Archived: Bellus Lodge

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.

People have their own bedrooms and shared access to two bathrooms one of which had a sensory spa. Shared areas also included a lounge and dining room, kitchen and laundry and an enclosed garden.

The service had 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.

Staff had received fire training and taken part in fire drills. The house had a completed fire risk assessment and people had individual personal evacuation plans. Not all senior staff were aware of the plans. We discussed this with the manager who told us they would review this and ensure that senior staff are aware of them and where to locate them in the event of an emergency.

Risks relating to the building had been assessed. We observed people accessing all areas of the house and garden safely. Risk assessments had been completed for when people went into the community and included the level of staff support people needed. This demonstrated that people’s risks were being managed with the least restriction on their freedoms and choices.

Risks to people had been identified and assessed. Some risk assessments were in relation to behaviours people had that may place themselves or others at risk of harm. We spoke with staff who demonstrated a good understanding of the risks people lived with and any identified interventions that reduced the risk. We saw that people’s records included a safeguarding plan. This provided information about how people were protected from abuse.

Families and visiting professionals told us they felt people were safe living at Bellus Lodge. Staff had completed safeguarding training and understood how to recognise potential abuse and the actions they would need to take. A safeguarding poster was in an easy read picture format. This meant that people using the service had information about safeguarding that they could understand.

The service had enough staff to support people safely. Staff had been recruited safely. Policies and procedures were in place for managing unsafe practice.

People had their medicines stored and administered safely. Staff had received training and had their competencies checked. Some medicines were prescribed for only when people required them. Procedures were in place to ensure that people only received these medicines when all other interventions had not been successful.

Staff received induction and on-going training that provided them with the specialist skills needed to carry out their roles effectively. Staff received supervision every six to eight weeks and told us they felt supported in their roles. Appraisals had been completed and staff had opportunities for career development and further training.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met.

We found that the service was mostly working within the principles of the MCA. DoLs applications had been sent to the local authority. One person had an authorised DoLs in place which had conditions attached to it that staff were aware of and were being met. People had a monitor in their rooms which enabled staff to listen in. They also had a peep hole in their door so that staff were able to look into their rooms. Both these measures had been put in place to enable staff to discreetly monitor a persons’ safety. We discussed this with the managers as there was no evidence that a best interest decision had been made to support these actions. We were told that this would be reviewed with immediate effect. Staff had completed MCA training and understood the need for people to consent to care.

People were supported to follow a healthy diet. People were involved in menu planning and supported in ways that enabled them as much independence as possible.

Records showed us that people had good access to healthcare.

People, their families and other professionals told us that staff were consistently kind and caring and had peoples’ best interests at heart. Staff had a good knowledge of people, how they liked to spend their time and what interested them. Staff used different types of communication with people which enabled meaningful conversation.

People were involved in decisions about how they wished to live their lives. Staff had a good knowledge of family and friends that were important to people. People who needed an independent representative to speak on their behalf had access to an advocacy service.

Some people needed staff to observe them most of the time. We saw staff achieving this in the least restrictive way respecting people’s rights to having freedom and independence around their home and garden. Staff understood the importance of respecting people’s dignity and privacy.

The service had a complaints process and families and professionals we spoke with felt able to use it and that staff would listen to them. We looked at the complaints log which did not contain any complaints about the quality of the service. The process did not capture verbal concerns raised with the service. We discussed this with the acting manager who told us they would introduce recording verbal complaints as well as written complaints in order to fully capture people’s feedback and the actions taken by the service in response.

Pre admission assessments had been completed and included information gathered from the person, their families and other health professionals. The pre admission assessment had been used to create individual care plans for people that provided information to staff about the person and how to support them. Staff had a good knowledge of care plans and how to support people. Plans included information on people’s goals and aspirations. Staff were able to tell us the actions that had been taken to support people to meet their personal goals.

Information had been gathered about people’s interests and the activities they enjoyed. Staff supported people to follow these both in the house and the community. People had good links with the local community which included opportunities for learning at local colleges and voluntary work placements. This gave people the opportunities to develop their skills and personal development.

Families and other professionals we spoke with told us there had been a lot of management staff changes that had caused communication to be difficult at times with the service. This had led at times to people being late for appointments or missing them. Families and professionals told us that the service did not always keep them up to date with information about people. This meant that people’s families and professionals involved in people’s care and support did not always feel empowered.

The registered manager was not present during our inspection. However they did contact us before the inspection to discuss the management arrangements of the service. During our inspection the day to day management of the service was being overseen by the organisations Business Development Manager. They had been undertaking the acting house manager role for four months. Also there was a newly appointed manager who had just taken up post and was undertaking their induction. We were told that the registered manager visited the service at least once a week and attended the manager’s weekly meeting.

Staff spoke positively about the service and the organisation. Staff were very motivated and spoke enthusiastically about their roles and the type of support they provided to people. They felt appreciated by management and felt their views were encouraged and had led to positive change.

The service completed regular audits which included accidents and incidents, recruitment, health and safety, medicines and care files. Audits highlighted any identified actions. Audit findings were discussed at management and staff meetings. We discussed with the acting manager recording any actions taken and subsequent outcomes to demonstrate improvements achieved. A quality assurance survey was currently under review and we were told would be issued within the next two months in order to gather feedback from people, their families, staff and other professionals.

Notifications were sent to CQC in a timely manner.