Bartholamew Lodge Nursing Home Limited

People’s experience of using this service:

People were supported by staff that were caring, compassionate and treated with dignity and respect. Any concerns or worries were listened and responded to and used as opportunities to improve.

People received person centred care and support based on their individual needs and preferences. Staff were aware of people's life histories and individual preferences. They used this information to develop positive, meaningful relationships with people.

People told us they felt well cared for by staff who treated them with respect and dignity and encouraged them to maintain relationships and keep their independence for as long as possible.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. People told us the atmosphere at the home was relaxed and friendly.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

Where people lacked capacity, staff worked with the local authority to make sure they minimised any restrictions on people's freedom for their safety and wellbeing.

Staff spoke positively about working for the provider, they felt valued and happy in their role. They felt well supported and that they could talk to management at any time, feeling confident any concerns would be acted on promptly.

Audits were completed by staff and the registered manager to check the quality and safety of the service.

The registered manager worked well to lead the staff team in their roles and ensure people received a good service.

More information is in Detailed Findings below.

Rating at last inspection: Good. (Report Published 30 June 2016)

Why we inspected: This was a planned comprehensive inspection based on the rating of Good at the last inspection. The service rating remained as an overall rating of Good.

Enforcement:

No enforcement action was required.

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 any concerning information is received we may inspect sooner.

The provider is registered to accommodate and deliver nursing and personal care to 30 people. People who lived there were elderly and had needs associated with old age and dementia.

At our last inspection on 11 May 2015 the provider was not meeting one of the regulations that we assessed which related to the governance and the quality monitoring of the service. This had some negative impact on the overall service provided. During this, our most recent inspection, we found that monitoring and checking processes were more thorough and were undertaken regularly and had improved the service provided. However, we found that attention was still required to ensure that staff received the training they needed and that there was a record of this.

A manager was registered with us as is required by law. 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.

Staff knew what to do to keep people safe and prevent the risk of abuse or harm to them.

Systems in place promoted safe medicine management to prevent people being placed at risk of possible ill health. We found that people were given their medicines as they had been prescribed.

Staff told us and records confirmed that they received induction training and the support they needed to ensure they did their job safely.

People, relatives and staff we spoke with confirmed that staff skill mix and staffing levels were adequate to meet people’s needs and to keep people safe.

Staff understood the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the registered manager was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

People were offered drinks and food that they enjoyed in sufficient quantities to prevent them from a risk of dehydration and malnutrition.

People’s health care needs were met by the care and nursing staff and a wide range of external healthcare professionals.

People were cared for and supported by kind and caring staff.

People were encouraged and supported by staff to be independent and attend to their own needs when they could.

Staff supported people to keep in contact with their family as this was important to them.

We found that people were able to make decisions about their care and they and their families were involved in how their care was planned and delivered.

There was a range of recreational activities for people to participate in and enjoy.

Systems were in place for people and their relatives to raise their concerns or complaints if they needed to.

People and their relatives told us that the quality of service was good. The management of the service was visible and consistent. There were processes in place to monitor the quality of the service to ensure that people received a service that met their needs and kept them safe.

At the time of our inspection 18 people lived at the home (although as one person was away on holiday so only 17 people were actually there). During our inspection we spoke with seven of those people, six relatives, six staff, the manager, and the registered provider. All of the people who lived there and their relatives were very positive about the home and the services provided. One relative said, 'It is excellent. Much better than the last place they were in'. Another relative told us, 'I have no concerns at all. It is a very good place'. One person who lived there said, 'I like living here. I give it nine or 10 out of 10'. A second person told us, 'Oh it is wonderful here'. We randomly looked at recently completed surveys that had been sent by the provider to people who lived there, relatives, external health care professionals and staff.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

All people we asked told us they felt safe. All people and relatives that we asked told us that they had not seen anything of concern. One person told us, 'The staff are not rough or unkind'. One relative said, 'A member of our family visits every day. Nothing like that has happened'.

Staff we spoke with knew of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury.

We found that people's risks and needs had been assessed. However, instructions in care plans regarding the frequency of the checking of people's wellbeing were not always followed by staff.

