Buckingham Care Home

Buckingham is a residential care home providing accommodation and personal care to older people, including people living with dementia. The service can support up to 72 people over 2 floors and 4 units, each with a separate dining room and lounge. One unit was undergoing refurbishment and not in use, and at the time of inspection there were 36 people living at Buckingham Care Home. The home is purpose built with ensuite bedrooms and communal areas. The home has a secure garden accessible from the ground floor.

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

At the time of inspection, the service had an infection outbreak affecting several residents and staff. We carried out a tour of the home and identified concerns regarding infection prevention and control. Some areas required a deep clean and outbreak management was not robust.

People, relatives, and staff raised concerns about staffing levels, consistency of staff and agency usage. There was a dependency tool used to ensure there were adequate staff on duty to meet people's needs and rotas viewed reflected staffing levels identified by the tool. The provider was actively recruiting more permanent staff.

We saw some positive interactions between staff and people; however, staff were not appropriately deployed and there were not enough staff available on one unit to respond quickly when people needed care, support, or reassurance. We discussed this with the provider on the day and action was taken to address this. We have made a recommendation for the provider to monitor and review staffing levels.

Staff were recruited safely however, assurances in respect of gaps in employment history were not always recorded in staff recruitment files. Confirmation was given verbally that all gaps were followed up, and supporting information was received following our inspection.

Risks assessments and care records for people lacked detail of how risks were mitigated and how people would like support to be provided which would make them more person centred. This was a records issue.

People received their medicines as prescribed. We identified some minor concerns in regard to maintaining appropriate records which were rectified immediately. We have made a recommendation for the provider to review their medication audits.

We found people received a balanced diet and a choice of options was available but not always routinely offered during our visit. The provider agreed to address this and ensure drinks were always available in individual rooms. We have made a recommendation for the provider to complete regular spot checks to ensure people have options offered and drinks are readily available.

Overall, people were supported to have 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.

Incidents and accidents were recorded appropriately to ensure lessons were learnt. Staff we spoke with understood safeguarding procedures and whistleblowing and stated they would report any issues immediately.

Effective systems were now in place to monitor and improve the quality of the service provided, address cultural issues, and expand on the involvement of people, relatives, and staff in how the service is run. However, we need to see these embedded and improvements developed and sustained.

The regional management team were responsive to our inspection findings. We received updates on the day and following our inspection about what action they were taking to address concerns we had identified.

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 31 May 2022). The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to infection prevention and control and good governance.

Please see the action we have told the provider to take at the end of this full report.

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.

Buckingham Care Home is a residential care home providing personal care. It can accommodate up to 72 people. Some people using the service were living with dementia. There were 37 people using the service at the time of the inspection.

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

Risks to people's care were identified staff understood those risks and managed them well to ensure people’s needs were met. However, documentation in place was not always up to date. Medication systems were in place and medicines were administered as prescribed. The environment was predominantly clean, however, we found some areas were not well maintained, therefore not able to be effectively cleaned. We observed staff followed best practice infection control procedures to reduce risk of cross infection and contamination.

There was a dependency tool used to ensure there were adequate staff on duty to meet people’s needs. However, during our observations we identified staff were not always present in communal areas to ensure peoples safety. This was reviewed by the service following our inspection.

The new registered manager had implemented a new management structure, there were two assistant managers, a unit manager and increased numbers of senior care staff. Staff spoke positively about the changes and told us the service had improved. The quality monitoring systems were effective, areas for improvement had been identified and the provider had an environmental action plan in place. Following our inspection, the provider prioritised the maintenance issues we identified at the site visit to ensure all areas could be effectively cleaned to ensure infection prevention and control was robust.

People told us the staff were very good. One person said, “Nothing is too much trouble for them [staff]”. Relatives also told us the staff were kind and caring. One relative said, "The staff are always nice, I have no concerns." 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 did support this practice. We observed when staff interacted with people, they were kind and caring. However, staff did not always involve people in decisions or communicated effectively with people. This had been identified by the new registered manager and was being addressed.

The environment was being improved to ensure it was dementia friendly. Social stimulation and activities were provided to engage people and promote their well-being. However, this could be improved for people living with dementia. The new registered manager was promoting a person-centred culture that achieved good outcomes for people. The new systems and changes required embedding into practice and sustaining.

Incidents and accidents were recorded appropriately to ensure lessons were learnt. Staff we spoke with understood safeguarding procedures and whistleblowing and all stated they would report any issues immediately. Every person we spoke with told us they felt safe living at Buckingham Care Home.

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 requires improvement (published 8 August 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made.

Why we inspected

The inspection was prompted in part due to a high number of concerns received from whistle blowers about poor care and lack of staff to meet people’s needs. A decision was made for us to inspect and examine those risks, to complete a focused inspection to review the key questions of safe, effective and well led.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• The service had arranged for relatives and friends to be provided with detailed information about visiting procedures. Visits were planned, timed and socially distanced. A discrete area in the new entrance area was used to take temperatures and take health information. Alternative arrangements for relatives unable to visit, including ipads and window visits, were also available.

