Archived: Balliol Lodge Nursing Home

Updated 23 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection of Balliol Lodge Nursing Home took place on 5 and 6 November 2015. The inspection was in response to concerns that had been raised by other stakeholders and also to follow up on the concerns found at the last inspection in July 2015.

The inspection team consisted of an inspection manager, an adult social care inspector, a pharmacist inspector, a specialist advisor in health and safety and an expert by experience with expertise in services for older people. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection we reviewed the information we held about the home. We usually request a Provider Information Return (PIR) prior to the inspection but had not done so for this inspection. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We looked at the statutory notifications the home was required to inform CQC about and other information CQC had received about the service. We contacted the Merseyside Fire and Rescue Authority, the local Clinical Commissioning Group (CCG), Sefton Social Services and the local infection prevention and control team and asked any updates about the service.

During the inspection we spent time in the company of or talking with 15 people who lived at the home and six family members who were visiting their relatives at the time of our inspection. We also spoke with the nurse-manager, a registered nurse, the housekeeper, the chef and five care staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at the care records for eight people living at the home, five staff recruitment files and records relevant to the quality monitoring of the service. We looked round all areas of the home, including people’s bedrooms, bathrooms, dining rooms and lounge areas.

Updated 23 December 2015

The inspection was unannounced and took place on 5 and 6 November 2015.

Balliol Lodge is a care home that provides nursing and personal care for up to 32 people. The care provided is for people with a diagnosed condition of dementia although some people have other enduring mental health needs. The home consists of two converted buildings over three floors. It is located very close to shops, local amenities and public transport links.

At the time of our inspection there were 22 people living at the home.

There was no registered manager in post. The previous manager had left the service shortly before our last inspection on 29 July 2015. An existing member of staff had taken up the role of manager shortly before this inspection. However, they had not applied to be registered. A registered manager is a person who has registered with the CQC 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.

Following the inspection in July 2015, the home was rated ‘inadequate’ overall. This meant the home was placed into ‘Special Measures’ by the Care Quality Commission (CQC). The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in Special Measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

People living at the home were not protected from abuse. There were a large number of serious incidents between people living at the home, many resulting in injury. Effective risk management measures had not been put in place to minimise the occurrences of such incidents. Not all staff had received training in adult safeguarding. The home did not have an adult safeguarding policy.

Individual risk was not managed effectively. Individual risk assessments and risk management plans were either not in place or were poorly completed.

We found the staffing levels were inadequate to ensure people’s safety was maintained at all times. The staffing levels had been reduced since our inspection in July 2015 despite an increase in dependency levels and continual incidents between people living at the home. Staffing levels were insufficient to ensure the shared areas were supervised by staff at all times.

The approach to recruitment of staff was not robust. Character references were accepted and references from previous employers were not always sought. Induction was not role-specific. Staff supervision was taking place but staff were not up-to-date with training needed to fulfil their role effectively.

Medicines were not managed in a safe way. For example, there was either no information or insufficient information to guide staff when administering medicines that are given when needed. There was also insufficient information recorded to enable staff to apply topical medicines (creams) properly. People’s medicines were not always given as prescribed and no explanations for these omissions were recorded. No action was taken by nurses to review people’s medicines, or seek medical advice, when they refused the medicines on a regular basis.

We found that the home was not very clean, safe or well-maintained. For example, not all of the window restrictors had been replaced following our last inspection. A stair gate was broken which meant people at risk of falling could access the stairs. Merseyside Fire and Rescue Authority had been monitoring the home closely following an allegation of serious deficiencies under the Regulatory Reform (Fire Safety) Order 2005. As a result of the visit, a Fire Safety Inspection was carried out and appropriate action was being taken. Despite these concerns, we found that weekly visual checks of smoke detectors, emergency lighting, door self-closures and firefighting equipment had not taken place since the end of August 2015.

Families informed us that their relatives had access to healthcare services when they needed it. Care records confirmed this.

Adequate measures and support were not in place to ensure people received enough to eat and drink to meet their nutritional and hydration needs. Snacks and drinks were not provided between meals. Water was not routinely offered to people as a drink.

Mental capacity assessments were not being undertaken in accordance with the principles of the Mental Capacity Act (2005). This showed staff lacked an understanding of the Act. Staff had not received training in mental capacity. Deprivation of Liberty safeguarding (DoLS) applications had been submitted to the Council for the people who needed them.

We found that not all staff were kind or caring towards the people living at the home. We heard staff speak sharply to people and we saw a member of staff displaying a dispassionate attitude towards people on a number of occasions. Staff did not make sure that people’s privacy and dignity was maintained at all times.

Care was not person-centred. Care records concentrated mainly on people’s physical health care needs and contained minimal information about people’s personal history, preferences and interests. Preferred routines were not recorded for people.

We observed no meaningful recreational or social activities taking place throughout the inspection. There was no evidence in the care records of activities taking place. Families told us activities had not taken place since the activities coordinator left in August 2015.

A complaints procedure was in place and the manager provided details of a complaint that had been resolved to the satisfaction of the complainant.

Since the registered manager left the service in July 2015, another manager and a deputy manager had been appointed but they had both since left. A registered nurse working at the home had been promoted to nurse-manager with only 10 hours of managerial time negotiable with the owner each week.

Staff meetings and meetings for relatives were taking place. The provider was not acting on feedback from these meetings. For example, staff raised concern about the low staffing levels in August 2015 yet the staff levels were reduced after this.

Structures to monitor the quality and safety of the service were ineffective. Audits and checks of the service had not picked up on serious issues we identified, such as concerns with the safety of the environment and the management of medicines. The provider was not informing the CQC of all the events CQC are required to be notified about.

CQC used its urgent powers to remove the location so that Balliol Lodge was no longer registered to carry out the regulated activities.