Boughton Lodge Care Home

Boughton Lodge Care Home provides accommodation and personal care for to up to 19 older people. The service comprises of one adapted building. At the time of our inspection there were 17 people using the service.

People’s experience of using this service and what we found

The provider and registered manager failed to have sufficient oversight of the health and safety of the service. They failed to have systems to monitor and maintain the fire and water safety, gas, electric, equipment and health and safety checks.

The provider and registered manager failed to monitor staff practice in preventing and controlling infection or to monitor the cleanliness of the home; they did not have systems to recognise when improvements were required.

The provider and registered manager failed to monitor recruitment procedures which meant they did not identify they had failed to follow safe recruitment procedures.

People were not always protected from harm and abuse as staff did not always understand how to recognise and report any concerns. The provider and registered manager failed to have systems to monitor and analyse accidents and incidents to gain the insight into trends and patterns to improve the service.

There were not enough staff deployed at night to meet people’s needs or to maintain the health and safety and cleanliness of the home.

People’s risks were not always reviewed when their needs changed.

Although staff had received training, the provider and registered manager did not check staff competencies in safeguarding and medicines management. People did not always receive their medicines as prescribed; the provider audits failed to detect missed medicines.

The provider's and registered manager's pre-assessment of needs was comprehensive and gathered information from relatives and relevant professionals.

People received food and drink that met their needs and preferences.

Staff identified when people were unwell and referred them to healthcare professionals promptly. People were supported to access healthcare appointments when they needed them.

People received care from staff they knew, who were kind and compassionate. People’s privacy and dignity was respected.

People and their families were involved in creating their care plans. People were supported to continue to practice their cultural faiths. People's communication needs were understood and supported.

People and relatives knew how to make a formal complaint. The provider used the information from complaints to review and improve the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last inspection was rated good, published 12 January 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well sections of this full report.

We have identified breaches in relation to health and safety, medicines, recruitment and governance at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect. You can see what action we have asked the provider to take at the end of this full report.

Boughton Lodge Care Home accommodates a maximum of 19 people in one adapted building. On the day of the inspection there were 17 people living at the home.

Boughton Lodge Care Home had 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.

This service had previously been inspected in October 2016 and was rated as Requires Improvement. At this inspection we found that the service had made improvements in all areas with the exception of the Safe domain, which remains as Requires Improvement.

Improvements were required to ensure the timely upkeep and maintenance of the home. The provider had been aware of damage in the main bathroom and this had not been rectified in a timely manner. We also found that improvements were required to the cleanliness of the home. The provider had taken action to rectify this however this had been reactive and improvements were required to the cleaning regime on a frequent basis.

People were supported by staff that understood how they could people safe. Safeguarding procedures were in place to help protect people from harm and staff understood their responsibilities to do so and to report any concerns. All concerns were investigated and appropriate action was taken.

Infection control systems were in place to support people to receive their personal care appropriately. Staffing within the home was adequate to meet people’s needs and keep people safe. Staff responded to people in a timely way and suitable recruitment systems were in place to recruit staff from appropriate backgrounds.

People’s medicines were administered in accordance with people’s preferences and people were given the appropriate support they needed to take them safely. Medicines were stored securely and medicines records were completed appropriately. Accidents and incidents were investigated and if learning was identified this was shared across the staffing team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service worked within the principles of the Mental Capacity Act and the registered manager completed appropriate documentation to evidence this.

The registered manager completed an assessment of people’s needs before they moved into the home to ensure the care staff would be able to support people effectively. People’s healthcare needs were monitored and when people required external support from other services, for example, the falls team, this was requested at appropriate intervals.

Staff had the skills and knowledge to provide people with safe and compassionate care. Most staff had regular supervision with a senior member of staff and feedback was given to staff to help improve their performance. People were supported to have a balanced diet and to have their nutritional needs met. We identified that people’s nutritional records were not always completed or reviewed in full and we have made a recommendation about the management of people’s nutritional records.

