Boughton Lodge Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm At our last inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm. People received safe care and treatment. Risks to their safety and wellbeing were assessed and planned for. The provider worked with people using the service, staff and others to learn when things went wrong and to improve the service for them. The environment and equipment were safe to use and well-maintained. Staff had training to understand about safe care and using equipment. There were systems for ensuring infection prevention and control and these were operated effectively. The provider worked in partnership with external professionals to help people access other services and get the safe care they needed. There were enough staff deployed to meet people’s needs. There were robust systems for recruiting and selecting staff; as well as training them and making sure they were competent and knowledgeable. People’s medicines were managed in a safe way.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt able to raise any concerns and the service had responded to feedback they had provided. Relatives told us they were involved in discussions about people’s care plans and risk assessments and had been offered opportunities to provide feedback via questionnaires and relative’s meetings. Staff told us the management team were open and shared learning with them. They felt able to raise concerns and said incidents were reported with openness and honesty. Staff were confident that actions would be taken where necessary to manage risks and make improvements. The management team responded openly and proactively to our feedback about areas for improvement identified during the assessment. At the last inspection, we identified a breach of regulations relating to good governance. At that time, we found the provider had failed to have systems to evaluate and improve the service. At this assessment we found improvements had been made and the provider was no longer in breach of regulations. The provider had processes to monitor standards and identify, record and learn from incidents that happened within the home. This included regular audits, supervision, meetings and external checks. This helped to ensure staff could make changes where necessary to improve care for people.

Assessments started as soon as people were referred to the service and included reviews of needs, development of care plans and personalised risk assessments. Relatives told us they were involved in discussions about their family member’s care plans and risk assessments. The registered manager told us about the processes used at the service to ensure people were safely admitted to the service. These included initial enquiries, pre-admission assessments, contact with relatives and visits to the person. People and their relatives were encouraged to visit the service before their admission and maintain ongoing contact. Feedback from health and social care professionals did not raise any concerns. Professionals were complimentary about how the service worked with them to ensure people were safe and received the care they needed. The service had suitable systems and procedures to support staff in working with other professionals. Policies and processes about safety reflected joint working with other key partners to promote shared learning and drive improvement. For example, there were links with the local authority safeguarding team and public health colleagues. Hospital passports provided records of people’s health needs and were shared with other professionals as required. This helped to keep people safe when receiving treatment and promoted continuity of care.

People told us they felt safe living at the service. A relative said, “It’s a good home here. People are looked after well and staff relate well to them”. People appeared relaxed and comfortable with the staff who supported them. People and their relatives told us they would speak with staff if they were unhappy or had concerns. Staff received training about how to recognise and respond to safeguarding concerns. The registered manager carried out regular competency assessments to ensure staff had the skills to keep people safe from harm and risk. The staff were able to demonstrate their understanding of safeguarding. Staff were attentive and mindful of people’s safety, ensuring they did not face unnecessary risks. People were able to move freely around the building, but they were kept safe because staff were present, and equipment was appropriately used. At the last inspection, we identified a breach of regulations relating to safeguarding. At that time, we found the provider and registered manager had failed to report safeguarding concerns to the appropriate authorities. At this assessment we found improvements had been made and the provider was no longer in breach of regulations. The provider had effective systems, processes and practices to make sure people were protected from abuse and neglect. Safeguarding materials were displayed for people, visitors and staff to see. The Mental Capacity Act 2005 provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. Staff assessed people’s capacity to make decisions and ensured decisions were in the individual’s best interests. If needed, they had appropriate legal authorisations to restrict people for their own safety. In care homes these are called Deprivation of Liberty Safeguards (DoLS).

