Boscombe Lodge Nursing Home

Boscombe Lodge Nursing Home is a care home providing personal and nursing care to up to 31 people. At the time of our inspection there were 25 people using the service. The home is split over 2 separate floors, people have their own rooms with some shared communal facilities.

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

People and their relatives gave us positive feedback on their experience of using the service. One person said, “Staff are as good as gold.” Another person said, “It is a very good home.”

Care and treatment were planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Staff had received appropriate training. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. Medication was dispensed by staff who had received training to do so.

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

The registered manager had systems in place to monitor the service, measure outcomes for people and make improvements where needed

Rating at last inspection.

The last rating for this service was good (published 31 May 2019).

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

Why we inspected

This inspection was carried following a safeguarding concern. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 COVID-19 and other infection outbreaks effectively.

Follow up

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

We found the following examples of good practice.

¿ The service was currently closed to visitors however, there was a process in place in ensure any visitors to the service such as health care professionals or contractors were screened for COVID-19 symptoms. Signs were in place to advise visitors on how to keep safe.

¿ Peoples wellbeing had been supported with regular video calls to loved ones and activities within the home using technology.

¿ The service was closed to new admission at the time of our visit. The registered manager confirmed they were following government guidance and all new admissions were isolated in their rooms for 14 days.

¿ Staff had received training in infection control and the correct use of personal protective equipment [PPE]. Staff demonstrated an excellent knowledge of how to use PPE correctly and good infection control practice.

¿ Staff and people living at the service had access to regular testing. All test results were recorded on a COVID-19 tracker that was regularly monitored.

¿ Staff had a good understanding of zoning and cohorting which had been used effectively during a recent infection outbreak.

¿ The service was very clean. There were cleaning schedules in place for staff to follow including regular cleaning of high touch point areas.

¿ Infection control audits took place regularly to ensure staff practices and the environment complied with current guidance.

People’s experience of using this service:

People and their relatives made positive comments about the staff and the care provided at Boscombe Lodge. Staff knew how to recognise abuse, neglect and discrimination and keep people safe. People could take positive risks and have choice and control over their lives. Policies and systems at the service supported this practice.

Staff were recruited safely and completed a comprehensive induction. Staff kept up to date with training requirements and professional qualifications through regular supervision and appraisals.

People’s health was well managed, they were supported to have medicines when they needed them and to have a good diet. People’s individual dietary needs and requirements were met.

People were able to take part in a range of activities if they wished to that were suitable for their needs.

Staff supported people to engage in friendships and maintain relationships with family and friends.

People and staff said they could raise concerns and knew how to do this.

Environmental risks had been regularly assessed, tested and audited.

Staff, people and professionals were complimentary about the management team at Boscombe Lodge.

The service met the characteristics of good in all areas; more information is in the full report

Rating at last inspection: At our last inspection, the service was rated “good.” Our last report was published on 22 October 2016

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any information of concern, we may inspect sooner.

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

Boscombe Lodge Nursing Home provides accommodation and personal care and nursing for up to 31 persons some of whom may be living with dementia. At the time of our inspection 28 people were living at the service.

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.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager was up-to-date with the law regarding DoLS and made referrals appropriately.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, district nurse, tissue viability nurse and palliative care nurse.

Staff were well trained and attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to.

The service had a number of ways of gathering people’s views including talking with people, staff, and relatives. The registered manager held regular meetings with people and their relatives and used questionnaires to gain feedback. The registered manager carried out quality monitoring to help ensure the service was running effectively and to make improvements.

At the time of our inspection there were 28 people using the service. As part of this inspection we spoke with eight people using the service, five staff, the registered manager and the provider’s general manager. Some of the people using the service could not communicate with us directly due to their physical or mental condition and so we used observation to help us understand their experience of the service. We also reviewed records relating to the management of the service and to the support needs of people who were using the service. These included six support plans, daily support records, staffing records and service quality monitoring processes.

If you want to see the evidence supporting our summary please read our full report. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People were treated with respect and dignity by the staff. Appropriate safeguarding procedures were in place and staff knew how to safeguard the people they supported.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This was to ensure that people who could not make decisions themselves were protected. Relevant staff had been trained to understand when a DoLS application should be made, and how to submit one. This meant that people were safeguarded as required.

Staff told us that they received good line management support in their roles which helped them to provide a caring and responsive service.

Is the service effective?