People were supported by staff that treated them well and were friendly and kind. Staff were attentive and encouraging and people’s independence was respected. People were encouraged to do what they could do for themselves and to make their own choices. The registered manager had a good understanding of advocacy services and took action to provide people with this support when required.

Care planning supported people’s diverse needs, and the service was able to support people with complex needs as a result. Staff had a good understanding of people’s preferences and supported people to participate in activities they enjoyed. The service had appropriate complaint procedures and the provider had systems in place to support people with their end of life wishes.

The culture within the home was open and transparent and the provider made efforts to ensure that people who lived at the home, their relatives and the staff were clear about where improvements needed to be made. People and their relatives were given opportunities to become involved in making improvements to the home. When people were asked for their feedback this was acted on. The provider and registered manager were keen to learn and to make improvements within the home wherever necessary. Quality assurance systems were in place to review the quality of the service, however we made a recommendation to review these audits to ensure they could sufficiently identify improvements proactively.

On 21 April 2016 we inspected this service and gave it an overall rating of Inadequate and placed it in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was 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.

We found that many improvements had been made in all of the areas of previous concern however there were still examples of care which illustrated that further improvements were required.

Improvements had been made to the risk assessment procedures. Risk assessments in relation to how people required their care had been rewritten and were regularly reviewed. The number of falls people had experienced had reduced since the previous inspection however further attention was required to ensure that staff followed the guidance that the risk assessments contained.

People’s skin care needs had been assessed and people received the support they required to keep their skin healthy however, there were examples to show that the assessment that had been completed may not provide an accurate picture of people’s needs. Staff were knowledgeable about the appropriate support people required.

Environmental risk assessments had been completed which identified risks to people using the service. The provider and manager were able to provide detailed explanations of the support that was in place, and the plans that were underway, however the risk assessments did not always record the required details.

People were supported to take their medication as prescribed. Medicines were stored securely and in correct temperatures, and people were given their correct medicine at the correct times.

Staff were knowledgeable about safeguarding incidents and how to recognise potential signs of harm. Safeguarding notifications and investigations were completed appropriately and where possible, actions had been taken to identify learning or take preventative action.

Staffing levels were sufficient to keep people safe and people received staff support when they needed it. However, further attention was required to ensure that a dependency tool was used to review the staffing levels at regular intervals. Recruitment procedures were thorough which ensured that staff were suitable to work in care.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) however further action was required to ensure full consideration had been given to every person living at the home.

Staff received regular support and guidance about their performance and a training program was in place to ensure staff were competent and confident in their role.

People’s nutritional needs were assessed and appropriate action was taken to support them with their needs. People’s healthcare needs were regularly reviewed and were managed with support from appropriate healthcare professionals.

People and their relatives were involved in care planning and staff took notice of how people liked their care; however there were occasions that people did not always receive person centred care.

People were supported to maintain their privacy and their dignity. People were comfortable and relaxed with staff and people enjoyed their company. People were encouraged to express their views and make their own choices.

Information about advocacy services was accessible to people and people were supported to have visitors at the home.

Care plans did not always have sufficient detail about people’s backgrounds. Staff had a good knowledge of people’s needs and were responsive to them.

People’s changing needs were understood and maintained by staff and systems were in place to receive, record and act on compliments and complaints. Outcomes to complaints were reviewed for learning opportunities to prevent further incidents.

The provider had invested in a quality assurance system which provided templates and guidance for the service. Improvements had been made to the whole quality assurance procedures which included regular auditing of the service by the registered manager and the provider however further action was required to ensure that the audits were thorough and effective at identifying where inconsistencies or improvements were required.

Accidents and incidents were analysed and reviewed for learning opportunities and systems were in place to receive and act on feedback about the service.

The culture within the home was open and transparent and people and their relatives were made aware of the improvements that had occurred, and were continuing.

Boughton Lodge Care Home is situated in Kinsgthorpe, near Northampton. It is registered to provide accommodation and personal care for up to 19 older people, who may be living with dementia. At the time of our inspection there were 18 people living at the service.

