Redfield Lodge is a care home operated by Bristol City council and is registered to provide personal care and accommodation for up to 40 people living with dementia.The inspection of the care home was undertaken by a CQC inspector over a period of two days. During our inspection we spoke with people living in the home and visiting relatives. We also looked at the records relating to people receiving care in the home and spoke with the care staff on duty and the registered manager.
We were unable to speak to some people who use the service in detail as they were living with dementia and had complex needs. We talked to staff and used observations to gain an insight into how they were involved in their care and support. We also used the Short Observational Framework for Inspection (SOFI) tool. SOFI is a specific way of observing care to help us to understand the experience of people who could not talk to us.
Following the inspection we considered all of the evidence we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
This is a summary of what we found:
Is the service safe?
People we spoke with told us they felt safe living in the home and knew who to tell if they didn't. One person told us 'I'd tell the manager if something upset me'.
People using the service told us that their medication was given as prescribed and appropriately. We found that the home had made arrangements for the safe use and management of medicines because there were systems in place for safe storage, administration and recording of medicines used. Where people needed support with their medicines, this was carried out by staff that had been trained to administer medicines safely.
CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that a DoLS application had been made in the weeks prior to the inspection and it had been approved by the relevant authority. There is however a requirement to submit a statutory notification to the CQC once a decision has been reached in respect of a DoLS application. We found that the required notification had not been submitted.
People's personal records were not always completed fully. Therefore it was not clear from the information whether the person had received care in line with their identified need.
Is the service effective?
People who were able to speak with us told us they were happy with the care being delivered and that their needs were being met by kind and attentive staff. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs.
Most care documentation that we viewed was reflective of people's current level of need. However some recording charts were not completed fully. This meant there was a risk people were not being given the support they required in line with their care plan.
The provider ensured that staff were supported through a series of supervisions. This meant that the provider ensured that staff performance was regularly monitored and reviewed. Staff told us they felt supported by the management; one member of staff said 'there is an open door policy here, we can always get help if we need it'.
Is the service caring?
People told us they felt reassured by the staff. One person said 'It's very nice here they look after us very well', another person said 'it's very good, they treat me kindly'.
Although people that we were able to speak with told us that staff treated them kindly, we found that people were not always treated with dignity, consideration and respect. We observed three separate incidences where staff spoke to people without consideration or respect and made comments about them using inappropriate language. We also observed an incident where a member of staff failed to act in accordance with the consent of the person receiving care. We have reported all of these incidences to the provider and the appropriate safeguarding authority.
The care plans we looked at provided details of people's individual wishes and preferences. We found that the service sought advice from external healthcare professionals where necessary.
Is the service responsive?
People's needs were assessed prior to them using the service. People and their relatives were involved in the assessments of their needs and planning their care. We saw evidence that demonstrated that people were able to discuss what was important to them with staff. One person told us 'I knew what I was getting myself into; they explained it all to me'. We saw that care plans were reviewed monthly or if required as a result of changing needs.
People had access to activities that were important to them. The service was well informed about people's preferences and therefore responded appropriately.
Is the service well led?
Staff had a good understanding of the role of the service. Staff told us they were clear about their roles and responsibilities. The staff told us that the management listened to them when they made suggestions to improve the service and that they could raise concerns without feeling intimidated.
It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.
People using the service and their relatives, were asked to provide feedback in the form of an annual survey. We found that the views of people using the service and their representatives were taken into consideration, though the action taken was not necessarily recorded.