The Care Quality Commission
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  • Care home

Archived: Beatrice Court and Citygate Lodge Home

Overall: Requires improvement read more about inspection ratings

36 St John Street, Lichfield, Staffordshire, WS13 6PB (01543) 418341

Provided and run by:
Litchfield Care Limited

All Inspections

07/10/2014

During a routine inspection

This inspection took place on the 6 and 7 October. It was an unannounced inspection.

Beatrice Court and Citygate Lodge are registered to provide personal and nursing care to 128 people. At the time of this inspection there were 81 people living at the home. Two units were closed and were being refurbished. Citygate Lodge accommodated people with residential care needs; Magnolia units provided care for people with both nursing and personal care needs. Ivy units were specifically for people with needs relating to mental ill-health and people living with dementia. The provider told us that when the home was fully open it would provide accommodation for 101 people.

The service has not had a registered manager since 2012. The current manager had recently applied to be registered with the commission. 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.

When we completed an inspection in December 2013 we asked the provider to make improvements in safeguarding people from abuse. The provider had made the necessary improvements.

People we spoke with and their relatives were positive about the care provided at the home. Although we saw some very positive aspects of care we also saw some areas that needed improvement.

Systems were in place to keep people safe but we saw some improvement was needed to be taken to ensure people’s ongoing safety. Some bedroom doors were wedged open and the provider did not have some equipment they had identified as necessary to support people to evacuate the home in the event of an emergency.

Some records of care were not completed or were not up to date. This meant that that there was a risk that people may receive inappropriate care and their preferences would not be taken account of.

Staff were not always following the principles of the Mental Capacity Act 2005. For example, people’s capacity to make decisions was not assessed and there was inadequate information to show the actions that were needed to support people to make decisions. This meant that people’s rights may not be upheld.

People living with dementia did not have enough to do. People spent periods with little stimulation and engagement with people and objects. When people were engaged and stimulated we saw positive benefits in their well-being.

Although people had noticed an improvement in the leadership and management of the home there remained areas that needed to be addressed to improve people’s care.

Staff had the knowledge and understanding to identify and act when potential abuse of people was suspected. This helped to make sure people were kept safe.

People’s health care needs were assessed and their individual needs were acted upon. People were supported to receive appropriate specialist health care support.

People were supported to have sufficient to eat and drink. There was a good choice of meals throughout the day. People could choose where to have their meals.

People told us and we observed that staff spoke with people in a caring and respectful manner. People felt that staff cared about them. Most people told us that the care staff took account of their individual needs and their wishes and choices were respected.

The home had an effective complaints procedure in place. People and relatives told us that the staff were responsive to their concerns. They said that when issues were raised these were acted upon promptly.

We found three 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 this report.

24 March 2014

During an inspection looking at part of the service

We had visited Beatrice Court and Citygate Lodge on 22 and 23 January 2014. Concerns about the care provided to people had been raised by the local authority and the home was subject to a large scale investigation. This is where the local authority, along with other relevant professionals investigate concerns. The provider was actively working with the local authority to address these concerns.

Following our inspection in January 2014 we commenced enforcement action. This meant that we gave the provider a formal notice requiring them to demonstrate improvements had been made and that they were compliant with the essential standards of quality and safety. We carried out this inspection to review the areas requiring improvement which had been identified in January.

Prior to the inspection in January we had received concerns regarding the management of pressure ulcers. This prompted us to look at the care and welfare of people at risk of pressure ulcers in detail. In order to do this a specialist advisor in tissue viability accompanied us on the inspection. The specialist advisor accompanied us again on this inspection.

We found that the management and care for people at risk of pressure ulcers was much improved. The staff we spoke with were positive about the changes and the improvement to care delivery. The staff we spoke with were knowledgeable regarding the care needs of the people they were supporting. We saw that staff had received additional training. There was detailed documentation available to ensure staff had the necessary information available to deliver appropriate care in a safe and consistent manner.

The manager at the home was newly appointed and had been in post for five weeks. We were told they were in the process of registering as the manager with the Care Quality Commission (CQC).

22, 23 January 2014

During an inspection looking at part of the service

Following our inspection on 20 September 2013 we found improvements to the service were required. The provider had sent us an action plan detailing the improvements to be made. We reviewed this as part of the inspection.

Concerns about the care provided to people had also been raised by the local authority. At the time of our inspection the home was subject to a large scale investigation. This is where the local authority, along with other relevant professionals investigate concerns. The provider was working with the local authority to address these concerns.

The people living at the home we spoke with were complimentary of the service provided. Where people were unable to tell us their experience we spent time observing support provided by staff. We saw that, generally, staff were available to support people in a timely manner. Development of care plans was underway; however detailed reviews of changing care needs were not sufficient to confirm appropriate care had been delivered in a consistent and appropriate manner. A process was in place for reporting concerns to the local authority safeguarding team, however we noted events when a referral would have been expected but this had not been completed.