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 or 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.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager had resigned from the service and was working their notice period. They were aware of their obligation to apply to the CQC to de-register. The provider had started the process of recruiting a new manager, who would register with the CQC once in post.

There were insufficient quality assurance systems in place at the service. The provider failed to complete checks and audits on a regular basis or use them to identify areas of development. Incidents and accidents had not been reviewed and action had not been taken as a result to manage future risks to people. Incidents of potential abuse or improper treatment had not been recognised as such and therefore had not been reported to appropriate external bodies.

Risk assessments were in place; however these were not reviewed regularly to ensure that the latest risks to people and the service were considered. Where risks had been identified, the risk level did not match what was recorded in people's care plans; therefore staff did not have the correct control measures or information available, to help them manage risks to people. Medication was not managed effectively. Staffing levels were not always sufficient to meet people's needs; however staff had been recruited following safe and robust procedures. Medication storage was not always secure and medication records were not complete. Stock levels of medication were not always recorded and were not checked regularly to ensure that they were correct.

People's consent to their care, support and treatment had not been sought and documented. Where people lacked the mental capacity to make their own decisions, the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards had not been adhered to.

Members of staff had not received regular training support and supervision to enable them to perform their roles and identify areas for them to develop their skills and knowledge.

Care plans did not show that people had been involved in planning or reviewing their care. These plans were not presented in a person-centred way and did not show that people's views and preferences had been taken into account.

People had enough to eat and drink to have a balanced and nutritious diet and referrals were made to appropriate healthcare professionals for support with this if necessary. People had access to other healthcare professionals, such as GP's or district nurses, if needed and could see them within the service or in a community based setting, such as a local GP practice.

There were positive relationships between people and staff. People were relaxed and happy at the service and felt comfortable with the staff caring for them. Staff treated people with respect and dignity and welcomed the visits of people's family members or friends. If people were unhappy with their care, there was a system in place to receive, log and act on any complaints that were made.

The detailed evidence supporting our summary please can be read in our full report.

Is the service safe?

People told us that the environment was safe, clean and homely and they felt safe living at the service. We saw there were sufficient numbers of experienced and competent staff on duty to safely meet people's care needs. We saw that a professional person spoke to people using the service about different kinds of abuse and who to report this to if they experienced any kind of abuse at the service. This was to keep people safe by making them aware of their safeguarding procedures.

Is the service effective?

We saw that people's care plans had been reviewed and new care plans were put in place. Staff told us that these plans were detailed and provided them with good information on how to meet people's needs. People and their representatives had signed their care plans as an agreement on how they wished to be cared for by staff. They told us that their needs were being met. We found daily care notes recorded for people were more detailed and showed what they did each day.

Is the service caring?

All the people we spoke with told us that they liked living at the service. One person said, 'Staff, are ever so nice and they will do anything for us'. They told us that the staff helped them with their personal care needs and maintained their privacy by closing the door. One visiting relative told us that they came on different days of the week and they found the atmosphere at the service was friendly and the staff were always pleasant to them and the people using the service. We observed staff speak to people in a kind and dignified manner.

Is the service responsive?

The provider took action from the outcome from our last inspection visit. We saw that they worked with other agencies to help them improve their service to meet people's needs better. We saw that meetings took place with people using the service to listen to their views and suggestions made were acted upon by the staff. For example, we saw that meals and activities had changed to meet people's needs.

Is the service well-led?

Since our inspection in April 2014, the registered manager had recently resigned from Boughton Lodge care home. The new manager in post was advised that an application to register with the Care Quality Commission (CQC) was required. The staff told us that the new manager was very supportive, approachable and listened to them. We saw that a meeting was held with people who used the service and their representatives to discuss what was happening at the service and they were asked to voice their opinions and any concerns to improve the way the service was delivered. We saw that the provider had systems in place to monitor the quality of service that people received.

'Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.'

On the day of the visit the provider told us that the registered manager had recently resigned from the service and a new manager was due to start the following week.

The detailed evidence supporting our summary please can be read in our full report.

