Boroughbridge Manor and Lodge Care Home

“This service was rated requires improvement at out last inspection (published 13 March 2024). During that inspection we found breaches of regulation relating to good governance and person-centred care. We made recommendations relating to staffing levels, using nutritional screening tools effectively and ensuring barriers to staff speaking up were explored. At this inspection we found improvements had been made in the areas of good governance and person-centred care and the provider was no longer in breach of these regulations. We also found the service had implemented the recommendations relating to the use of effective nutritional screening tools and staff being able to speak up. However, we identified a breach of regulation relating to staffing levels. This is because we found staff did not have the time to spend quality time with people, interactions were very task orientated and, staff did not always have the time to comfort people when distressed or upset.”

“We identified concerns with staffing levels and deployment, particularly in communal areas, where people were often left unsupported for extended periods. This impacted the responsiveness of care and about people’s safety and dignity. Support was frequently task-oriented, and people were not always offered choices, such as where to spend their day.”

“Care plans and risk assessments were in place and recorded where people had consented to their care. However, people with capacity were not always supported to make informed decisions, and there were inconsistencies in how risks were managed and mitigated against. Repositioning and hydration monitoring were not always timely or well-documented. We discussed this with the registered manager and were assured this would be reviewed and appropriate action taken.”

“We found gaps in the recording of food and fluid intake for people at risk of malnutrition or constipation. Some care plans lacked detail to guide staff in responding to and supporting people experiencing anxiety and distress. We discussed this with the registered manager and was assured immediate action would be taken to address this.”

“Signage to support people living with dementia was not in place. However, the provider had already identified this and was taking the necessary action.”

“Medicines were administered safely by trained and knowledgeable staff. The environment was generally clean and welcoming. People and relatives provided mainly positive feedback about the service. One visitor said, “The people I see appear well looked after. I think it’s safe, if it wasn’t I would voice my concern. I think the staff have time to listen and talk to the people here.” There was evidence of person-centred care planning. However, observations and documentation showed care delivery did not always meet expected standards, particularly in relation to timely support, personalised interaction and risk management.”

“The service demonstrated a strong commitment to improvement and had a positive learning culture. Staff were encouraged to speak up, and leadership was visible and responsive. The registered manager had implemented a wide range of audits and governance systems to monitor care quality and safety.”