The inspection took place on 22 September 2016 and was unannounced. This meant the registered provider and staff did not know we would be visiting. Bruce Lodge is a purpose build care home situated in Stockport. The service can provider care and accommodation for up to 47 older people. At the time of our inspection 46 people were living at the service. The service has communal lounges, dining rooms and bathing facilities available. Accommodation is provided over two floors which can be accessed by a lift. To the front of the building is a large secure landscaped garden and car parking is available.
The service had a registered manager in place. 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.
Emergency procedures were in place for staff to follow and personal emergency plans were in place for everyone, however these lacked details. Fire drills had not taken place; discussion on what to do in the event of a fire had taken place but these were not practical fire drills.
Medicines were not always managed appropriately. The registered provider had policies and procedures in place to ensure that medicines were handled safely. Medication administration records were completed fully to show when oral medicines had been administered and disposed of. People we spoke with confirmed they received their oral medicines when they needed them. However, topical medication, such as creams, was not always recorded when it had been administered and we saw gaps in these records.
People and their relatives told us they felt safe. Risk assessments were in place for people who needed these. Risk assessments had been regularly reviewed and updated when required.
Accidents and incidents were monitored to identify any patterns and appropriate actions were taken to reduce the risks.
Staff we spoke with understood the procedure they needed to follow if they suspected abuse might be taking place and the registered provider had a policy in place to minimise the risk of abuse occurring.
Certificates were in place to ensure the safety of the service and the equipment. Maintenance and fire checks had been carried out regularly.
A recruitment process was followed to reduce the risk of unsuitable staff being employed. All new staff completed a thorough induction process with the registered provider.
Staff performance was monitored and recorded through a regular system of supervisions and appraisal. Staff had received training to support them to carry out their roles safely.
People were supported to maintain their health. People spoke positively about the food and drink provided at the service. Staff understood the procedures they needed to follow if people became at risk of malnutrition or dehydration.
Staff demonstrated good knowledge and understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and knew what action they would take if they suspected a person lacked capacity. We saw that documentation was in place to show best interest decisions being made appropriately.
Each person was involved with a range of health professionals and this had been documented within each person's care records. From speaking with staff we could see that they had a good relationship with health professionals involved in people’s care. People’s care records contained evidence of appropriate referrals to professionals such as falls team, SALT and tissue viability nurses.
The service was clean and neutrally decorated throughout but was adapted to support people living with a dementia. People were able to bring their own furniture and personalise their bedrooms.
People spoke highly of the service and the staff. People said they were treated with dignity and respect.
People, and where appropriate their relatives, were actively involved in care planning and decision making. This was evident in signed care plans and consent forms. Information on advocacy was available.
Care plans detailed people’s needs, wishes and preferences and some were person-centred, however some areas of the care plans lacked person centred information. Care plans had been regularly reviewed and we saw evidence that relatives had been invited to these reviews. Relatives we spoke with confirmed this.
The service did not currently have an Activity Lifestyle Facilitator who managed activities, but there were plans to recruit a person for this position. Staff spent time preparing and conducting activities with people and we saw a variety of activities on offer. Some people felt activities could be improved and more stimulation was needed.
The service had a clear process for handling complaints. There had been two complaints received in the past twelve months which had been managed appropriately. People we spoke with confirmed they knew how to make a complaint.
Staff told us they enjoyed working at the service, felt supported by the management and were confident any concerns would be dealt with appropriately. We could see from our observations and speaking with people that the registered manager had a visible presence at the service.
Quality assurance audits were completed by the registered manager and action plans were generated. However, effective monitoring systems were not in place and the issues we found during inspection had not been identified such as care plans were not always person centred, activities were not accurately recorded and practical fire drills had not taken place.
Feedback was sought from people, relatives, and staff. ‘Comment cards’ were regularly given to people and relatives to complete. The manager told us this information was evaluated and action plans produced where needed.
Staff worked with various healthcare and social care agencies and sough professional advice to ensure that people's individual needs were being met.
The registered manager understood their role and responsibilities and was able to describe when they would be required to submit notifications to CQC.