on 29 & 30 August 2018. At this inspection, we found improvements had been made and the legal requirements had been met. However, further improvements were needed to make sure all shortfalls were promptly identified and where changes had been made, these were consistent and sustained.

At the time of our inspection, an incident relating to medicines management for medicines that required additional security had been reported to the police and to the Local Authority safeguarding team. A safeguarding investigation was being undertaken.

Overall, the service has remained Requires Improvement.

There was a registered manager in post. They completed the registration process soon after our inspection visit. 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.

Sufficient numbers of staff were not deployed on the first day of our inspection. Sufficient staff were deployed on the second day of our inspection.

Staff were safely recruited. Staff received sufficient supervision and training to ensure they could meet people’s needs.

There were improvements in the management of medicines and shortfalls were acted upon with actions agreed. Further improvements were needed to make sure the improvements were consistently implemented.

Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.

People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

Risk assessments and risk management plans were in place. Improvements were needed to make sure care was consistently delivered in line with assessed and current needs.

Incidents and accidents were recorded and showed that actions were taken to minimise the risk of reoccurrence.

People’s dietary requirements and preferences were recorded. People did not always receive the support they needed at mealtimes.

Staff were kind and caring. People were being treated with dignity and respect and people’s privacy was maintained.

An activities programme provided a range of activities and entertainment.

Systems were in place for monitoring quality and safety. Improvements were needed to make sure shortfalls were identified and actions taken consistently to make improvements.

In line with our procedures for services that have been repeatedly rated as Requires Improvement, we will meet with the registered

Inspection carried out on 26 September 2017

During a routine inspection

Bamfield Lodge provides nursing and personal care for up to 60 people. The home comprises of four units, located over three floors. The Crocus unit provides residential care. The Daffodil and Bluebell units provide nursing care. The Snowdrop unit provides care for people living with dementia. At the time of our inspection there were 57 people living in the home.

The inspection took place on 26 September 2017 and was unannounced. The last inspection report was published on 2 December 2016. At that inspection there were four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches, some of which were repeated from the previous inspection, related to medicines management, person centred care, record keeping and quality assurance.

This comprehensive inspection was brought forward due to a number of safeguarding concerns being raised that related to the safety, care and treatment of people living in the home. The local authority safeguarding team and the police were currently involved in investigations which were on-going at the time of our inspection.

There was no registered manager in place at the time of our inspection. 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. One of the provider’s registered manager’s from another care home had been providing management support for the home. On the day of our inspection one of the provider’s senior support managers started in post, on a full time basis.

At our previous three inspections we found that peoples’ records were not accurately completed and that care plans did not always reflect peoples’ individual needs. We issued requirement actions. The provider sent us an action plan telling us what actions they were taking to become compliant. At this inspection we found that improvements had been made. However, further improvements were needed.

We found medicines were not always safely managed. Risk assessments and risk management plans were in place but were not always accurate and up to date. Safe staff recruitment procedures were completed. Sufficient numbers of staff were not always deployed to meet peoples’ needs. Staff were not always provided with sufficient support, supervision and training.

There was a lack of consistency in the process followed when people lacked the capacity to consent and make their own decisions. The managers and staff were not aware who had authorised Deprivation of Liberty Safeguards in place. This had been identified at our last inspection as an area for improvement.

Staff demonstrated a kind and caring approach and they treated people with dignity and respect. Staff knew people well and were able to tell us about people’s likes and dislikes, choices and preferences. These were not always reflected in the care records. People were provided with a range of activities and entertainment on a daily basis.

There was no registered manager in post. Most people were not aware of the management arrangements in the home. Staff expressed concerns with regard to the lack of consistent leadership and management.

Sufficient actions had not been taken in response to the breaches of regulation identified at the last inspection. People were not receiving safe care and treatment. The provider’s quality assurance systems did not identify, or actions had not been taken, to consistently address the shortfalls we found.

We made a recommendation with regard to staffing.