Where possible, people were informed about risks and supported to keep themselves safe. Staff were proportionate in their approach to risk and respected people’s choices. Relatives said staff knew their family members well and understood the risks they faced. Relatives shared examples of the measures the service had in place to manage their family member’s risks. One person had expressed their wish to manage their own medication and staff were supportive of this. Some people’s relatives were involved in making risk decisions in their family member’s best interests. Relatives told us they were updated and involved in discussions about people’s care plans and risk assessments. Staff knew people well and demonstrated a positive approach to managing risks and respecting people’s dignity. The registered manager told us people’s care plans and risk assessments were reviewed with them and their relatives. The team worked alongside the local GP surgery as well as speech and language therapists, physiotherapists, district nursing and mental health teams to manage risks safely. Staff had access to up to date information about people’s risks and responded to changes. Our observations raised no concerns about staff practice, or the management of people’s risks, and staff had a good understanding of people’s needs. We saw staff supporting people in line with safe practice and their individual risk assessments. When people needed help to move, staff used equipment safely and applied appropriate techniques. Care records were regularly reviewed with the involvement of people, relatives, and staff to ensure they contained the most up to date information. Care plans overall described risks which might be faced by people, and what staff should do to reduce these risks.

We spoke with people and their relatives who all spoke positively about the environment, it’s condition and cleanliness. A relative told us, “There is a really good standard [of cleanliness] here”. Staff received training to keep people safe, such as fire safety and the use of different types of equipment. They told us about safety measures for individual people, such as the safe use of hoists. Staff felt able to deliver safe and effective care because facilities and equipment were well-maintained and helped them meet people’s needs. The environment was safe and met people’s needs. The provider had an ongoing programme of maintenance and improvement to ensure the building, fixtures and equipment was now kept in good working order. At the last inspection, we identified a breach of regulations relating to premises and equipment. At that time, we found the environment and equipment was not always suitably used or maintained. At this assessment we found improvements had been made and the provider was no longer in breach of regulations. The provider had systems to detect and control potential risks in the care environment. This included building safety and equipment checks, management audits and a process for identifying and rectifying issues. We saw evidence the service had necessary checks and certificates.

People and their relatives spoke positively of the support they received from staff. One person said, “Staff are so kind and caring. They really try and make our days better”. Staff we spoke with told us there were enough staff to meet people’s needs. Staff were positive about working at the service. Staff said they received regular supervision, appraisal and training. Training records showed staff were up to date with essential training in subjects such as fire, manual handling and safeguarding. They attended regular refresher courses to ensure their knowledge and skills remained up to date. New staff followed an induction process which included essential training, shadowing more experienced staff and meeting with the registered manager. During our visits, we saw there were enough staff to provide people with the support they needed and there was a calm atmosphere in the home. The staffing levels we saw were in line with those deemed safe by the provider. At the last inspection, we identified a breaches of regulations relating to recruitment and staff training and support. At that time, we found the provider had failed to follow safe recruitment procedures and failed to provider staff with required training and support. At this assessment we found improvements had been made and the provider was no longer in breach of regulations. The provider had recruited staff safely, and relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people. The provider now had suitable systems and processes to monitor and ensure training and supervision were up to date. Staff now had the training they needed to carry out their roles and this supported best practice.

People and their relatives told us the home was clean and tidy and no concerns were raised. Staff received training and had a good awareness of infection prevention and control principles. The registered manager told us the service had measures to keep people safe. This included the effective use and disposal of personal protective equipment (PPE), cleaning, laundry management, staff training and competency assessments such as hand washing. During our visits, we found the service to be clean and free from clutter and bad odours. Staff used appropriate personal protective equipment (PPE) to keep people safe during mealtimes. We were assured that the provider was protecting people, relatives, staff and visitors from the risk of infection. At the last inspection, we identified a breach of regulations relating to infection prevention. At that time, we found the provider had failed to assess, monitor and mitigate risks to people regarding infection prevention. At this assessment we found improvements had been made and the provider was no longer in breach of regulations. Staff now conducted regular audits to ensure the home remained clean and met hygiene standards. Staff maintained records of daily and deep cleaning which were regularly checked by the management team. The service had an infection prevention and control policy which reflected relevant national guidance.

People received their medicines safely and as prescribed. People and their relatives told us they were satisfied with the support they received with medicines. Staff who gave medicines had received training and their competency was checked by the registered manager to ensure their practice was safe. The staff we spoke with had a good awareness of safe medicines processes and practice. At the last inspection, we identified a breach of regulations relating to medicines. At that time, we found the provider had failed to ensure the proper and safe management of medicines. At this assessment we found improvements had been made and the provider was no longer in breach of regulations. The provider had quality assurance measures to ensure medicines were managed safely. This included staff training and competency assessments, audits and stock checks. The medicines policy was up to date and reflected current and relevant best practice and professional guidance.