Archived: Beverley Lodge Nursing Home

Beverley Lodge Nursing Home provides accommodation and nursing care to up to 16 older people, most of whom are living with dementia. At the time of our inspection 16 people were using the service. This included two people who were receiving respite care.

The service had received a change in manager since our focused inspection in September 2016. The new manager was aware of their responsibility to register with the Care Quality Commission and had started the application process. 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 provider had sustained the improvements made since our previous inspection to ensure safe medicines management. People received their medicines as prescribed and robust processes were in place to check stocks of medicines. Staff continued to safeguard people from abuse and the management team liaised with the local authority safeguarding team about any concerns raised. Risks to people’s safety were regularly reviewed and management plans were followed to minimise the risk from occurring. There were sufficient staff to meet people’s needs and staff responded promptly to people’s requests for assistance.

Staff continued to stay up to date with their mandatory training to ensure they had the knowledge and skills to undertake their roles. They were supported to undertake qualifications relevant to their role and received regular supervisions and appraisal. Staff adhered to the Mental Capacity Act 2005 code of practice and adhered to the conditions of people’s deprivation of liberty safeguards authorisations. People received the support they required with their health and nutritional needs. Staff liaised with relevant healthcare professionals if they had concerns a person’s health was deteriorating.

Care and support was provided in line with people’s wishes and preferences. Staff were aware of how people communicated and involved them in day to day decisions. People’s care records detailed people’s decisions in regards to end of life care and this was shared with other healthcare professionals involved in their care. Staff respected people’s privacy and maintained their dignity.

The provider had sustained improvements made since our previous inspection to ensure detailed, complete and accurate care records were maintained. People’s care records provided clear instruction to staff about how to support people and the level of support they required. Staff used the ‘red bag’ initiative from the London Borough of Sutton’s Vanguard project to enable consistent and coordinated transitions when people move between services. A complaints process remained in place to investigate and learn from concerns raised.

Robust processes had been maintained to monitor and improve the quality of service delivery, including a programme of audits and review of key performance data. Staff, people and their relatives were encouraged to feedback about the service through regular meetings and completion of satisfaction surveys. The provider liaised with the local authority and Clinical Commissioning group (CCG) to learn about new models of care and implement good practice initiatives. The provider adhered to the requirements of their Care Quality Commission (CQC) registration and submitted statutory notifications as required by law.

We undertook an unannounced focused inspection on the 23 September 2016 to check they were meeting legal requirements relating to good governance. This report only covers our findings in relation to this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Beverley Lodge Nursing Home’ on our website at www.cqc.org.uk.

Beverley Lodge Nursing Home provides accommodation, nursing and personal care to up to 19 older people. At the time of the inspection 13 people were using the service, some of whom were living with dementia.

A registered manager was in post. 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.

Care records had been reviewed and updated. They provided clear and detailed information about people’s needs and how they were to be supported, including what equipment they required. There was consistency in the information provided, and the previous concern about conflicting information had been addressed. Staff had improved the recording of the daily support provided to people.

Care record audits had been strengthened. Where improvements were identified these were discussed with staff and addressed.

The above shows that the provider had made the necessary improvements to meet legal requirements they were previously breaching. We have however not changed the rating of the key questions for the location from 'Requires improvement' to 'Good', because to do so would require consistent and sustainable improvements at the service over time.

We undertook a focused inspection on the 16 June 2016 to check that they now met legal requirements. This report only covers our findings in relation to this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Beverley Lodge Nursing Home’ on our website at www.cqc.org.uk.

Beverley Lodge Nursing Home provides accommodation, nursing and personal care to up to 19 older people. At the time of the inspection 14 people were using the service, some of whom were living with dementia.

A registered manager was in post. The manager of the service had become their registered manager, and the provider had stepped down as the registered manager since our previous 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.

Whilst improvements had been made since our last inspection, there were still inaccuracies and missing information from people’s care records. We saw that care records did not provide accurate and detailed information about people’s care needs. We also saw that accurate records about the support provided, and the preventative measures taken to protect people’s skin integrity were not maintained. Audits of care records did not capture all aspects of care documentation and did not review the quality of daily records.

Progress had been made and in the main safe medicines management processes were followed. We saw that on the whole records were kept of medicines administered, and correct stocks of medicines were maintained. People received their medicines as prescribed. Audits of medicines management had identified some areas requiring improvement and these had been addressed.

Systems were in place to monitor key events that occurred at the service, and whether a statutory notification needed to be sent to the Care Quality Commission. This included ensuring notifications of serious injuries and the outcome of deprivation of liberty safeguards applications were submitted.

The service continued to be in breach of the regulation relating to good governance. We are taking further action against the provider in relation to this and will report on this when our action is completed.

Beverley Lodge Nursing Home provides nursing and personal care to up to 16 people, many of whom have dementia. At the time of our inspection 15 people were using the service.

One of the proprietors was the registered manager but was not based all the time at the service. They had appointed a person to manager the service on a day to day basis. They were in the process of being assessed by the Care Quality Commission to become the registered manager, and would take on this role once approved. 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. Throughout this report we refer to the registered manager as the ‘registered manager’, and to the person managing the service on a day to day basis as the ‘manager’.