We found repeated breaches in two of the regulations at this inspection. We found a further breach with regard to staff supervision and training. Full information about CQC's regulatory response to any concerns found during inspections is added to the report after

Inspection carried out on 3 November 2016

During a routine inspection

This inspection took place on 3 November 2016 and was unannounced. The last full inspection took place in October 2015 and, at that time, three breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to need for consent, person centred care and good governance. These breaches were followed up as part of our inspection.

Bamfield Lodge is registered to provide personal and nursing care for up to 60 people. The service comprises of four units. The Crocus unit provides residential care. The Daffodil and Bluebell Units provide nursing care. The Snowdrop unit provides residential care for people living with dementia. At the time of our inspection there were 60 people resident in the home.

There was no registered manager in place on the day of our inspection. 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 service is currently undertaking a recruitment drive to appoint a new manager.

At our previous two inspections we found that that people’s records were not always completed consistently or correctly to monitor and manage their long term health conditions. The provider sent us an action plan telling us what they were going to do to become compliant. Although improvements had been made this area of their work requires further development.

At our previous two inspections we found that the care plans did not reflect people’s individualised needs. The provider sent us an action plan telling us what they were going to do to become compliant. Insufficient improvements had been made. The quality and content of care plans continued to be variable. Although some were well written, with clear guidance for staff to follow, this was not consistent. Care plans were not consistently written in conjunction with people or their representative and people had not signed their care plans to indicate their agreement. This area of their work requires further development.

In October 2015 we found that people’s rights were not being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. Although we found sufficient improvements had been made staff knowledge of Deprivation of Liberty Safeguard authorisations required improvement.

Medicines were not managed safely. We saw gaps in some Medicine Administration Record (MAR) charts where staff had omitted to sign to confirm they had administered medicines as prescribed. The service was not following the provider’s own policy in relation to covert administration. Topical medicine charts were in place, but these had not been consistently signed to indicate that people had their lotions and creams applied as prescribed.

Records showed that a range of checks had been carried out on staff to determine their suitability for work. Staffing rotas viewed demonstrated that staffing levels were maintained in accordance with the assessed dependency needs of the people who used the service. Staff were supported through an adequate training and supervision programme. People told us they felt safe living in the service.

People had access to on-going healthcare services. Records showed when people were reviewed by the GP, district nurse, tissue viability nurse, speech and language team and the dementia well-being team. Referrals for advice and support were made in a timely manner and when people’s needs changed.

People told us the staff were kind, caring and respectful. Comments from people and relatives included, “The staff are all good” “They [the staff] are lovely to me” and “I’m pleased to be here, the staff are so kind.” Throughout the day, we saw and heard kind, caring and respectful

Inspection carried out on 9 & 12 October 2015

During an inspection to make sure that the improvements required had been made

This inspection took place on 9 and 12 October 2015 and was unannounced. The last full inspection took place in February 2015 and, at that time, four breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to safe care and treatment, staffing, good governance and person-centred care. These breaches were followed up as part of our inspection.

Bamfield Lodge is registered to provide personal and nursing care for up to 60 people. The service comprises of four units. The Crocus unit provides residential care. The Daffodil and Bluebell Unit provides nursing care. The Snowdrop unit provides residential care for people living with dementia. At the time of our inspection there were 58 people resident in the home.

There was no registered manager in place on the day of our inspection. The acting manager had processed their registered manager’s application and they were formally registered on 15 October 2015. 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.

In February 2015 we found that that people’s records were not always completed consistently or correctly to monitor and manage their long term health conditions. At this inspection the provider continued not to protect people against the risk of poor or inappropriate care as accurate records were not being maintained. Not all records were completed to manage people’s on-going needs to ensure they were met.

In February 2015 we found that the care plans did not reflect people’s individualised needs. At this inspection insufficient improvements had been made. The quality and content of care plans were variable. Although some were well written, with clear guidance for staff to follow, this was not consistent. Care plans were not consistently written in conjunction with people or their representative and people had not signed their care plans to indicate their agreement.