There was an advocacy service available if people needed it. This meant that, when required, people had access to additional support to help them make decisions.

People’s health and care needs were assessed and they were involved in their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by cheerful and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. A person who used the service we spoke with told us, “The staff are lovely to me, I’m satisfied here.” Another person told us, “I’m content with the care here I could not wish for a better crowd of staff."

The views of people who used the service and their relatives were asked for as part of regular quality monitoring reviews of the service. Any shortfalls or concerns raised were addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided by staff in accordance with people’s wishes.

Is the service responsive?

Where concerns about an individual's wellbeing had been identified, staff had taken appropriate action that ensured people were provided with the healthcare support they needed. This included seeking support and guidance from care professionals, including doctors and occupational therapists.

People had the opportunity to enjoy a range of activities and, mostly with family and friends support, were able to get out and about in the local community.

Since our previous inspection, in April 2014, morning staffing levels had been increased to try to ensure people’s needs were being fully met. A person who used the service we spoke with told us, “The staff are around if I need them and they ask me if I’m ok, they usually answer my call bell pretty quickly and help me with what I need doing.”

Is the service well-led?

The service worked well with other agencies and services to ensure all aspects of people's needs were being met.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the aims of the home and of the standards of care and support that was expected of them.

Regular service monitoring processes were in place. This helped to ensure that people received a good quality service at all times. A person who used the service we spoke with told us, “The manager gives us survey forms to fill in and gets back to me about the things I say.”

We considered our inspection findings to answer five key questions; is the service safe, effective, caring, responsive and well-led? This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff checked our identity and we were asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they were happy living in the service and that they would speak with the staff if they had concerns. People did however raise issues with us about staff availability and waits for care. We have asked the provider to look into this and reassess people's needs to ensure that sufficient staff are being provided at all times.

We found that appropriate arrangements were in place to ensure that people who used the service were protected against the risks associated with the unsafe use and management of medicines. People had their medicines at the times they needed them, and in a safe way.

When people needed to use equipment such as hoists, specialist beds and mattresses we found that these were kept clean and well maintained to ensure people's safety.

People told us that they were satisfied with the level of cleanliness and hygiene in the service. We found that the provider had systems in place to ensure that cleanliness was maintained and monitored.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. Staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS.) This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks which meant that people were protected in the event of a fire.

Is the service effective?

Apart from some concerns about staffing levels people told us that they were happy with the service and that it met their needs. People made comments such as, "I am quite satisfied," and, "The staff here are second to none and I have no concerns." People who were unable to verbally express their views were relaxed, interacted well with staff and were supported.

People's care was supported through assessments, care plans and risk assessments being in place. This ensured that staff understood people's needs and could care for them safely, effectively and consistently.

Staff who worked in the service were supported through on-going training and supervision to offer people care and support that meet their needs.

Is the service caring?

We saw that staff interacted with people living in the service in a caring, respectful and professional manner. Staff demonstrated an affection and warmth for the people they supported.

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives. People's choices were taken in to account and listened to.

We saw that staff were responsive to people's changing wishes and needs about where they went and what they did and supported them well.

People's care records showed that where concerns about their well-being had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from other health care professionals.

Is the service well-led?

The service had a registered manager in post. Qualified nurses provided leadership and support on each shift. We found that they were knowledgeable about people's needs and provided support to the staff team. A general manager was available at times to oversee and monitor all aspects of the service. The provider had systems in place such as quality surveys and audits to monitor and improve the service. These things showed us that the service was being well led.

Reasons given by relatives for choosing the service included that it, “Seemed friendly,” and it, “Feels homely.”

We found that the provider had arrangements for assessing and recording consent and capacity to consent. People were asked for their consent before support was given. Where they lacked capacity appropriate assessments were generally completed.

We saw that people's care and treatment was planned and reviewed with their involvement, where possible. Risks to people's health, welfare and safety were identified and managed.

We found that most areas of the home and all types of equipment required more thorough cleaning to improve overall cleanliness and to protect people against the risk of infection.

We saw that equipment was regularly serviced and available in sufficient quantities, however a large number of pieces of equipment were rusty and in some cases broken. These included toileting equipment, shower and bath seats. Staff had received training in the safe use of equipment.

Staff were selected and recruited in a way that ensured they were suitably qualified and fit for the job.

We found that there were some systems in place to assess and improve the quality of service provision however these were insufficiently robust to identify areas of non-compliance.