Bamfield Lodge

About the service

Bamfield Lodge is a care home providing personal care and accommodation to up to 60 people. At the time of the inspection, 60 people were living there. The service provides support to older people with a range of health and social care needs, including those living with dementia.

People’s experience of using this service and what we found

This was a targeted inspection that considered staffing levels and the impact this may be having on people who lived at the service. Based on our inspection, we found there were usually sufficient staff to keep people safe and provide high quality care at Bamfield Lodge. Sometimes unforeseen events such as illness affected staffing levels, but this was monitored and actions taken to arrange cover.

The numbers and skills of staff matched the needs of people using the service and staffing levels were reviewed and amended as necessary. Staff knew people well and understood their needs. The service was responsive when people’s needs changed.

People, their relatives and most staff were happy with the levels of staffing at Bamfield Lodge. People and their relatives were satisfied with the care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 29 July 2022).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing. We found no evidence during this inspection that people were at risk of harm from this concern. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bamfield Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People's experience of using this service and what we found

There had been significant improvements following the inspection of 3 and 4 November 2021 and 29 and 30 August 2018. Positive changes had been made so enough competent staff were safely deployed. The provider had looked at staffing levels overall within the home and had increased this. Agency use had significantly reduced, and the home now had its own pool of bank staff who helped to support staff to cover shifts. The provider had looked at the dependency levels within the home and had reduced admissions for people with complex needs.

Risks to people were assessed and monitored. The number of people on food and fluid charts had reduced. Food and fluid charts and monitoring records were filled out accurately. A new manager and deputy were in post who were supported by the regional director. Staff and people were positive about the changes that had been made at the home. Learning had taken place since the last inspection with improvements made to governance audits and the overall monitoring of the home.

Staff demonstrated a good level of understanding in relation to safeguarding. Appropriate referrals to the local safeguarding team had been made. Staff were trained in safeguarding and understood their responsibility to protect people from harm. Staff were recruited safely and there were enough staff to provide safe and effective care. People received their medicines safely. Safety checks of the premises and equipment had been undertaken. People had personal emergency evacuation plans (PEEPs) in place.

The manager provided clear direction and good leadership. Feedback about the home was positive. Staff felt valued and supported, and were confident people received good care. Systems and processes for monitoring quality and safety were effective. There was a programme of audits in place to assist the management team to identify and address shortfalls.

Rating at last inspection

The last rating for this service was Requires Improvement (published 15 December 2021). At our last inspection 3 and 4 November 2021 we found people were not always protected from risk because the provider failed to deploy enough suitably qualified, competent and experienced staff. Improvements were required to ensure risks were assessed and monitored to prevent people from receiving unsafe care and treatment. The provider had failed to ensure consistency so that people received quality person centred care, promoted learning and improved service delivery and promoted an open and fair culture. At the inspection of August 2018 we found staffing levels had affected the delivery of person centred care. At this inspection we found improvements had been made.

Why we inspected

We carried out an inspection of this service on 3 and 4 November 2021 and 29 and 30 August 2018. We rated the service requires improvement in Safe, Responsive and Well Led due to the shortfalls we identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Responsive and Well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bamfield Lodge on our website at www.cqc.org.uk.

Bamfield Lodge is a care home providing accommodation, nursing and personal care for up to 60 people. At the time of the inspection there were 53 people living at the home. The home is purpose built with facilities over three floors. The top floor was called Snowdrop and people who lived there required support with dementia. People on the middle floor, Daisy, required nursing care and the residential ground floor, Crocus, facilitated those people with low dependency. We will refer to the names of each floor throughout the report when required.

People's experience of using this service and what we found

The inspection clearly identified a disparity of experiences and views dependent on which floor you lived, visited or worked. This meant we received mixed feedback across the whole home. Despite the negative feedback from people, visitors and staff they also provided a balanced, positive overview. Although improvements were required it was considered a nice place to live, visit and work.

