This unannounced comprehensive inspection took place on the 13, 14 and 21 February 2018. The inspection was prompted in part by increased statutory notifications from the registered provider. From those notifications we identified some vulnerable people were not being adequately safeguarded. The notifications indicated potential concerns about the management of people's care needs. This visit was also brought forward following information of concern being shared with us by the local authority. This inspection examined those risks. Bartley Green Lodge Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bartley Green Lodge accommodates up to 47 people in one adapted building comprising of three units, two of which specialise in caring for people living with dementia. At the time of our inspection 44 people were living at the home.
Since our previous inspection in November 2016 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.
At the last inspection in November 2016, the service was rated Good but required improvement in the key question, ‘Is the service Safe?’ We identified issues around the management of medicines and the management of risks to people.
At this inspection of February 2018 there was not a registered manager in post. 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. The provider had recently appointed a new home manager who was undertaking their induction. The home manager was present throughout our inspection.
During this inspection in February 2018 we found significant shortfalls in the service. We found examples of where people had been exposed to actual harm and abuse and staff had failed to protect people from future occurrences. We were so concerned about our findings that we made immediate contact with the local authority to discuss the shortfalls and we used our urgent enforcement powers to ensure the registered provider took immediate action to ensure the safety of people who had been identified as at high and extreme risk of harm.
People were not protected from harm due to staff not recognising and reporting safeguarding incidents to the local authority. We found there to be insufficient numbers of staff working at the service to keep people safe. People were not receiving the levels of supervision they needed. People had experienced and were at risk of experiencing unsafe care and support as a result. People did not always receive their medicines as prescribed.
People were not supported by care staff that had the training, skills and knowledge to support them effectively. Staff had received safeguarding training but still failed to recognise abuse and had failed to escalate and follow processes. People were not supported in a way that protected them from unlawful restrictions due to staff lack of understanding and knowledge of the Mental Capacity Act. People did not have their fluids intake managed safely when it had been identified that they were of risk of dehydration. People were supported to see healthcare professionals for routine appointments or when a change in their health was identified.
Although staff were caring in their interactions they had not recognised the need to protect people from potentially abusive situations and did not appear to recognise the severity of the situation. Staff did not have time to spend with people and missed opportunities for interaction. Staff were focused on tasks and people did not receive care that was responsive to their individual needs. People's privacy and dignity were not always respected.
People did not receive personalised care which met their needs. People were not supported to access hobbies and activities and supported to choose how they spent their time. People knew how to complain and processes were in place to manage concerns and complaints.
There was inadequate monitoring in place at the service and this had resulted in poor outcomes for people. People had been placed at risk of significant harm and some had experienced harm which could have been prevented. Ineffective quality monitoring systems had failed to pick up and address the failings we identified during our inspection and as a result people had been exposed to harm. In addition the registered provider had failed to notify us of events as required by law.
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 of 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.
We found that the provider was not meeting all of the requirements of the law. We found multiple breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We have taken urgent enforcement action to impose immediate conditions on the registered provider’s registration in order to protect people’s safety and well-being.