There had been positive changes to the environment. Replacement of bathrooms, shower rooms and kitchenettes had improved the atmosphere in the home. All of the staff we spoke with were complimentary about the changes.

20 September 2013

During an inspection in response to concerns

We visited Beatrice Court in July 2013 and found improvements to the service were required. The provider had sent us an action plan detailing how improvements would be made; we reviewed this as part of this inspection. We had also received information of concern which prompted us to look at staffing levels at the home.

During this inspection we spoke with five people who lived at the home, two visitors, and 12 staff members, the manager and the provider.

On arrival at the home we found a medication delivery which had been left unsecured. This meant the system in place to manage medicines was not robust. When auditing the quantity of tablets in the home we identified some errors in the quantities of tablets in stock.

Care plans and risk assessments were not reviewed or updated in a timely manner to ensure people's individual welfare and safety requirements were met. The staffing levels, particularly at night, also meant safe and consistent care was not always evident.

We found there were on-going improvements to the management of infection control. Hand washing facilities had been improved and staff had received additional training.

During the last inspection we had identified that some areas of the home were in need of maintenance. We did not review this outcome during this inspection as the work was still in progress. We will review this at our next inspection.

1, 2 July 2013

During an inspection looking at part of the service

We visited Beatrice Court and Citygate Lodge in March 2013 and found improvements to the service were required. We carried out this inspection to see if improvements had been made. The provider had sent us an action plan detailing how improvements would be made; we reviewed this as part of the inspection.

We involve people who use services who have unique knowledge and experience of using social care services; we call them experts by experience. Together with the expert by experience, we spoke with 24 people living at the home, seven visitors to the service, staff members, senior managers and the provider.

We could not always see that appropriate measures were in place to ensure that all service users were protected against receiving care that was unsafe or inappropriate. For example, as with our inspection in March 2013, we observed some poor moving and handling techniques being used.

We had received information that prompted us to review the processes for infection control. We found that in the absence of suitable hand washing facilities the provider was unable to demonstrate that hand hygiene practices were in place. Some of the equipment in use at the home, for example wheelchairs, had not been maintained.

At the last inspection we had identified that some areas of the home were in need of maintenance. On this occasion we saw that some work to shower rooms and bathrooms had been completed. Additional maintenance was required in other areas of the home.

13 March 2013

During a routine inspection

At this inspection we spoke with eight people living at the home, three families, who were visiting, nine staff members, the manager and the provider. The manager at the home was newly appointed. We were told they were in the process of registering as the manager with the Care Quality Commission. Most of the people we spoke with told us that things seemed to have improved at the home recently and they liked the new manager.

We found that generally people living at the home were treated with dignity and respect. The home had appointed 'Dignity champions' to further promote the importance of dignity and respect in the home.

We did not see that all the people living at the home had their care needs met in a consistent manner. For example we observed one member of staff had not followed the guidance in care plans and risk assessments when moving people. We found that there were no records for one person to show that their wound dressings and wound assessments had been completed.

Systems were put in place to ensure all staff had the necessary knowledge and information for recognising and reporting concerns of abuse.

Systems were in place to monitor the quality of services provided. A maintenance programme was in place at the home. We found that bathrooms were not adequately maintained whilst awaiting refurbishment.

We found that staffing levels were monitored at the home. On the day of the inspection staff were available to support people in a timely manner.

16 February 2012

During an inspection looking at part of the service

We carried out this review to check on the care and welfare of people using this service. We visited Beatrice Court in order to up date the information we hold and to establish that the needs of people using the service were being met. The visit was unannounced which meant the provider and the staff did not know we were coming.

During the visit we spoke with people who lived at Beatrice Court, staff members, the manager and the provider. A staff member said, 'It's a lovely home to work in'. People living at the home told us, 'It's nice, the staff do their best to help.' Another person told us, 'Some staff are good some aren't it depends who is on duty'.

The environment felt homely, recent decoration had taken place and we saw that people who used the service had been invited to contribute to the new colour scheme. One person told us, 'It feels like home'. Another said, 'I'm going to talk to the nurse about having a phone in my bedroom.' We found that toilets in communal areas required attention.

We looked at plans of care for three people and found that they held information about each person, the care they required and how they would like to receive the care. There were completed risk assessments but some documentation did not give sufficient detail to ensure safely and appropriate care delivery. For example, when someone was unable to use a call bell there was no information to explain how their needs would be met.

We involve people who use services and family carers to help us improve the way we inspect and write our inspection reports. Because of their unique knowledge and experience of using social care services, we have called them experts by experience. Our experts by experience are people of all ages, from diverse cultural backgrounds who have used a range of social care services.

An expert by experience took part in this inspection and talked to the people who used the service. They looked at what happened around the home and saw how everyone was getting on together and what the home felt like. They took some notes and wrote a report about what they found and details are included in this report.