The management of day to day risks and safety should be improved upon. Those include systems to prevent dehydration and malnutrition.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

Systems regarding menu planning and meal variety were effective. All people we spoke with told us that the meals were good. One person said, 'I love the food here'.

Most of the non-compliance we determined had already been raised with the provider by external care agencies. (Non-compliance is when the provider does not meet the requirements of the law or there are shortfalls in care delivery or practice). Although the provider had made some changes we still found non-compliance in day to day basic practice. This did not give assurance that the provider was adequately effective.

People's health and care needs were assessed but they were not always included in detail in their care plans. For example, staff practice for one person did not reflect the instructions in their care plan. When we asked staff to clarify what was required we were given different views. This meant that care plans were not able to consistently support staff to meet people's needs.

We found that day to day activity provision was not adequate to meet people's needs. One person said, 'There is not much to do'.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning to ensuring that the service is effective.

Is the service caring?

We determined that staff showed people respect and promoted their dignity. We saw that staff showed patience when supporting people.

All of the people and their relatives were very complimentary about the staff. They described them as being, 'Caring', and 'Kind'. One person who lived there said, 'I like all the staff. They are very kind and friendly'. A relative told us, 'I cannot fault the staff here. They are very kind and considerate'.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensure that the service was caring.

Is the service responsive?

People who lived there and their relatives had been given the opportunity to complete satisfaction surveys. The provider told us that they were in the process of analysing the surveys and would take action and make changes where there was a need. This showed that the provider was willing to listen to the views of the people who lived there, and their relatives, to improve the overall service provision.

The provider told us that improvements had been made since external health care professionals had raised issues. Those external health care professionals had confirmed some improvements. However, our observations and the evidence that we gathered showed that staff did not always perform to the standard that was required regarding the following of instructions in care plans.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make to ensuring that the service is responsive.

Is the service well-led?

At the time of our inspection there was no manager registered with us. It is a requirement in law that the home should have a registered manager. The manager told us that they had made an application to register. The registration of the manager would give people who lived there greater assurance that the service provided would be consistent and well led.

Documents that we looked at and our observations confirmed that records were not all completed adequately to evidence sufficient food and fluid intake to prevent ill health. This showed that staff had not undertaken tasks as they should have done and did not give assurance that the service was well led.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make in relation to the management of staff and quality assurance processes to demonstrate a well led service.

Everyone we spoke with was very complimentary about the overall service, the care provided, and the staff. One person who lived there told us, 'I have had a very good life. I am glad that my daughter found this place for me. The place is good, the food is good, and the staff are good. I am happy and content to spend the rest of my days here'. Another person said, 'It is a very good place. We are well looked after'. A relative told us, 'It is very good here. I have no concerns. They are well looked after'. All staff we spoke with told us that they enjoyed their work and that they felt that the people who lived there were well looked after and were safe.

During the time we spent with people we saw that staff treated them with respect and dignity. All people we spoke with told us that choices were offered and their views had been taken into consideration. We saw that people's needs had been assessed by a range of health professionals including specialist doctors and the optician. This meant that staff had enabled people to have their health care and safety needs monitored and met.

We found that medication management systems were adequate. People had been given their medication as it had been prescribed by their doctor.

We saw that the environment had been refurbished and enhanced to offer a pleasant place for people to live.

We found that staff were provided with guidance and support to meet people's needs and to keep them safe.

We saw that complaints processes were in place for people who lived there or their relatives to use if they were not happy with the service provided.

All people we spoke with told us positive things about the home. One person told us "I have been in other homes before but this one is the best, we have good care and it is very friendly and homely". Another person said 'I came here before for short stay care. When I needed long term care I insisted I came back here because I had liked it so much". A third person said "Everything here is wonderful, the staff, the food and the care". One relative said 'It is excellent. I can not fault it they are very well looked after". An external care worker told us "I have never seen anything concerning here.This is one of the better places we go to".

We saw that staff were polite to people and showed them respect. People's needs had been assessed by external health professionals including the dietician and speech and language therapists.This meant that people's health care needs had been monitored and met.

Staff were able to give a good account of what they would do if they were concerned about anything or witnessed abuse.

Recruitment processes ensured that staff employed were suitable to work with the people living at the home which protected them from harm.

Records and staff both confirmed that systems had been used to monitor how the home had been run.