In February 2015 we found that that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the safe keeping and safe administration of some medicines. We found that improvements had been made. We observed that medicine administration rounds were more organised and uninterrupted. People’s preferences of how they wanted to take their medicines were observed and noted in the front of the Medicines Administration Records (MAR) chart. People received their medicines at the time they needed them and the records were accurate so the effectiveness of the medicines could be monitored.

We found areas in the provider’s medicines management which required improvement. The provider needed to work more closely with the GP to share information on peoples’ medicines compliance and consumption behaviour to optimise the effectiveness of peoples’ medicines.

In February 2015 we found that people were not always safe as there were not always sufficient numbers of suitably qualified and skilled staff to support their needs. Although we received mixed comments from staff and people regarding staffing levels we found improvements had been made. The manager told us that the current staffing levels were in accordance with the assessed dependency needs of the people who used the service. We did not observe unsafe practice and people received the appropriate support at the correct times such as meal times, medicine rounds and when personal care was needed.

People’s rights were not being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. In some people’s support plans we did not see information about their mental capacity and Deprivation of Liberty Safeguards (DoLS) being applied for. These safeguards aim to protect people living in care homes from being inappropriately deprived of their liberty.

A range of checks had been carried out on staff to determine their suitability for the work. Staff were supported through an adequate training and supervision programme. Staff we spoke with demonstrated a good understanding of how to recognise and report abuse.

People had their physical and mental health needs monitored. All care records that we viewed showed people had access to healthcare professionals according to their specific needs.

People and relatives spoke positively about the staff and told us they were caring. One person told us; “I can’t fault it really. If I ask them for help they would. I feel safe and well-supported.” Staff were knowledgeable about people’s needs and told us they aimed to provide personal, individual care to people.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them. One person commented; “It’s lovely here and I go out with my family.”

Since the appointment of the manager the overall feedback about the service had been positive and there had been a perceived notable improvement in the running of the service. Staff spoke positively about the manager. People were encouraged to provide feedback on their experience of the service and monitor the quality of service provided.

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.

Inspection carried out on 24 February 2015

During a routine inspection

This inspection took place on 24 February 2015 and was unannounced. The previous inspection was carried out on 13 March 2014. There had been no breaches of legal requirements at that time.

Bamfield Lodge is registered to provide accommodation and personal care and nursing care. The service comprises of four units over three floors. The top floor unit provided care to people who were living with dementia. At the time of our inspection there were 59 people using the service.

A registered manager was not in post at the time of inspection. 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.

Systems were in place to safely manage people’s medicines however improvements needed to be made in this area. Some people’s medicines were not given at the time recorded.

Not all staff received training to help them understand their obligations under the Mental Capacity Act 2005 and how it had an impact on their work. However some staff we spoke with confirmed they had an understanding and were awaiting training dates.

Not all staff had attended Deprivation of Liberty Safeguards training (DoLS). This is legislation to protect people who lack mental capacity and need to have their freedom restricted to keep them safe. Two people using the service were subject to a DoLS authorisation. All documentation was appropriately completed that safeguarded the person’s human rights.

There were not sufficient staff to enable them to perform their roles effectively. Some people received their medicines later than prescribed and staff were not always available to support people to keep them safe. Some people who used the service and their relatives told they felt there was not enough staff on duty at certain times of the day. People were observed unsupervised in shared areas when they required support.

Not all records were completed to manage people’s on going health needs to ensure they were met. Risks associated with nutrition and hydration were not always managed effectively as the records were not always completed fully or correctly.

We saw care files contained sections for medicines, mobility, nutrition and other care needs. The care plans were reviewed mostly monthly, although there were some gaps were found.

The care plans we viewed contained information about people’s likes and dislikes as well as their needs.

We found the provider had systems in place that safeguarded people and staff understood the policy and guidance. People we spoke with told us they felt safe living in the home.

Staff meetings and manager meetings took place with the service manager on a regular basis. Minutes were taken and any actions required were recorded.

Safe recruitment processes were in place and appropriate checks were made before people started work in the service.

Quality and safety in the home was monitored to support the registered manager in identifying any issues of concern. There were systems in place to obtain the views of people who used the service and their relatives.

We found several beaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which now correspond to 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.

