Archived: Bluebell Lodge

Bluebell Lodge is situated in Skegby, Nottinghamshire and is operated by Bluebell Nottingham Limited. The service accommodates up to 36 people. At the time of our inspection there were 28 people living at the home, all were older people and some were living with dementia.

At our last inspection in March 2018 the service was rated Requires Improvement. Three breaches of the legal requirements were found, there were in relation to safe care and treatment, staffing and dignity and respect. At this inspection we found the quality and safety of the service had deteriorated. Consequently, we found concerns across areas including safety, medicines management, staffing, consent, person centred care and leadership and governance. This resulted in several 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. This was the first time the service had been rated as Inadequate.

There was a 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.

Throughout our inspection of Bluebell Lodge, we found serious concerns that posed a risk to the safety of people living at the home. People were at risk of harm as risks associated with their care and support were not managed safely. Risk such as falls, choking and pressure ulcers were not properly assessed and there were insufficient measures in place to reduce risk. People were at risk of injury due to poor moving and handling practices. People were unable to summon help as their call bells were not always left within reach. We found multiple concerns with the management and administration of medicines which placed people at risks of not receiving their medicines as prescribed. People were not protected from environmental risks. The home was not clean and infection control practices were not followed. People were not protected from abuse and improper treatment. Safeguarding referrals had not been made when allegations had been raised against staff and people were subject to restrictive behaviour management techniques. There were not enough staff to meet people’s needs and people were supported by staff who did not have the competency to ensure their wellbeing or safety. Safe recruitment practices were followed.

People were not offered enough to eat and drink and were at risk of dehydration or malnutrition. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. People were deprived of their liberty without the necessary authorisations. Care and support was not properly planned and coordinated when people moved between services. People’s health needs were not met and their needs were not reassessed when their health changed. Care was not always delivered in line with current legislation and standards. People were supported by staff who did not have the required skills or competency to provide safe and effective support. The environment did not fully accommodate people’s physical needs and the needs of people living with dementia and/or memory loss had not been fully considered.

People did not receive consistently kind and caring support. There was an inconsistent approach to involving people in decisions about their care and support. People’s right to privacy was not always respected. Staff did not always recognise when people needed support. Staff routines took priority over person centred care.

People were not provided with adequate levels of basic care. Care plans were contradictory and did not reflect people’s needs, some people did not have care plans in place at all. This meant there was no information about what mattered to these people or how best to support them. Staff knowledge of care and support was variable and people did not always receive safe support that met their needs. People’s end of life needs and wishes were not planned for. The care and support provided at Bluebell Lodge did not reflect people’s preferences. People’s social needs were not met, many people spent long periods of time unoccupied, there was little attempt to interact with people socially or provide the opportunity for meaningful occupation. There was a risk people’s diverse needs may not be met. Appropriate action was not always taken in response to complaints.

There had been a failure to identify and address serious issues with the safety and quality of the service at Bluebell Lodge. Systems to monitor and improve the quality of the service were not effective. Where audits had identified areas for improvement action had not been taken to address issues. We had concerns about the competency of the leadership team. Effective action was not taken to address concerns raised during our inspection. The implementation of improvement plans was disorganized and there was a lack of effective oversight of planned action. Failings in leadership and governance placed people at risk of harm.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was a registered manager in post 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.

During this inspection, we found the service was not consistently safe. People were not always protected from risks associated their care and support. People were at risk of choking as staff did not following guidance to reduce the risk. We also found inconsistent practice related to the management of risks associated with falls and with people’s behaviour. There were not always enough staff available and staff were not deployed effectively to meet people’s needs and ensure their safety. This placed people at risk of harm.

People told us they felt safe and there were systems and processes in place to minimise the risk of abuse. Safe recruitment practices were followed to ensure staff were suitable to provide support. Medicines were stored and managed safely and records showed people received their medicines as required. The environment was clean and hygienic; however, improvements were needed to ensure the cleanliness of equipment used in people’s care and support.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Systems in place to protect people from risks associated with eating and drinking were not always effective. We received mixed feedback about the food. People were supported to attend health appointments. However, there was a risk people may not receive appropriate support with specific health conditions. This was because care plans did not consistently contain sufficient information for staff to follow and staff did not always have adequate knowledge of people’s health conditions. Overall though, we found people were supported by staff that had the skills and knowledge to provide good quality care and support. There were systems in place to ensure information was shared across services when people moved between them. The design and decoration of the building accommodated people’s diverse needs.

People told us they were involved in decisions about their care and support; however, we found this was not always the case. We observed some occasions where staff made decisions on people’s behalf without consulting them. People’s right to privacy was not always respected and they were not always treated with dignity. Despite this, people told us staff were kind and caring. People had access to advocacy services if they required this.

People were at risk of receiving inconsistent support, as care plans did not all contain accurate, up to date information and staff did not always follow the guidance in care plans. People were provided with some opportunities for social and recreational activity, However, we observed opportunities for meaningful activities were missed and activities did not meet the needs of all people living at the home. People’s friends and family were welcomed into the home and were involved in the care and support of their loved ones. People were provided with an opportunity to discuss their end of life wishes and this was compassionately recorded in people’s care plans. There were effective systems in place to investigate and respond to concerns and complaints.

There were no formal systems in place to identify and address issues with the day to day practice of staff, consequently some poor practices had developed which impacted negatively on people living at the home. Staff did not have adequate access to IT systems that meant they were unable to keep up to date records of the care they provided to people. There were systems in place to monitor and improve the quality and safety and to analyse and learn from adverse incidents. However, improvements were required to monitor the practice of staff more effectively. Staff and people living at the home were able to express their views in relation to how the service was run and this was used to inform improvement. Staff and people who used the service were positive about the registered manager and felt supported. The management team were responsive to our feedback and developed an action plan in response to the concerns identified during this inspection.

During this inspection, we found two breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.