We carried out an unannounced inspection of this service on 6 January 2015. The last inspection was in July 2014 and seven of breaches of regulations were found. These related to a lack of accurate information in people’s care plans, insufficient support for people’s nutritional needs, lack of reporting of allegations of potential abuse, inadequate infection control systems, unsafe medicines management and shortfalls in quality monitoring. Improvements were made to meet the legal requirements in the majority of areas, however the actions relating to medicines were not fully completed.
Bishopsmead Lodge is registered to provide accommodation and nursing care for up to a maximum of 51 people. The service cares for older people, some of whom are living with dementia. At the time of our inspection there were 37 people living in the home.
A registered manager was in post at the time of the 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 and associated Regulations about how the service is run.
Improvements had been made in medicines management since our last inspection. However we found that some medicines were not always looked after safely. A delay in receiving some people’s medicine meant one person was not able to take one of their prescribed medicines for a week. Records were not kept of the receipt of all medicines so it was difficult to check whether they had been looked after safely.
Call bells were available within people’s reach in their own rooms and staff responded quickly. For example, we were with one person when they used their call bell. However in the lounge area there was only one call bell that was fixed to the wall. This was out of reach for some people who were unable to move on their own. We recommend the provider reviews current best practice information in relation to the access to call bells or alternatives to ensure people’s safety.
People said they felt safe and well looked after and this was confirmed during our observations. Relatives we spoke with also confirmed this. Several people told us staff supported them well and they also received the services of a weekly hairdresser.
Staffing levels were sufficient to meet the current needs of people living in the home. People told us staff usually answered their calls bells swiftly. During our inspection we observed staff responded to people’s needs promptly.
People’s risk assessments gave detailed guidance for staff to follow as they were comprehensively completed. This meant that staff had full information to ensure people were kept safe and protected from harm.
Detailed care records were completed. People’s care files recorded their care and treatment. This included nutritional recording charts. This enabled staff to monitor people’s nutritional intake effectively. Staff we spoke with were knowledgeable of people’s needs.
People were protected from the risks associated with cross infection. The staff followed the Department of Health infection control guidelines. Shared areas of the home were clean, free of clutter and unwanted odours. Staff were observed using personal protective equipment (PPE) such as aprons and gloves when required to reduce the risks of cross infection when assisting people.
People were happy with the food and drink they received in the home. We observed a mealtime and observed people’s needs being met effectively. We found that people received the support they required. We observed staff sat with people and they provided one to one support in line with people’s assessed needs.
The provider had ensured that staff had the knowledge and skills they needed to carry out their roles effectively and ensure people were safe. Staff had completed their safeguarding adults training to ensure their knowledge was current and in accordance with current guidance.
Staff had training in the Mental Capacity Act 2005 and had a good understanding of the processes to be followed to ensure decisions were made in people’s best interests. This information was correctly recorded to help protect people’s rights
There were positive and caring relationships between staff and people at the service. People praised the staff and told us they provided a good standard of care even when they were very busy. We observed people were relaxed in the company of staff and engaged in conversations. All the feedback we received from people and their relatives was positive.
People’s care records demonstrated their involvement in care planning and decision making processes. Some people had signed their documentation. This was confirmed when we spoke with people living in the home and their relatives who confirmed reviews took place.
Staff meetings and registered manager meetings were scheduled regularly and staff were encouraged to express their views. Meetings were held with people and their relatives to ensure that they could express their views and opinions about the service they received. People could also raise any complaints at these meetings.
Quality and safety in the home was monitored, systems had been improved since the last inspection, and new systems implemented to support the registered manager in identifying any issues of concern and had taken action.
We found one breach of regulation relating to medicines. You can see what action we told the provider to take at the back of the full version of the report.