Blandford Lodge

Blandford Lodge is a care home for up to four adults with mental health needs. At the time of the inspection, three people were living at the service. The registered manager also managed another registered care home and supported living services. The staff sometimes worked across all of the services. The provider was a small limited company providing care and support in two residential care homes and other supported living services.

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

People were generally happy living at the service. They had good relationships with the staff and felt comfortable and at home.

There had been improvements since our last inspection. In particular, systems for supporting people with their finances, the way in which medicines were managed and audits and checks on the service.

People's care had been planned in a way which reflected their needs and choices. They had access to healthcare services and staff supported them to take part in a variety of activities inside and out of the home. People developed relationships with friends who lived nearby and the staff helped them to stay in touch when they wanted.

The service was a family style home in a residential street. People had their own rooms which they had personalised and shared communal areas. The staff supported them to take part in household tasks, meal preparation and shopping.

There were enough suitable staff and they felt supported by the managers. They had thorough inductions and training to get to know about their roles and responsibilities, as well as the needs of people who they were caring for.

The registered manager was supported by a team of senior staff. There were suitable systems for dealing with complaints, incidents and other adverse events. The management team had systems for monitoring and improving the quality of the service.

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.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published 6 October 2021).

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

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 13 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous 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 until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Blandford Lodge is a care home for up to four adults with mental health needs. At the time of the inspection, three people were living at the service. The registered manager also managed another registered care home and supported living services. The staff worked across all of the services.

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

People were not cared for in a safe way. There were risks within their environment which had not been monitored or mitigated. Including failures to follow systems to manage infection prevention and control.

Medicines were poorly managed because they were not stored securely, and records were incomplete and inaccurate. Large quantities of old medicines, including medicines belonging to people who were deceased, were stored in unlocked cabinets and there were no records about or monitoring of these.

People's money was not safely managed. Records of financial expenditure were incomplete and large amounts of cash had been withdrawn from people's accounts or spent without proper explanation. We raised a safeguarding alert about this with the local authority.

The provider had not identified serious failings at the service or risks to people, despite recording that they had completed audits on different aspects of the service, such as medicines and people's money. There had been a lack of oversight which led to poor practice and poor record keeping. Lessons were not always learnt following incidents and the provider's response to these was restrictive and reactive.

People's needs were not always met. The staff had failed to respond appropriately and seek help when people's needs deteriorated. People did not always take part in meaningful activities that reflected their individual needs and preferences; and there was a lack of therapeutic support for people to manage their mental health.

Two of the people who lived at the service and both care workers we met told us they were happy at the service.

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

Rating at last inspection

The rating at the last inspection was good (published 4 October 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the provider's other location. These concerns were linked to aspects of this location. In particular, we were alerted to concerns about how people's money was being managed and staffing arrangements. A decision was made to inspect both of the provider's registered services to assess whether people were being safely cared for. We focused our inspection on the key questions of Safe, Responsive and Well-led because the concerns we had received related to these.

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.

We have found evidence that the provider needed to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

The key questions of Effective and Caring were not looked at on this occasion.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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

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 person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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.

The last inspection took place 27 September 2016 when we rated the overall service and safe, effective, responsive and well-led as Requires Improvement. At this inspection we found improvements had been made in these areas.

Blandford Lodge provides support and accommodation for up to four people who have mental health needs and/or learning disabilities. There were three people using the service at the time of this inspection.

There was 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.

We brought forward the inspection of this service as there was an ongoing safeguarding investigation taking place. This had not been concluded at the time of writing our report. Shortly after the inspection, a second separate safeguarding investigation was started and was ongoing at the time of this report being written.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. People using the service told us they would feel able to talk with staff if they had a concern.

People’s care records included people's needs and preferences. We saw information had been reviewed on a regular basis.

There were checks on a range of areas in the service to ensure people received safe good care.

Feedback from people using the service and staff we spoke with was positive about the service.

Staff received support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged in areas that were relevant to staff member's roles and responsibilities.

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

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service. When we pointed out to the registered manager the need to check if there were any changes to a staff member returning to work after a few months absence, they immediately addressed by this by carrying out a risk assessment and applying for a new Disclosure and Barring Service criminal record check.

People received the medicines they needed safely.

People had access to the health care services they needed and their nutritional needs were being met.

People were supported to engage in activities both in the service and out in the community and to also spend time with relatives.

There was a complaints procedure available and people said they would go to staff if they had a complaint. People could share their views on the service and care they received through a range of ways, including when they met with staff on a one to one basis, at review meetings and by attending the regular house meetings that were held.

There were a range of audits and checks to monitor quality in the service and identify where they could make improvements.

Blandford lodge recently re-registered with the Care Quality Commission (CQC) in August 2016 to become registered with the provider’s limited company. The service had previously been operating for several years but this was the service’s first inspection under this new registration.

This inspection took place on 27 September 2016 and was unannounced

There was 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.

There were some risk assessments in place. However, these did not always fully inform the staff on how to safely support people using the service.

Although many staff received training we found one senior staff member who had worked in 2016 with no formal training on any subject. There was no plan in place to ensure when they would complete the mandatory training.

People’s care records and care plans did not fully guide and inform staff on how to support people and meet their individual needs.

Although there were quality checks in place these were not on all aspects of the running of the service. Therefore there were not all the processes in place to monitor, assess and identify where improvements needed to be made.

You can see what action we told the provider to take at the back of the full version of the report.

We made a recommendation for the provider to seek national guidance on following good recruitment practices.

We made a recommendation for the provider to seek national guidance on infection control to ensure the service followed good practice when keeping the service clean and hygienic.

People could personalise their bedrooms but we did find areas in the service that were not as homely and welcoming for people to live in as they could have been.

The majority of the staff team had undertaken training in the Mental Capacity Act (MCA) 2005 and the registered manager was aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). People confirmed that they were given choices and the opportunities to make decisions.

There were arrangements in place for the safe management of people's medicines.

People's nutritional needs were met, and people chose what they wanted to eat and drink.

People were supported to stay healthy and to see other health care professionals when needed.

A range of activities were provided both in the service and in the community.

There was a clear management structure, and they encouraged an open and transparent culture within the service. People were supported to raise concerns and make suggestions about where improvements could be made.