We could not be satisfied staffing levels would keep people safe from harm. After our inspection activity was completed we fed back our concerns to the regional director and registered manger. They provided us with assurances about what immediate action they had taken since the inspection visit. This included, re-assessing the dependency levels of care and support required for people who lived on Daisy. The registered manager had been working shifts as a member of the care team on Daisy. This was to support staff and gain a greater understanding about the pressures and concerns that had been shared and how they could be resolved. This would further help ensure people were protected from potential risks to their health and welfare.

Medicines were managed safely, and records were up to date. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. People were protected from the risk of cross infection and appropriate guidance was followed.

The service was effective in meeting people’s needs. Staff received supervision and training. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. People told us they enjoyed the food and their choices were respected. People were supported with choice, preferences and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in place supported this practice.

The service was not always well led. Improvements were required to ensure the providers process to determine staffing levels was effective. This would help ensure people received care that was safe, of a good quality and person centred. We received mixed feedback from staff about whether they felt supported and listened to by the provider and the management team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good. (5 October 2020)

Why we inspected

The inspection was prompted due to consistent concerns we received about staffing levels in the home. In addition, there were common themes about how this had an impact on the care people received including the safety and quality. A decision was made for us to inspect and examine those areas of risk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified breaches in relation to the service response in ensuring safe levels of staffing and managing risks. This meant that improvements were required to ensure quality monitoring and management and that provider oversight was more effective.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bamfield Lodge is a care home providing personal and nursing care for up to 60 people, on three floors. Crocus provides personal care, Daisy provides personal and nursing care, and Snowdrop provides care for people living with dementia. At the time of our inspection, 49 people were living in the home.

People’s experience of using this service and what we found

People received a service that was safe. People had access to call bells. They looked comfortable and relaxed in the presence of staff. Systems were in place to ensure medicines were safely managed. Staffing levels were safe and robust recruitment systems were in place.

Staff had a good understanding of safeguarding processes and were confident the registered manager would act on any concerns they raised. Effective infection prevention and control measures were in place.

Risks associated with people's care needs and the environment had been assessed and staff

were provided with information on how to support people safely. Incidents and accidents were reviewed to ensure lessons were learned to reduce recurrence and make improvements.

People’s needs were assessed, and when people moved into the home, protocols were in place to isolate people, in line with current pandemic guidance.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way and in their best interests. The policies and systems in the service supported this practice.

People were provided with choices at mealtimes and provided with the support they needed to eat and drink.

The provider had systems and procedures to monitor and assess the quality and safety of the home. People using the service, relatives and staff told us the care home was well led.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was requires improvement (published 25 October 2018).

The provider completed an action plan after the last inspection to show what they would do and by when, to improve.

Since the last inspection, the care home has been taken over by Barchester Healthcare Limited. At this inspection we found improvements had been made and the rating for this service has improved to good.

Why we inspected

We undertook this focused inspection to check the service had followed their action plan and to check they had made improvements. This report only covers our findings in relation to the Key Questions: Safe, Effective and Well-led.

The key question, Responsive, was not looked at on this occasion. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bamfield Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 manager. We will discuss the actions they are taking to make sure the service improves to Good when we undertake our next inspection. We will also require an action plan to be sent to us each month to tell us about the improvements they are making.

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 any representations or appeals have been concluded.

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 interactions between staff and people living in the home. Staff were knowledgeable about people’s needs and told us they aimed to provide personal, individual care to people.

People spoke positively about the activities offered and told us the programme was varied and enjoyable. A range of activities was offered to people and the weekly programme was displayed on notice boards.

The provider had systems in place to receive and monitor any complaints that were made. We reviewed the complaints file. Where issues of concern were identified they were taken forward and actioned. People and their relatives and friends told us they knew how to make a complaint.

The acting manager was well respected by staff, people and their relatives and they saw him regularly. The acting manager communicated with day and night staff about operational issues that needed to be addressed. The provider sought feedback from people so that they could evaluate the service and drive improvement.

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.

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.

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.

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.

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.