Is the service safe?

People told us that they felt safe living at the service. This was also confirmed by two relatives we spoke with. The people told us that the environment was safe, clean and homely. We saw that people were able to move around the communal areas safely.

Is the service effective?

We saw people's care needs had been reassessed and new care plans had been put in place. The people and their representatives had been involved in this process. This was confirmed by talking with two relatives and some people using the service. We found people's daily care notes were more detailed and showed what they did each day.

Is the service caring?

All the people we spoke with told us that they liked living at the service. They told us that the staff respected their privacy and dignity. Two visiting relatives of people using the service also told us that they liked the home and they were happy with the care provided by staff. We observed staff speak to people in a kind and dignified manner.

Is the service responsive?

The provider acted upon the findings of our last inspection visit. They employed a consultant to help them to make improvements in respecting and involving people who use services. We also saw that the provider worked with other agencies to help them improve their systems to meet people's needs better.

Is the service well-led?

We found that the new management approach as a result of the improvements was open, and positive. We saw that the staff, people who used the service and their representatives were asked to voice their opinions and any concerns to improve the way the service were acted upon.

The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

The detailed evidence supporting our summary please can be read in our full report.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. People received their medicines safely and at the times they needed them. Recruitment practice was safe and thorough and we found that no staff had been subject to disciplinary action.

People's rights and dignity were not always respected. For example, one person using the service said, 'The manager has been here a while. She's alright she is, she's fair, but she does seem to have a bit of a temper sometimes.' Some people told us that the manager was not always approachable. One person told us that they were lonely because the manager had told them that they could not go down stairs and mix with other people due to their personal care needs. This meant people were not enabled to make decisions about their care and their rights were not being met.

Risk management plans were not written for some people with particular needs, this was putting these people at unnecessary risk of harm.

There was no system in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This meant that people were not benefiting from a service that was taking on board lessons learnt.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was limited evidence of people being involved in assessments of their needs and planning their care, particularly people with dementia. Some people who did not have dementia also told us that staff had not spoken with them about their care needs. Some of the care plans had not been reviewed regularly to ensure information was up to date to meet people's needs. Daily care notes recorded for people were not detailed and did not show what they did each day. It was therefore not possible to confirm that all people's needs were being met.

Is the service caring?

Nine people we spoke with told us that they liked living at the service. Several relatives also told us that they liked the home and they were happy with the care provided. We observed staff speak to people in a kind manner. People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. The outcome of the last survey was positive.

We saw that some of the terminology used in recording the daily notes by staff, was inappropriate and did not respect people's privacy, dignity, and independence.

Is the service responsive?

The provider told us that they had not received any complaints. However we saw that one person had complained about the lack of integration with other people at the home. The person's family and their funding authority had discussed their concerns and we saw that the provider had not responded correctly to the person's concerns. We also saw that a family had raised concerns about their relatives care. This was because they were asked to pick their family member off the floor when they fell. We saw that the concerns raised were not acted upon properly or in line with the provider complaints policy.

Is the service well-led?

We found that the management approach was not always open, and positive. The registered manager did not have strategies for enabling staff, people using the service and other people to voice their concerns to improve the way the service was delivery.

We found that the service did not have a robust quality assurance system in place. Records seen by us showed that not all of the shortfalls identified had been addressed. The systems in place did not make sure that staff were able to provide feedback to their managers, so their knowledge and experience was not being properly taken into account.

People living in the home expressed satisfaction with the care and service that they received. They told us that the home was 'lovely and homely' and staff looked after them well. One person told us 'I like it here and the staff are lovely' and they spoke to them in a nice manner. Another person told us: 'We do activities and we had a singer here yesterday' and enjoyed this. All the people told us that they enjoyed the meals provided. We observed people eating their meals in a relaxed atmosphere and staff offered support when required in a dignified manner.

However we found that people's care plans needed more information recorded so staff had all the information needed to meet people's needs. The staff also did not receive regular one to one meetings with management to look at their personal development needs and monitor how they were meeting the needs of people using the service.