Background to this inspection
Updated
21 June 2017
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.
The inspection took place on 28 February and was announced. It continued on 2 March 2017. The provider was given 24 hours’ notice of the inspection to ensure people were available to speak with us. The inspection was carried out by two inspectors on the first day of the inspection and three inspectors on the second day.
Before the inspection we reviewed the information we held about the service. The provider completed 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 spoke with one person and four relatives of people living in the home. We spoke with 11 care staff and reviewed six people’s care and support records. We also looked at records related to the running of the home such as: policies, risk assessments, quality audits, incidents and complaint forms. We looked at four staff files, the recruitment process, training, supervision and appraisal records.
We spoke with a director and members of the management team. There had been changes in the management of the home immediately prior to this inspection. The manager registered with us no longer managed the carrying on the regulated activity.
Updated
21 June 2017
The inspection took place on 29 February 2017 and was announced. The inspection continued on 2 March 2017.
We carried out an announced comprehensive inspection of this service on 5 April and 6 April 2016. After that inspection we received concerns in relation to the care and support of people and management of the home. As a result we undertook another comprehensive inspection.
Bellus Lodge provides accommodation and personal care to people with learning disabilities and behaviour support needs. It is registered for up to six people. At the time of our inspection there were six people living there. There were two bedrooms on the ground floor and four bedrooms on the first floor. There was a main kitchen and open plan living and dining area. This led into an enclosed garden and patio area.
As a condition of registration the service must have a registered manager. 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. There had been changes in the management of the home immediately prior to this inspection. The manager registered with us no longer managed the carrying on the regulated activity.
Bellus Lodge was not always a safe place for people to live. Safeguarding systems and processes in place were not established and did not operate effectively to prevent potential abuse of people.
Risks were not always managed safely. Risk assessments were not always followed appropriately and several staff told us they had not read these. We found that injuries and marks were not always recorded or reported.
People were not always receiving care from staff that were competent, skilled and experienced. There was a risk that people were receiving care from staff who had not had training to meet the needs of people with learning disabilities and complex behaviour. People were being physically restrained and administered medicines by untrained staff. People received bruising following restraint by untrained staff. This left people at risk of unsafe care and treatment because staff did not have the appropriate training and knowledge to provide effective care.
Information regarding pre-employment checks was not available to us during the inspection.
People's rights were not always protected under the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty they have been authorised by the local authority as being required to protect them from harm. Assessments had not been completed specific to the decision that needed to be made around people's capacity. DoLS applications had been submitted to the local authority.
People were not always supported effectively in relation to their nutritional needs or continued health care. Plans and guidelines were not being followed by staff. Staff confirmed that menus did not always reflect people’s food likes and dislikes. People were not always supported to access health care services appropriately.
Positive caring relationships were not always established between people who lived at Bellus Lodge and staff members working with them. We found that staff had not read people’s files and did not know everyone they supported.
Staff at the Bellus Lodge did not always treat people with dignity and respect. Care and support was not always delivered privately. There were times where people were watched and observed for periods of time throughout the day. There was evidence of lack of interaction and choices for people at the service around how their care was to be delivered.
The service was not always responsive to people’s health, social and recreational needs. Care plans and assessments were not always followed by staff. Daily recording was irregular and did not reflect each person each day. Staff were unable to look back on previous daily note entries or their colleagues as the on line system they used didn’t allow this. This meant that staff and the provider could not be certain that each person’s needs were being met on a daily basis.
Families and friends were not supported to express their views or get involved in decisions. Feedback surveys to people, relatives, friends and stakeholders had not been coordinated or sent out.
Bellus Lodge was not managed or lead well. Staff were able to give examples of when they had felt unsupported. Professional boundaries were not established and a positive culture was not embedded.
There were not effective systems in place to assess and monitor the quality of the service. Although some audits had been undertaken these had not been used to improve the quality of care for people and actions identified had not been followed up or completed.
Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The provider had not informed the CQC of a number of significant events.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach under Health and Social Care Act 2008 (Registration) Regulations 2009 . The overall rating for this service is 'Inadequate' and the service is therefore placed into 'Special measures'.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
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.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.