Archived: Bafford House

Bafford House is a residential care home providing accommodation for up to 19 older people, some who live with dementia. At the time of the inspection 17 people were living in the home.

People are accommodated in one adapted building. Each person has their own furnished bedroom; eight have ensuite facilities and the remainder have a hand washbasin in the bedroom. A communal lounge and dining room is also available as are communal toilets and one adapted bathroom. There is a large garden for people to enjoy in good weather and limited car parking.

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

Information of concern had been shared with us by the local health protection team (HPT) in relation to some staff members not following national self-isolation requirements following a positive COVID-19 test. This had put people at potential risk of exposure to COVID-19 infection. During the inspection we found people and staff were not protected from the risk of infection.

Systems and processes were not in place to assess and reduce the risks associated with Legionnaires Disease. People were at risk of injury if a fire was to occur as emergency evacuation training and evacuation arrangements were not up to date. Actions identified by a fire safety officer visit in October 2020 still needed to be completed.

We found some good practice in relation to the identification and management of Covid-19 related risks. However, improvement was needed to ensure that risks in relation to laundry, cleaning and the spread of infection during an outbreak was managed in accordance with national guidance.

Following the inspection, we asked the provider to forward to us an immediate action plan telling us what action would be taken, by when, to address the above areas of risk. The provider had taken some action to reduce risks to people and staff, although further action was needed to ensure people’s safety. The provider has started work with external agencies to make the necessary improvements.

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 rating for this service was Good (published 16 July 2019).

Why we inspected

We undertook this targeted inspection to follow up on information shared with us by the local health protection team. This related to risks associated with COVID-19 infection prevention and control. We also followed up progress made to address non-compliance with The Regulatory Reform (Fire Safety) Order 2005, identified during a visit by a fire safety officer in October 2020.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the safe section of this report.

At this inspection we have identified a breach of safe care and treatment in relation to infection control and fire safety arrangements in the home.

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

Some action was subsequently taken by the provider to address the more significant risks to people. Arrangements had been made to have a fire risk assessment completed and the fire safety officer was returning to follow up the provider’s progress on the fire safety non-compliance in early May 2021. Action had been taken to reduce the risk of scalding associated with unregulated hot water. Cleaning schedules were given to staff to follow and arrangements put in place to monitor staff COVID-19 testing. The provider informed us they were making plans to continue to work with external agencies who could provide support to make further necessary improvements.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bafford House on our website at www.cqc.org.uk.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bafford House is a residential care home which provides personal care to 19 older people and people living with dementia or a mental health condition. At the time of the inspection 15 people were receiving care.

Bafford House is located in Charlton Kings, a suburb of Cheltenham. The home is set in well presented gardens which people could access. There was a range of communal areas that people and their relatives could use.

People’s experience of using this service:

• People and their relatives felt Bafford House was a safe and homely place. People enjoyed spending time with the staff and were comfortable in their company.

• Staff understood the risks to people and the support they required to ensure their health and wellbeing.

• The registered manager and provider had clear plans to increase the stimulation and support people living with dementia received. The provider had provided additional support to the service to achieve this goal.

• People’s dignity and rights were protected. People were supported by caring and compassionate staff.

• Care staff spoke positively about the service and felt they were supported and had access to all the training and professional development they required.

• The provider had a clear plan and vision for Bafford House. Staff were aware of this vision and were focused on providing high quality, person centred care.

• People’s needs were met by sufficient numbers of staff to ensure people’s safety and well-being.

• Staff had a good understanding of people’s needs. People’s healthcare and wellbeing needs were being met. People were supported with their dietary needs.

• Staff understood their responsibility to report concerns and poor practices. The provider followed the duty of candour and ensured people and their relatives, as well as appropriate agencies were informed of any concerns.

• The provider had systems to monitor and improve the quality of service they provided at Bafford House. The provider ensured opportunities were taken to learn from incidents, accidents and complaints.

Rating at last inspection:

Requires Improvement (The last report was published 31 May 2018). We had not identified any breaches of the regulations, however improvements which had been made had not been fully embedded at this inspection. Following our last inspection, conditions imposed on the providers registration remained in place, which meant the provider supplied us with bi- monthly updates on their governance systems. Additionally, we met with the provider to discuss the improvements they were making at Bafford House.

Why we inspected:

This was a planned inspection based on the previous rating. At this inspection we found that the service had improved. We rated the service as “Good”. Previous CQC ratings and the time since the last inspection were also taken into consideration.

Follow up:

We will continue to monitor this service and plan to inspect in line with our inspection schedule for those services rated as Good. We have asked the provider to apply to remove conditions imposed on their registration from August 2017 as these are not required to improve the service any more.

We last inspected the home on 12 and 13 April 2017 and rated the service as “Requires Improvement”, with the question ‘Is the service well led?’’ being rated as “Inadequate.”