• The unit was self-contained with a separate entrance with ramp, medicine room, staff dining area, and room for putting on and taking off personal protective equipment (PPE). There was a unit manager who supported the safe admission of people. In addition, NHS staff working in an adjacent wing had a separate entrance.

• There was a dedicated staff team, which includes separate management arrangements. Staff supported people to undertake well-being activities on an individual basis.

• A robust cleaning schedule was in place. Increased clinical waste collections had been arranged. Good ventilation has been enhanced by two air-filtration units. Enhanced laundry bags were in use. Laundry procedures followed best practice guidelines.

• An Infection Prevention and Control (IPC) Policy was in place. The service had worked closely with IPC specialist nurses. Staff have individual risk assessments and an individualised programme to protect them at work.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Buckingham Care Home is a residential ‘care home’ providing personal and nursing care to 44 people aged 65 and over at the time of the inspection. The service can support up to 72 people over four different wings. One of the wings specialises in providing care to people living with dementia.

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

Improvements had been made following the previous inspection. Risk assessments and care plans detailed what care and support was needed to reduce risk to people. There were enough staff to take care of people. Medicines were managed safely. We also assessed and were assured with infection control procedures within the home. We were assured that appropriate systems were in place to help keep people safe.

People were happy with the food available to Buckingham Care Home and they were encouraged to drink enough. There were appropriate risk assessments and care plans in place for nutrition and hydration and people's nutritional intake was recorded and monitored.

The provider and manager and senior staff regularly completed a range of checks and audits to assess the quality and safety of the service. The manager used the results of these audits to make improvements to the service. People spoke highly of the home’s management team, commenting they were approachable and supportive. The manager understood the regulatory requirements. People told us they thought the service was well-led.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published August 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Requirement Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Requirement 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 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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Buckingham is a ‘care home’ providing personal and nursing care to 48 people aged 65 and over at the time of the inspection. The service can support up to 72 people.

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

People were offered a choice of food and drink and the meal time experience was a positive one. However, for some people who were at risk of poor nutrition, we were unable to establish if their dietary needs had been met.

People’s care records were not always up to date and accurate. This created a risk people would not receive the right care and support.

The service worked with other health care professionals. However, we found information in relation to visits was not always recorded in peoples’ care plans. The service was working with local health professionals to improve this.

People told us they thought the service was well led. The registered provider had a system of governance in place to monitor and improve the quality and safety of the service. However, we could not see how once issues had been identified, how they were managed in a timely manner.

People who used the service and their relatives were asked for their views about the service and these were acted on.

Medicines were managed safely.

People who used the service and their relatives told us staff were kind and caring. People were supported to have 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.

People's likes, preferences and dislikes were assessed, and care packages met people's desired expectations.

Staff were being recruited safely and there were enough staff to take care of people. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the manager and were receiving formal supervision where they could discuss their ongoing development needs.

There was a complaints procedure and people knew how to complain.

Everyone spoke highly of the registered manager who they said was approachable and supportive. The provider and registered manager understood the regulatory requirements and monitored the quality and safety of the service on a regular basis.

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

The last rating for this service was requires improvement (published 5 June 2018). The service remains rated requires improvement following this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breache at this inspection in relation to not monitoring the quality and safety of the services provided in the carrying on of the regulated activity. This was a breach of Regulation 17: Good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Buckingham care home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Buckingham Care Home is located in Penistone and has access to the local amenities. The home has 72 bedrooms with en-suite facilities on four residential units, across two floors, including ‘Memory Lane’ designed for people living with dementia. Some of the bedrooms have direct access to the garden and patio. Within the home there are four lounges, four dining rooms and a café. There is a car park to the front of the property.

At the time of our inspection the service had a registered manager. 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 were safeguarded from the risks of abuse. Staff were knowledgeable about identifying abuse, recording and reporting it. Risks associated with people’s care had been identified and staff knew how to manage risks. However, documentation did not always evidence the risks and action staff should take to minimise them. We observed staff interacting with people and found there were enough staff available to meet people’s needs in a timely way. Medication systems were in place, however, protocols in place to manage medicines prescribed on an ‘as and when’ required basis lacked detail. Documentation also needed to evidence that topical creams were being applied as prescribed. Accidents and incidents were monitored on a monthly basis showing a clear audit trail.

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. This was because the management team were aware of who had an authorised Deprivation of Liberty Safeguards or if any conditions were attached. Consent to care and treatment was sought in line with current legislation. Best interest decisions were considered but were not always documented.

Staff received training on a regular basis both face to face and online. Staff were knowledgeable about their role. People received a nutritious diet, although documentation for recording this could be improved. People had access to healthcare professionals and staff adhered to their advice.

We observed staff interacting well with people and were kind and considerate. People’s privacy and dignity were respected.

People received personalised care and staff were aware of people’s needs and preferences. However, this was not always detailed in care records. A range of activities took place but did not always involve everyone. People felt able to raise concerns and complaints were listened to. The registered provider learned lessons from complaints received and took appropriate actions.

Audits were in place to ensure policy and procedures were followed. Audits mainly identified areas of development and these were actioned. However, audits could be more detailed to ensure all outstanding issues are identified. There was evidence that people had a voice and were given opportunities to be involved in the home.