About the service:

Beeston Lodge is a residential care home with nursing and is registered for a maximum of 28 people. At the time of the inspection, there were 25 people living in the 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.

The home is registered to provide nursing and personal care for older people, people living with dementia and people living with physical disabilities. The home is a three - storey property (adapted from former semi-detached residential accommodation with a two - storey extension and small garden at the rear).

It is located in a busy suburb of Nottinghamshire, on a through road on the outskirts of the town centre; with good access to local amenities, the local train station and wider transport links.

People’s experience of using this service:

People told us they felt happy and the service assessed risks to the health and wellbeing of people who use the service and staff.

People felt there were not enough staff to support them safely at night time.

The environment was not fully supportive for people living with dementia and reduced mobility.

Medicines were handled safely by staff who had been assessed as competent to do so, although the provider had not applied all recommendations from a recent medicine’s audit.

People felt the service they received helped them to maintain their independence where possible.

People and their relatives said staff were caring and respected their privacy and dignity.

People received care that was designed to meet their individual needs and preferences. Although we found evidence that the provider did not have a robust system of auditing and sharing learning across the staff team.

Rating at last inspection:

The home was previously rated as Good in all domains (Report published 24/10/2018.)

Why we inspected:

This was a comprehensive inspection, which was brought forward due to concerns raised in response to the closure of another home owned by the provider and information we received from the local authority.

Enforcement:

We found a breach of two regulations relating to the environment of the home and compliance with the fundamental standards; and in relation to good governance. We have made recommendations to the provider in relation to these.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit

as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 5 and 7 June and 25 July 2018 and was unannounced. Beeston Lodge is Care 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. Accommodation for up to 28 people is provided in the service. The service is designed to meet the needs of older people living with or without dementia. There were 28 people using the service at the time of our inspection. The service was last inspected on February 2017 and was rated as requires improvement.

A registered manager was in post and was available throughout the 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.

Risks were managed so that people were protected from avoidable harm. People were safely assisted to move and infection control practices were in place and were effective.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Medicines were safely managed.

External professionals were involved in people’s care as appropriate. Staff received induction, training and supervision.

People’s rights were not always protected under the Mental Capacity Act 2005. People received sufficient to eat and drink, though the mealtime experience could be improved. People’s needs were met by the adaptation, design and decoration of the service.

Staff respected people’s privacy and dignity. Interactions between staff and people who used the service were kind caring and staff created a relaxed atmosphere.

People and their relatives were involved in decisions about their care and advocacy information was available to people. Visitors could visit without unnecessary restriction and people’s independence was promoted.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints. People had the opportunity to take part in activities of their choice.

There were effective systems were in place to monitor and improve the quality of the service provided. People and their relatives were involved or had opportunities to be involved in the development of the service.

Staff told us they would be confident in raising any concerns with the management team and that appropriate action would be taken. A registered manager was in post and statutory notifications had been sent to the CQC when required.

This inspection took place on 22 and 23 February 2017 and was unannounced.

Accommodation for up to 28 people is provided in the service. The service is designed to meet the needs of older people living with or without dementia. There were 24 people using the service at the time of our inspection.

A registered manager was in post and was available throughout the 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.

Risks were not always managed so that people were protected from avoidable harm. People were not always safely assisted to move and infection control practices required improvement.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Medicines were safely managed.

External professionals were involved in people’s care as appropriate. Staff received induction, training and supervision. However, our observations during the inspection suggest that training and supervision was not fully effective.

People’s rights were not always protected under the Mental Capacity Act 2005. People received sufficient to eat and drink, though the mealtime experience could be improved. People’s needs were not fully met by the adaptation, design and decoration of the service.

Staff did not always respect people’s privacy and dignity. Interactions between staff and people who used the service were mixed. Some interactions were kind but some were very task focussed.

People and their relatives were involved in decisions about their care and advocacy information was available to people. Visitors could visit without unnecessary restriction and people’s independence was promoted.

Activities required improvement. People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

Some systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective. People and their relatives were involved or had opportunities to be involved in the development of the service. However, their comments were not always acted upon.

Staff told us they would be confident in raising any concerns with the management team and that appropriate action would be taken. A registered manager was in post and statutory notifications had been sent to the CQC when required.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

We inspected the service on 03 and 04 December 2014. Beeston Lodge Nursing Home provides accommodation for up to 28 people who require nursing or personal care. On the day of our inspection 28 people were using the service.

The service had not had a registered manager in place since 31 August 2014. 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 and associated Regulations about how the service is run.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The acting manager had applied the principles of the MCA and DoLS.

The environment was warm, clean and homely. There were enough staff with the knowledge and skills to provide safe and appropriate care and support. There were systems in place to protect people from the risk of abuse. People were able to receive their medicines as prescribed and had access to sufficient quantities of food and drink.

Staff monitored and responded to changes in people’s health and wellbeing and supported people to see external NHS professionals when this was needed.

People were treated as individuals and their opinions mattered. Staff treated people with care and interacted respectfully.

The provider had day to day involvement at the service and valued communication with people who used the service, their relatives and the staff. Audits of the quality of the service were taking place to continually improve the way care was provided to people who used the service.