Buckingham 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

The provider was finding it difficult to recruit staff to work at the service. This had led to a large number of staff vacancies. The provider had therefore used agency staff and had sponsored oversees workers. This had created a training and development need and the skills mix of the staff team was not always meeting the needs of people using the service. A large number of incidents had been reported to the local authority in January 2024. Action had been taken to mitigate future risks such as liaison with professionals such as the falls team. Some care records required further information to ensure they directed staff to meet people's needs. This was shared with the registered manager. The service was aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person. The provider had systems in place to record and analyse accidents and incidents. People were supported to receive their medicines safely. People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. The premises were well maintained and a range of detailed environmental checks were in place. Equipment checks were undertaken to support the delivery of safe care. Systems were in place to share information with professionals involved in people’s care to help ensure they received effective care and treatment.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had systems in place to record and analyse accidents and incidents. A large number of incidents had been reported to the local authority in January 2024. Action had been taken to mitigate future risks such as liaison with professionals such as the falls team.

People and relatives felt confident they could raise concerns and action would be taken to address those concerns. One relative said, "They [staff] respond really well, the manager responds and looks into things.” However, one relative felt concerns were not always resolved effectively. The said, "I can sit and tell her [manager] everything and nothing changes.”

The management shared information on how challenging it had been to obtain an appropriate skilled staff team at the service. They recognised the staff team required upskilling to ensure there was continuous improvement and to embed good practice.

Processes were in place to enable a smooth transition between services and to reduce the impact on people. The provider had a 24hr falls pack which included an accident and incident checklist, body map for recording injuries, first aid check lists for a fallen person, guidance regarding accidents and incidents and a post-accident observation record. This was in place to ensure information was passed on between staff and other professionals.

The registered manager explained the service used a system known locally as 'right care' for referring people to appropriate health care professionals. This system replaced a single point of access system. Staff contacted 'right care' explaining what they needed and the operator ensured the most appropriate professional was notified and engaged with the service. The registered manager felt the system operated well and the response times were good.

People and relatives told us the GP regularly visited the service. Relatives could ask for their family member to be seen by the GP if they felt they were unwell.

The local authority had concerns about the quality of care and safety of people due to staff competencies.

The service was using a high usage of agency and overseas staff who required further upskilling to ensure people were appropriately supported.

The management team shared information of the action they were taking to ensure people were appropriately supported and safeguarded from abuse and possible harm. There was a commitment from the management team to provide staff with the skills and knowledge to keep people safe from abuse and neglect.

People told us they felt safe and had no worries or concerns and felt they could raise concerns if they needed to. Most relatives felt their family member was safe living at the service and said they would speak with staff if they had any concerns. One relative shared how their family member had been treated by agency staff "He was ‘manhandled’ into the shower."

We could not be confident the systems, processes and practices to make sure people were protected from abuse and neglect were always effective in practice due to the staffing issues at the service. The local authority had raised concerns with the provider about the number of incidents reported in January 2024. The local authority had made a decision to place an embargo on the service to stop any further people being admitted. Action had been taken by the provider to mitigate future risks such as liaison with professionals such as the falls team. The service was aware of the need to and had submitted applications for people to assess and authorise that any restrictions in place were in the best interests of the person.

The management team were aware of the concerns about staff team skills mix and there was a risk that people may not be appropriately supported. In response to these concerns the registered manager and deputy manager would be working alongside staff to minimise this risk and upskill staff.

The staffing situation at the service showed there was a risk people would not receive care and support that was evidence based and in line with good practice standards. The management team was taking action to address this risk.

People had individual risk assessments in place. The risk assessments were relevant to the individual and promoted their safety and independence. However, some care records required further information to ensure they directed staff to meet people's needs. We shared this feedback with the registered manager.

People and/or their relatives told us they were involved in assessing and managing risks. Some relatives were concerned their family member's risks may not be managed by staff due to either a lack of skills or language barrier. One relative shared concerns that some staff may not understand their family member if they expressed they were in pain. Another relative shared concerns about the care provided to their family member and told us the oversees workers needed further training.

We saw evidence that environmental and equipment checks had been completed. Equipment was available in different areas of the service for staff to access easily. The service was separated into 4 units however due to the current low occupancy; one unit upstairs was completely closed and one unit downstairs was currently occupied by only 2 people. These people only slept on this unit and spent the rest of the day in the adjoining downstairs unit. Signs were available to help people to navigate around the service.

People were cared for in a safe environment that was designed to meet their needs. People had a range of equipment available to use.

We did not receive any concerns from staff about the environment or equipment within the service.

Environmental safety checks were in place, ensuring the environment and equipment was safe for people to use. This included fire safety, legionnaires and lifting equipment precautions.

Most relatives raised concerns about the number of agency staff and overseas workers deployed at the service. They told us this impacted on the quality of care provided to their family member either due to a lack of skills and/or English language ability. One relative shared how some staff could engage with people with a bit of 'banter'. This helped improve their wellbeing. Whilst other staff did not speak and were not able to follow the conversation. The language barrier made it difficult to understand, or be understood, by some staff.

There were sufficient staff available in numbers, however there was a disparity in the skill mix. During our visit we saw some staff providing guidance to staff who were less knowledgeable. For example, during lunch we observed a staff member explaining to another staff member why they should show the food to people. The staff member said, “If you show [the food], there’s more chance of them having some.” We also observed one staff member being reminded to put on an apron and gloves before serving food.

The provider acknowledged the service had received concerns from the local authority, relatives and staff. They had taken action to address these concerns. The registered manager and deputy manager were working across 7 days a week to ensure a management presence was within the service and to work alongside the staff team to develop skills and knowledge. The provider was actively recruiting for staff.

The management team told us there had been several recruitment drives to obtain staff but they hadn’t been very successful. So, the provider had begun to sponsor oversees workers. The service was also using a high amount of agency staff. The management team had tried to employ a diverse workforce. This had resulted in concerns about the skills mix of the staff team. The management had a plan in place to address these concerns. Some staff felt they were always compensating for the lack of skills and experience of agency and/or overseas staff.

People and relatives did not share any concerns about the cleanliness of the service.

We observed a few minor issues which were resolved by the registered manager. For example, there were some open continence pad bags left in the sluice area and kitchenette area off the dining room was in need of a deep clean.

Staff had ensured people were protected from the risk of infection because premises and equipment were kept clean and hygienic.

The systems used by the provider to monitor infection, prevention and control practice were effective in practice and ensured people were protected from the risk of infection.

Staff were assessed as competent to support people with their medicines.

The service had appropriate arrangements in place to manage medicines so people were protected from the risks associated with medicines. Accurate, up-to-date information about people’s medicines was available. There were appropriate arrangements for the safe management, use and oversight of controlled drugs.

Most people told us they received their medicines as prescribed. One person said they were given the wrong medication on one occasion but they spoke with the registered manager who addressed the concern. One relative felt staff required a better understanding on how to approach their family member if they refused to take their medication so they agreed to take it.