Medicines were stored securely at the service. However, we observed that medicines administration records (MAR) were not always sufficiently completed to reflect the medicines administered. We also observed some discrepancies in the stocks of medicines kept at the service. Safe medicines management processes were not consistently followed and there was a risk that people did not receive their medicines as prescribed.

Staff were knowledgeable about people’s support needs. However, accurate and detailed records were not kept in regards to the support people required and the level of support delivered. People’s care records, including confidential information, were not kept secure.

The manager undertook audits to review the quality of care provided. However, we observed that whilst the audits reviewed whether certain documents were in place they did not always comment on the quality of those documents. We also saw that where audits had previously identified concerns with medicines administration recording that sufficient action was not taken to address the issues.

The registered manager had not adhered to all the requirements of their registration and had not submitted notifications of the outcome of deprivation of liberty safeguard (DoLS) authorisations or in regards to all incidents that led to serious injuries. DoLS in a process of lawfully depriving a person of their liberty to maintain their safety and welfare.

An activities programme was in the process of being developed delivering one to one and group activities. However, people told us there often was not much to do and we did not observe many activities taking place at the time of our inspection. We recommend that the provider looks into national guidance to provide activities to engage and stimulate people with dementia.

There were sufficient staff to keep people safe and meet their needs. The manager regularly reviewed the staffing levels at the service as people’s needs changed to ensure they were able to provide a timely service to people.

Staff had received training and had the knowledge and skills to support people. Staff received regular supervision and annual appraisals to discuss their roles and review their performance. Staff told us they felt able to speak with their colleagues and their manager if they needed any additional support or advice about how to meet people’s needs.

Staff were knowledgeable about the people they were supporting. They were aware of the level of support they required and delivered this in line with people’s needs and preferences. Staff liaised with other healthcare professionals when required to provide people with the additional level of care they required, including with their health needs and any dietary requirements. A GP regularly visited the service to review people’s health needs and staff supported people to attend hospital if they had more serious concerns about people’s health. Staff provided people with meals in line with their dietary requirements.

Staff were aware of the risks to people’s safety. Assessments were regularly undertaken to review the risks to people’s safety and staff supported people to minimise those risks. Action was taken in response to any incidents that occurred to ensure people’s safety and to review the level of support people required as their needs changed.

Staff were aware of their responsibilities to support people in line with the principles of the Mental Capacity Act 2005. Where able, people were involved in decisions about their care and staff respected people’s choices. Staff kept people informed and updated about the support they were providing and encouraged people to be involved, as much as possible, in their care needs.

People, their relatives and staff were asked for their views about the service, and were encouraged to feedback about their experiences. They were supported to make suggestions to improve the quality of the service and these were listened to.

We identified breaches of legal requirements in relation to safe care and treatment, good governance and the submission of notifications. You can see what action we have asked the provider to take at the back of the main body of the report.

Following the inspection the provider sent us an action plan on the 31 May 2014 setting out what steps they had taken to make the necessary improvements.

This visit was carried out by an inspector who helped to answer one of our five questions: Is the service safe? Is the service caring? Is the service responsive? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection. We also looked at three sets of information about people who use the service and talked with two members of staff, the manager and a representative of the provider. There were 15 people living at the home on the day of our visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service effective?

Care plans showed that people’s needs were identified and met. These plans were now regularly reviewed and updated so that they were meeting people’s current needs. Any risks were assessed and reviewed regularly to ensure people’s safety was promoted whilst ensuring their independence.

The Care Quality Commission monitors the operation of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). The manager and staff team had received training and they showed that they knew how to make a referral to the local authority when a DoLS assessment was required. The home currently has three active DoLS applications in place. This could help to ensure that people’s human rights were properly recognised, respected and promoted.

A range of activities were available for people based on their interests and needs. People had choices about the activities they wanted to participate in.

People were cared for by staff who in turn were supported to deliver care and treatment safely and to an appropriate standard.

We were concerned that some people’s care plans were not up to date and the care plans we saw did not always reflect people’s identified needs. We found there were a number of instances where care was not delivered as specified in care plans and risk assessments were not always reviewed with the frequency they should have been, as stated in the risk assessment.

We were concerned that people’s social well-being was not adequately planned and catered for. Comments we received included, “There is nothing to do here most days except look at the four walls. I would like to go out. It would be nice if someone could read to me every so often.” Another person told us, “I don’t go out. I sit here most days.”

We found that people were cared for in a clean, hygienic environment and there were systems in place to prevent the risk and spread of infection.

There were effective recruitment and selection processes in place and appropriate checks were carried out before staff began to work with people. However, we were concerned that staff were not adequately supported by the service through receiving regular training, supervision and appraisal.

People who use this service were able to make choices with regard to their daily lives such as what they would like to wear or to eat or whether they would like to join in any activities. Staff helped people in the way that they preferred and they had their wishes, privacy, dignity and independence respected. The staff interactions we observed were positive.