15 February 2017
During a routine inspection
Bywater Hall Lodge provides accommodation and care for up to 88 older people. Some may be living with dementia or other mental health conditions.
The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
All the people we spoke with said they felt safe in the home. These were some of the comments people made, “I do feel safe, I feel there is enough staff to look after me.” “I’m happy here and feel safe.” I do feel safe here because there are a lot of people about to look after me.”
At this inspection we found some aspects of medicines management were not always in line with the provider's policy. Records did not always show when creams and lotions known as ‘topical medicines’ was applied and how often.
We received a mixed response when we asked staff about the management of the service. Some felt well supported where others did not. We saw from the staff records we looked at that supervision and appraisals had not been carried out on a regular basis, and in line with the provider’s policy. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.
Staff knew how to keep people safe from the risk of harm and abuse; they had received relevant
safeguarding training and knew how to report issues of concern.
We found people's health care needs were met and relevant referrals to health professionals were made when needed. People's nutritional needs were met. There were choices available on the menus and alternatives if people didn't like what was on offer.
Care plans were not signed by people or their representatives to show they agreed with the contents, and there was a lack of consent documentation for things such as administration of medicines, living at Bywater Hall Lodge and photography for medical and other purposes.
Staff we spoke with told us people could make day to day decisions about their care, for example, when to get up and where to sit. Staff said they had completed MCA training and understood that when people had capacity they had the right to make unwise decisions and when people lacked capacity, decisions had to be made in people’s best interests. One member of staff said, “I can’t make a choice for someone if they have capacity. My role is to make sure they have all the information and explain things.”
A range of activities were offered for people to participate in and people told us they enjoyed these.
There were systems in place to ensure complaints and concerns were fully investigated. The manager had dealt appropriately with any complaints received.
A range of checks and audits were undertaken to ensure people's care and the environment of the home was safe and effective. These checks had identified the issues we noted around the management of medicines but the service had not responded robustly and these were still occurring.
We found four 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.