Archived: Bluebell Lodge

Updated 16 January 2020

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 to look at concerns we received about the quality and safety of the service and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 11, 12 and 17 December 2018. The inspection team consisted of two inspectors, an inspection manager and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to our inspection visit, we reviewed information we held about the service. This included information received from local health and social care organisations and statutory notifications. A notification is information about important events, which the provider is required to send us by law, such as allegations of abuse and serious injuries. We also contacted commissioners of the service and asked them for their views. We used this information to help us to plan the inspection.

During our inspection visit, we spoke with eight people who used the service and the relatives or friends of three people. We spoke with five members of care staff and the activities coordinator. In addition, we spoke with the following members of the management team; the registered manager, two directors and the Nominated Individual. The nominated individual is a person who is nominated by the provider to represent the organisation.

To help us assess how people's care needs were being met we reviewed all or part of 15 people's care records and other information, for example their risk assessments. We looked at people’s medicines records, four staff recruitment files, training records and a range of records relating to the running of the service, for example, audits and complaints. We carried out general observations of care and support and looked at the interactions between staff and people who used the service.

As this was a responsive inspection we did not ask the provider to complete a ‘Provider Information Return’ prior to our inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We gave the registered manager the opportunity to share this information with us throughout the inspection.

Updated 16 January 2020

We conducted an unannounced inspection at Bluebell Lodge on 11, 12 and 17 December 2019. Bluebell Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This was the second time we had inspected this service since it was registered in 2016.

Bluebell Lodge is situated in Skegby, Nottinghamshire and is operated by Bluebell Nottingham Limited. The service accommodates up to 36 people. At the time of our inspection there were 28 people living at the home, all were older people and some were living with dementia.

At our last inspection in March 2018 the service was rated Requires Improvement. Three breaches of the legal requirements were found, there were in relation to safe care and treatment, staffing and dignity and respect. At this inspection we found the quality and safety of the service had deteriorated. Consequently, we found concerns across areas including safety, medicines management, staffing, consent, person centred care and leadership and governance. This resulted in several 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. This was the first time the service had been rated as Inadequate.

There was a registered manager in place at the time of our inspection. 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.

Throughout our inspection of Bluebell Lodge, we found serious concerns that posed a risk to the safety of people living at the home. People were at risk of harm as risks associated with their care and support were not managed safely. Risk such as falls, choking and pressure ulcers were not properly assessed and there were insufficient measures in place to reduce risk. People were at risk of injury due to poor moving and handling practices. People were unable to summon help as their call bells were not always left within reach. We found multiple concerns with the management and administration of medicines which placed people at risks of not receiving their medicines as prescribed. People were not protected from environmental risks. The home was not clean and infection control practices were not followed. People were not protected from abuse and improper treatment. Safeguarding referrals had not been made when allegations had been raised against staff and people were subject to restrictive behaviour management techniques. There were not enough staff to meet people’s needs and people were supported by staff who did not have the competency to ensure their wellbeing or safety. Safe recruitment practices were followed.

People were not offered enough to eat and drink and were at risk of dehydration or malnutrition. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice. People were deprived of their liberty without the necessary authorisations. Care and support was not properly planned and coordinated when people moved between services. People’s health needs were not met and their needs were not reassessed when their health changed. Care was not always delivered in line with current legislation and standards. People were supported by staff who did not have the required skills or competency to provide safe and effective support. The environment did not fully accommodate people’s physical needs and the needs of people living with dementia and/or memory loss had not been fully considered.

People did not receive consistently kind and caring support. There was an inconsistent approach to involving people in decisions about their care and support. People’s right to privacy was not always respected. Staff did not always recognise when people needed support. Staff routines took priority over person centred care.

People were not provided with adequate levels of basic care. Care plans were contradictory and did not reflect people’s needs, some people did not have care plans in place at all. This meant there was no information about what mattered to these people or how best to support them. Staff knowledge of care and support was variable and people did not always receive safe support that met their needs. People’s end of life needs and wishes were not planned for. The care and support provided at Bluebell Lodge did not reflect people’s preferences. People’s social needs were not met, many people spent long periods of time unoccupied, there was little attempt to interact with people socially or provide the opportunity for meaningful occupation. There was a risk people’s diverse needs may not be met. Appropriate action was not always taken in response to complaints.

There had been a failure to identify and address serious issues with the safety and quality of the service at Bluebell Lodge. Systems to monitor and improve the quality of the service were not effective. Where audits had identified areas for improvement action had not been taken to address issues. We had concerns about the competency of the leadership team. Effective action was not taken to address concerns raised during our inspection. The implementation of improvement plans was disorganized and there was a lack of effective oversight of planned action. Failings in leadership and governance placed people at risk of harm.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.