We found that there were not always effective management systems in place to maintain and improve the quality of the service. Staff did not always maintain an accurate record of people’s care and wellbeing needs. Care staff did not always receive effective training and supervision and the provider did not always ensure care staff were of good character. Following the inspection in April 2017 we imposed a condition on the registration of the provider. The provider was required to send us bimonthly information on the actions they were taking to improve the quality of service people received.

At this inspection we identified significant improvements had been made however some of these systems required more time to be embedded to ensure they were sustainable. For this reason we have rated Bafford House as ‘Requires Improvement.’

There was a manager registered with CQC at the service and the registered provider worked in the home on a daily basis. The provider had recruited a manager as the registered manager had reduced their presence within the home, however was still involved in providing management support. 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.

People told us they felt safe living at Bafford House. There were enough staff deployed to ensure people’s needs were being met. The provider had recruited more care staff which meant the service was less reliant on the support of agency staff. People received the support they required to meet their health and wellbeing needs. People enjoyed engaging and interacting with care staff.

Care staff treated people with dignity and ensured they had their nutritional needs met and received their medicines as prescribed. Care staff were aware of and met people’s individual dietary needs. Staff spoke positively about the support and communication they received. All care staff felt the provider and manager were approachable and that they had access to the skills and support they required to carry out their role.

People and their relatives felt their concerns and views were listened to and acted upon. Relatives told us the management team was responsive and approachable. The provider and care staff worked alongside healthcare professionals to ensure people’s ongoing needs were met. The provider ensured lessons were learnt from any concerns and complaints to improve the quality of the service.

The manager and provider had implemented systems to monitor and improve the quality of service people received at Bafford House, including a detailed electronic care planning system. While a range of improvements had been made, improvements regarding people’s care records, incident and accidents, medicine management and the monitoring of quality required further time to be embedded.

At our inspection on 12 and 13 April 2017 there was a registered manager in post who was also the provider of the service. 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 last inspected in September 2016 and found that the provider was not meeting a number of the regulations. We found that people were not always protected from the risks associated with their care and people’s legal rights were not always protected. Additionally people could not always ensure a safe environment was maintained. The provider did not have effective systems to monitor the quality of the service. Additionally people did not always receive care which was personalised to their needs and an accurate record of their care was not maintained. Following our inspection in September 2016, we issued the provider with two warning notices in relation to safe care and treatments and good governance. The provider sent as an action plan of the actions they would take to meet the legal requirements. We found some improvements had been made however some regulations were not being met.

People and their relatives were generally positive about the home. They felt safe and well looked after. People enjoyed the food they received in the home and had access to food and drink. People felt there were enough activities; however activities care staff provided were not always documented.

The provider and registered manager had implemented systems to monitor and improve the quality of service people received, however these systems were not always effective and were not consistently applied. There was no current system to seek people and their relative’s views on the care people received. The provider and registered manager had not identified concerns we had identified during the course of this inspection.

People were now being protected from the risks associated with their care; however people’s care and risk assessments were not always reflective of their needs.

Staff were deployed effectively to ensure people’s basic needs were met and kept safe. However people could not be assured new staff were of good character as all recruitment checks had not been maintained. Care staff had not received all the training they needed to meet people’s needs. The provider and registered manager did not have an overview on staff training needs and competencies.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of this report.

We last inspected in August 2015 and found that the provider was not meeting a number of the regulations. We found that people did not consistently receive safe care and treatment, because an assessment of their care needs had not always been written or maintained. Additionally staff did not always have access to the training and support which they required. The registered manager did not have effective systems to monitor and improve the quality of service people received and did not always notify us of notifiable events within the service. Staff did not always ensure people were protected from harm or identify if they had capacity to consent to their care. People did not always receive the support they needed to meet their nutritional needs. Following our inspection in August 2015, the provider provided us with a plan of their actions to meet the fundamental standards. However, during this inspection we found while some improvements had been made the service was not meeting a number of the fundamental standards.

At our inspection on 29 and 30 September 2016, 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.

The provider did not have effective systems to monitor the quality of service people received. Audits were not consistently carried out and did not address shortfalls in the quality of the service to drive improvements. There was no evidence that people and their relative’s views had been sought or acted on.

There were enough staff deployed to meet people’s day to day needs. However, there was a high level of agency staff working at the service who did not always know people’s needs when they started working at the home, There was a consistent management team in place who were managing the staffing levels, by recruiting staff.

People mostly received their medicines as prescribed at times. Where people could receive their medicines covertly, there was no clear guidance for staff to follow on how to ensure people received these prescribed medicines.

People were at risk of unsafe care and treatment as assessments of their needs had not always been completed. People’s care plans did not always reflect their needs or provide care staff with clear guidance to follow. People did not always receive care which was personalised to their individual needs.

People we spoke with were positive about the home. They felt safe and looked after. People enjoyed the food they received in the home and had access to food and drink. People did not always benefit from meaningful engagement from staff. Records did not always show if people had been involved or enjoyed activities and external entertainment.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The purpose of the inspection was to answer our five questions; Is the service safe, effective, caring, responsive and well led?

