Bishopsgate Lodge Care Home

We last inspected the service in February 2018 and found the provider had breached two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These related to the systems and processes used to manage medicines safely and record keeping. We asked the provider to complete an action plan to show what they would do to improve the service.

Bishopsgate Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates 47 people across three floors. At the time of the inspection 42 people were being supported in the home, 15 requiring nursing care and some were living with dementia.

The service had a registered manager 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.’

At this inspection we found the provider had taken action to improve.

The provider had introduced additional documentation to support the administration of medicines. Medicines were managed by staff trained in the administration of medicines. Observations demonstrated people received their medicines safely. The provider had employed a clinical lead to provide additional support to nursing staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Risks to people were assessed and plans put in place to mitigate against them. Risk assessments were reviewed regularly or when there was any change in the person’s needs. Risk assessments for the environment such as slips, trips and falls were in place and reviewed regularly.

Recruitment processes were in place with all necessary checks completed before staff commenced employment. Nurses had their professional identification numbers (PIN) checked on a regular basis.

The provider used a dependency tool to ensure staffing levels met the needs of the people living in Bishopsgate Lodge. Staffing rotas were completed in line with the dependency tool.

The provider had a business continuity plan in place for staff guidance in case of an emergency. People had Personal Emergency Evacuation Plans (PEEPS) in place which were updated regularly.

Staff were aware of safeguarding processes and knew how to raise concerns. Where lessons could be learnt from safeguarding concerns, these were used to improve the service. Accidents and incidents were recorded and monitored as part of the provider’s quality assurance system.

The provider ensured appropriate health and safety checks were completed. We found up to date certificates were in place which reflected gas safety checks and mobility equipment checks.

We found staff received regular supervision and an annual appraisal. Opportunities were available for staff to discuss performance and development. Staff training which the provider had deemed mandatory was up to date.

People’s nutritional needs were assessed and we saw people enjoying a varied diet, with choices offered and alternatives available. People were supported with eating and drinking in a safe, dignified and respectful manner. People had access to healthcare professionals when necessary and were supported with health and well-being appointments.

The provider had systems and processes in place to ensure the principles of the Mental Capacity Act 2005 (MCA) were being met.

People and relatives felt the service was caring and promoted people’s independence where ever possible. We observed how staff provided support in a respectful manner ensuring people’s privacy and dignity was promoted.

Care plans were personalised to meet people’s needs and reviewed on a regular basis.

People enjoyed a range of activities. The service had links with the local community with people accessing the local shops and places of interests.

The provider had a complaints process in place which was accessible to people and relatives.

Staff were extremely positive about the registered manager. We observed the registered manager was visible in the service and found people interacted with them in an open and honest manner. People and relatives felt the management approach in the home was positive.

The premises were well suited to people’s needs, with ample dining and communal spaces. Bedrooms were personalised to people’s individual taste. Bathrooms were designed to incorporate the needs of the people living at the home. A refurbishment plan was in place to address the damaged units in one of the dining rooms.

The provider worked closely with outside agencies and other stakeholders such as commissioners and social workers.

Bishopsgate Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Bishopsgate Lodge Care Home accommodates 51 people in a purpose built building, across three floors. Some of the people living there were receiving nursing care and some people had a dementia type illness. On the day of our inspection there were 44 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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.

We last inspected the service in December 2015 and rated the service as ‘Good.’ At this inspection, we identified issues with the management of medicines. One person used an inhaler however their risk assessment was not up to date. Some people were prescribed PRN (as required medicines). However, for some people PRN protocols were not in place or did not contain sufficient information. One person’s hand written medicines administration record (MAR) had not been countersigned by a second member of staff to confirm that the record was accurate. For one person whose medicines had been changed, it was not clear who had authorised the discontinuation.

For a medicine that staff administered as a patch, a system was in place for recording the site of application and the days when the patches were renewed or replaced. However, staff had not fully completed this for one person. Some people received support with medicinal creams. We saw that a body map was in place for one person to show where the cream should be applied however there was no record to confirm when the cream had been applied. For three people a medicinal cream was listed on their MAR however there was no body map or topical MAR to show where the cream should be applied. The service conducted a number of medicines audits however these were not robust and had not identified the issues we found.

We identified issues with record keeping that had not been addressed following internal audits of the service. For example, one person’s support plan indicated that they had “fluctuating capacity”. The deputy manager told us the person did not have fluctuating capacity and were able to make decisions independently. In all the care records we viewed, consent to care on individual support plans was not signed by the person if they were able or by a legally authorised representative. In two people’s records, we saw no written consent for photographs or for the use of bedrails. We also found food and fluid charts had been inconsistently recorded.

Care records were regularly audited however most of the records we viewed had identified actions that had not been signed or dated to say the action had been completed. For example, a care records audit for one person, dated 9 January 2018 included a number of actions including re-writing all the support plans. We checked the person’s care records and saw the communication support plan had been re-written but none of the other support plans had been re-written since January or February 2017. Therefore, actions from the audit had not been completed.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Bishopsgate Lodge Care Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account. Support plans were in place that recorded people’s plans and wishes for their end of life care.

A programme of activities was in place, and activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had a quality assurance process in place however this had not addressed the issues with medicines and documentation we had found. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

We found two 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 the report.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that they were attentive and demonstrated knowledge and understanding of people's needs. Staff encouraged and supported people to make choices and be independent. We observed that people were seen to respond positively to the staff throughout.

People we spoke with told us they were involved in decisions about their care. Comments from people included 'They are champion here, the staff are really good, and they listen to me.'

People who used the service explained how their care and welfare needs were met. One person said 'I have been ill during the night, I can call the staff and they will come'.

During the inspection we spoke to people using the service and they told us they could speak to staff about any concerns they may have. One person told us 'They have been so good to me, really very nice, I wouldn't change it'.

We were able to speak with all the staff on duty at the home. All of the staff told us they felt well supported by the manager and supervisors. They told us they received regular training and they were encouraged to ask for support when needed. On the day of the visit an occupational therapist was visiting and she told us 'The staff are very helpful and knowledgeable. I know I can speak with the manager at anytime'.

We found that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people using the service and their carers, family and relatives were also regularly recorded.

People we spoke with told us they were involved in decisions about their care. On the day of our visit a dentist was visiting the home. People living in the home described how the staff had asked them if they wanted to see the dentist. Comments from people included 'I said to them I don't want to see the dentist. The staff respected my decision.'

We observed staff providing care and support to people throughout the inspection. There was a calm, friendly atmosphere around the home and people were seen to respond positively to the staff throughout. People were well presented and appeared cared for.

People who used the service explained to us how their care and welfare needs were met. One person said 'The staff get the doctor in if I'm feeling bad.' Another person told us 'I felt dizzy one night and couldn't reach the buzzer so I shouted. The staff came straight away.'

People's nutritional needs were met. Comments from people included 'The food is beautiful and we always have a choice.'

We found staff received appropriate professional development. One person living in the home said 'You cannot get staff better than them".

Everyone said they would have no hesitation in making a complaint if they were unhappy. One person said 'I would tell them if I was not happy.'