Inspection carried out on 13 March 2014

During an inspection to make sure that the improvements required had been made

We undertook an inspection on 21 August 2013. The provider was not meeting one of the "Essential Standards of Quality and Safety" regarding staffing. The staffing levels at the home were not based on the needs of the people who used the service. We conducted a follow-up inspection on 13 March 2014. The purpose of the inspection was to check that the necessary improvements had been made to ensure compliance with the essential standards.

We spoke with seven members of staff, five people who used the service and five relatives. Some people thought things had improved and staffing levels were better. Other people felt that no improvements had been made. The people we spoke with all provided positive feedback regarding the care staff. We observed that staff acted professionally throughout our inspection.

We found that the provider had undertaken a recruitment drive to employ nursing and caring staff. They had also recruited a pool of bank staff which could respond to unexpected changing circumstances, such as covering sickness. The provider completed a Royal College of Nursing (RCN) dependency assessment which assessed the person’s need for nursing care. The needs assessment demonstrated that the current staffing levels met the nursing needs of the people who used the service.

The provider had taken the appropriate steps to ensure that there were sufficient numbers of suitably qualified and skilled persons employed for the purposes of carrying out the service.

Inspection carried out on 21 August 2013

During an inspection in response to concerns

We carried out this inspection as concerns had been raised about the levels of staffing and the care and support provided at Bamfield Lodge.

On the day of our inspection there were 57 people living at the home. We spoke with eight people living at the home. We were unable to speak to all the people in detail about their experience of living at Bamfield Lodge as they were living with dementia and had complex needs. We used observations and spoke with staff to gain an understanding of their experience.

We saw that care plans had been reviewed regularly. The care plans reflected the current needs of the people living at the home.

Staff we spoke with demonstrated that they had a detailed knowledge of the people they were supporting. We saw care workers on the dementia unit interacting with people in a friendly and respectful manner. When people showed signs of agitation the staff were able to distract people and reassure them effectively.

We saw that activities were planned to take place at the home and in the community. However, we found that regular activities were not happening at weekends.

We found that the staffing levels at the home were not based on the needs of people. Staff we spoke with felt that there were not enough staff working at the home.

We found there were effective systems in place to monitor the quality of the service provided.

Inspection carried out on 8 April 2013

During a routine inspection

We spoke with thirteen people who used the service to find out their views of Bamfield Lodge and also what they thought of the staff.

We used a number of different methods to help us understand the experiences of people who used the service, because some people had complex needs which meant they were not able to tell us their experiences. We relied on our observations and discussions with staff to understand the experience of care for those people living at Bamfield Lodge.

Peoples’ privacy and dignity were respected by the staff. People had positive views of the way they were treated by staff. Examples of comments made included “they are so kind” , “they treat us very well” “I’m very happy here”.

Peoples’ needs were effectively met by the staff who assisted them. Care plans clearly informed staff how to meet peoples’ range of personal care and nursing needs.

People spoke highly of the quality and the choice of meals at Bamfield Lodge. Staff knew how to support people with their nutritional needs and what to do to assist those who were at nutritional risk.

People were effectively supported by staff who were knowledgeable about their range of needs. People were protected by effective recruitment procedures so that only suitable staff were employed at Bamfield Lodge.

The quality of the service received was being effectively monitored and reviewed. This involved seeking the views of people who used the service and those who represented them.

Inspection carried out on 1 October 2012

During a routine inspection

The majority of people we met had positive views about life at the home and expressed comments of satisfaction about the care and service they received. People told us, " it's my home now ". There is always something to do here" ."The staff are all so helpful".

People who used the service were treated in a respectful way by the majority of staff and their needs were properly met. However a minority of staff failed to show respect and did not maintain people’s dignity when supporting them with their needs.

People were protected from abuse and their rights were respected by the majority of the staff. However a minority of staff acted in a way that did not show respect for people’s rights.

There was a sufficient number of competent and suitable staff employed to meet people’s needs range of needs.

People were supported to be able to make complaints about the services. When complaints were received these were properly investigated by the provider.

Reports under our old system of regulation (including those from before CQC was created)