Is the service safe?

The staff were knowledgeable about safeguarding and knew how to protect people from harm. They had received training in safeguarding and followed procedures to ensure any concerns were followed up.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the provider was making applications for DoLS appropriately after having reviewed people's mental capacity.

The service had a suitable policy and procedure for managing infection control. Staff followed guidelines to ensure safe practice was maintained in relation to infection control.

Is the service effective?

People's needs were assessed and personal care and support was planned and delivered in line with their individual care plan. One relative told us, 'This home meets my relative's needs'.

People's care files contained information from the funding bodies and showed that support had been provided from health and social care professionals. One relative told us they had shared their knowledge with staff regarding their family member's likes and dislikes. The visiting professionals spoke positively about the service, the management and the team of staff.

Is the service caring?

The visiting professionals told us staff cared for people with complex needs in a caring and sensitive manner. One visiting professional, for example, told us, 'This is a caring home in the manner people are supported'. A relative commented, 'The staff are very kind and attentive'. One person told us they felt comfortable after receiving personal care.

On many occasions, staff interacted with people in a caring way. For example, we observed a member of staff assisting a person to eat whilst speaking in a gentle and compassionate way. Whilst people were walking around the home, staff acknowledged them and asked about their welfare and their needs. A relative told us 'All the staff are calm and peaceful'. The staff spoke positively about being employed at the service.

Is the service responsive?

People's care plans were detailed and personalised. They were regularly reviewed and contained sufficient information to guide staff about the care people needed. This included support with personal care, mobility and communication.

Risks were assessed to ensure people's independence was promoted in a safe way.

People participated in social and therapeutic activities they enjoyed. Those people who were unable to take part in group activities were given the opportunity for one to one support. One member of staff told us they read to people in their rooms.

Is the service well-led?

The provider had an effective system to assess and monitor the quality of service people received. This included a regular infection control audit carried out by the registered manager.

A relative spoke favourably about the service and how it was managed. Visiting professionals also commented positively about the service people received and the management of the home.

Arrangements for assessing people's needs and planning their care had improved, as had the arrangements for managing people's risks. There was evidence to show that although many people had been unable to engage in this process, their representatives had been given opportunities to speak on their behalf. We found staff had clear guidance on how to meet people's needs and people's care had been delivered in line with their care plans. Improvements had been made to the arrangements for protecting people from abuse and inappropriate use of physical intervention. This meant, where minimal physical intervention might be required, guidance on what this entailed and how it was to be used in each person's case, was clear.

The new arrangements for staff training and staff support had started and we found staff had already begun to update their knowledge. Management staff were more engaged with the systems designed to help them assess and monitor the service. Some improvement to how staff recorded the care they gave was needed.

These improvements were in their infancy and will need to be sustained in order to fully provide people with the on-going protection they require.

We found shortfalls in how people were protected from excessive use of restraint and/or physical force and how the service identified possible acts of abuse. This meant that people were not protected from the possibility of abuse.

We found improvements in how the service was staffed. Some successful recruitment had taken place and it was hoped that further new staff would soon start work. Shortfalls were found in some staff training, meaning that people were at risk of receiving care or having decisions made about them by people who had not received appropriate training.

Arrangements for addressing complaints and resolving them had been improved. The service did not have effective systems in place to monitor the care provided, to identify shortfalls in compliance and address these. This is an on-going failing of the service which results in failure to sustain improvement. Records relating to people's care had improved, other records were not being kept or maintained but this had not had a negative impact on what the service had aimed to achieve.

Managers were aware of the legal requirements under the Mental Capacity Act and were putting processes into place to ensure people who could not give consent were protected. Care was not always planned and delivered in a person centred way, with set routines and task orientated ways of working being evident. Arrangements, designed to safeguard people, were not always in place or not being followed. The arrangements for medicines were not robust enough to protect people from possible related risks.

At times there were not enough staff on duty to safely supervise people. Staff had not been supported well enough, either through training or example to always be able to demonstrate best practice. The service could not demonstrate that people's complaints and concerns were being managed . Record keeping was, in places, not accurate and sometimes absent. The home's policies and procedures were not always being followed. The processes we were told were in place, to monitor the service and staff practices, were ineffective and ultimately not benefitting or protecting the people who used the service.

These related to a specific safety issue within the environment, the deployment of staff and arrangements for monitoring and improving the services provided.

During this inspection we found that all areas of required compliance had been met and that further improvements were work in progress.

We also evidenced that the service had been inspected by the Food Standards Agency in April 2012 and awarded a rating of 5 (the highest rating awardable to this kind of premises).

The service had also been inspected by the Fire Safety Officer on 17 October 2012 and found to be compliant with the Regulatory Reform (Fire Safety) Order 2005 and other legislation.