Archived: The Boltons

Updated 12 December 2018

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, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 8 and 9 October 2018 and was unannounced. The inspection was carried out by one inspector and an Expert by Experience (ExE). An ExE is a person who has personal experience of using or caring for someone who uses this type of care service.

We used information the provider sent us in the Provider Information Return (PIR). 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. Prior to the inspection we looked at all the information we had collected about the service. This included information received and notifications the registered manager had sent us. A notification is information about important events which the service is required to tell us about by law.

During the inspection we spoke with six people who use the service and four relatives. We spoke with the registered manager, two deputy managers and received feedback from seven care staff members.

We observed interactions between people who use the service and staff during our inspection. We spent time observing lunch in both dining rooms. We requested feedback from six external professionals and received two responses. We looked at four people's support plans and related monitoring records, medicine management records. We looked at four staff recruitment files, staff training records and the staff training log. Medicines administration, storage and handling were checked. We reviewed a number of documents relating to the management of the service. For example, various audits, meeting minutes, activities plan, incidents and accidents information, complaints and compliments, service maintenance and checks records.

Updated 12 December 2018

The inspection took place on 8 and 9 October 2018 and it was unannounced.

The Boltons is a care home without nursing and provides a service for up to 27 older people, some of who may have mental health needs. The services provided include respite care. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection there were 26 people living at the service.

There was 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.’

At the last inspection the service was rated Good overall. During this inspection we found two breaches. When there is a breach or more, the overall rating cannot be Good. There was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager did not ensure they recorded and kept a copy of actions taken as required in the Duty of Candour regulation when a notifiable safety incident occurred. We asked the management team about this on our first day of inspection. However, they were not able to provide evidence the provider’s policy was followed. There was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not ensure care and treatment was provided in a safe way.

The registered manager had quality assurance systems put in place to monitor the running of the service and the quality of the service being delivered. However, they did not always ensure all tasks were completed as part of the management of the service such as complete safety checks, medicine management and staff training. Thus, the quality assurance system did not always provide an accurate overview of the service. Without an effective system the registered manager would not able to make improvements where and when necessary so that people could receive the support and care they needed.

We found some errors with recording of the medicine. Where people's medicines were given covertly, the principles of the Mental Capacity Act had not always been adhered to.

Staff training records indicated which training was considered mandatory. Not all staff were up to date with their mandatory training and some were due their refresher training. The management team was overseeing and booking training when necessary to ensure all staff had the appropriate knowledge and skills to support people. We have made a recommendation for the management to refer to the current best practice guidance on ongoing training and monitoring for social care staff.

Some people’s records contained consent forms signed by the family members. However, it was not clear if staff had checked they had a legal right to do that. We observed staff asking people for their consent to deliver care, giving time for people to respond and respecting those decisions. Not all staff were aware of the MCA and their responsibilities to ensure people made decisions that were in their best interest.

The registered manager did not always ensure all maintenance checks and assessments were up to date. Some staff did not always follow good practice using personal protective equipment to maintain appropriate infection control. The premises and adaptations were not always dementia friendly. We made a recommendation to review guidance on making the environment more 'dementia friendly'.

The management carried out risk assessments and had drawn up support plans to ensure people's safety and wellbeing. We noted some information was contradictive throughout the support plans and dates of the updates were not always clear to reflect most current information. Not all people had opportunities for social engagement and meaningful activities according to their interests to avoid isolation.

People told us staff were available when they needed them most of the time and staff knew how they liked things done. The provider had a system to assess staffing levels and make changes when people's needs changed. Staff felt there were enough staff when they needed to support people appropriately.

The premises and equipment were cleaned and well maintained. The dedicated staff team followed procedures and practice to keep the service clean. We observed kind and friendly interactions between staff and people. People and relatives made positive comments about the staff and the care they provided.

The provider investigated and responded to people's complaints, according to the provider's complaints procedure. Annual questionnaires were sent to people and their relatives so they could share their views of the service. The provider encouraged feedback from people and their families, which they used to make improvements to the service. The service’s aim was to ensure people were protected against the risks of receiving unsafe and inappropriate care and treatment.

Staff had ongoing support via regular supervisions with their senior staff. They felt supported by the registered manager and senior staff and maintained great team work. Staff had handovers and meetings to discuss any matters with the team. There were appropriate recruitment processes in place. People and their families were involved in the planning of their care.

The management team and staff responded to changes in needs and risks to people who use the service. These changes were reported to the senior staff member to ensure a timely response and appropriate action was taken such as referral to professionals.

People felt safe living in the service. Relatives also felt their family members were kept safe and were satisfied with the care and support provided. Care staff knew how to identify potential abuse and understood their reporting responsibilities in line with the service's safeguarding policy. There were contingency plans in place to respond to emergencies.

People were supported effectively regarding their nutrition and hydration needs. Hot and cold drinks and snacks were available between meals. People were assisted with their meals where necessary. People had their healthcare needs identified and were able to access healthcare professionals such as their GP. Staff knew how to access specialist professional help when needed. The service worked well with other health and social care professionals to provide effective care for people.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards and to report on what we find. The registered manager had acted on the requirements of the safeguards to ensure people's rights and freedom were protected. They made appropriate applications to ensure people's liberty was not restricted in an unlawful way.

The management was working with the staff team to ensure caring and kind support was provided in a consistent way. People confirmed staff respected their privacy and dignity. Their choices were respected. Staff felt the management was approachable and supportive, and they communicated well to ensure smooth running of the service. People and relatives felt the service was managed well and that they could approach management and staff with any concerns.

You can see what action we have asked the provider to take at the end of the full version of this report.