Badgeworth Court Care Centre

Badgeworth Court Care Centre is a residential care home which provides personal and nursing care to 60 older people and people living with dementia. There were 52 people living in the home at the time of our inspection. Badgeworth Court Care Centre is set across three units, it has a range of communal areas and gardens which people could access.

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

People and their relatives told us they felt safe living at Badgeworth Court Care Centre. They also spoke positively about the quality of care received.

People received personalised care which was exceptional, and the service was outstandingly responsive to the needs of people and particularly to the changing needs of people living with dementia. The service used the Dementia Care Well-being framework to support and enrich the life of people living with dementia. Activities available to people were personalised and they had been supported to build links with the local community.

Working in a sector with significant workforce challenges, the staffing team spoke with pride about the consistency of care they could offer people by not using agency staff and implementing a whole home approach when needed. The registered manager told us: “They [staff] go above and beyond” and that they were very proud of their team.

Staff understood people's needs and how to assist them to protect them from avoidable harm. Care plans and risk assessments were in place, which provided staff with guidance on how to meet people's needs and manage identified risks.

People were supported to receive their medicines safely and as prescribed.

People were supported by staff who had been trained and supported to meet their needs. People and their relatives were very complimentary about the caring nature of the staff.

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.

The registered manager and extended leadership team offered exceptional leadership and had a clear vision about the service. There were robust quality assurance systems in place to ensure people received the best possible service. The registered manager worked closely with the provider, partner agencies and services to promote best practice within the service and make a positive impact to people's lives.

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 25 June 2019)

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 read the report from our last inspection, by selecting the 'all reports' link Badgeworth Court Care Centre on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Badgeworth Court is a residential care home which provides personal and nursing care to 60 older people and people living with dementia. At the time of the inspection 45 people were receiving care. Badgeworth Court is located in Badgeworth, near to the town of Cheltenham. The home is set across three units, Norwood, De Clare and Selwyn Payne. 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 the service had dramatically improved since the registered manager came into post in 2018. They felt the registered manager and deputy manager were incredibly approachable, open and transparent. People and their relatives were hoping for continued stability in the day to day management of the home.

• People and their relatives felt Badgeworth Court was a safe and homely place. Staff understood the risks to people and the support they required to ensure their health and wellbeing.

• People had access to a range of activities and events which they enjoyed, including music and movement. The registered manager was highly motivated in making and developing links local community groups which could support and enhance people’s contacts in the wider community.

• 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 and nursing 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 and registered manager had a clear plan and vision for Badgeworth Court. 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 were available 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, with some people having access to their own personal menus. The home had a head chef who was aware of people’s dietary needs.

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

The registered manager and provider had robust systems to monitor and improve the quality of service they provided at Badgeworth Court. The registered manager took every available opportunity to learn from incidents, accidents and complaints.

Rating at last inspection:

Requires Improvement (The last report was published 03 May 2018). We found four breaches of the Health and Social Care Act in relation to the requirements of person-centred care, safe care and treatment, good governance and fit & proper persons employed. Following our last inspection, we met with the provider to discuss the improvements they planned to make to Badgeworth Court. The provider sent us regular updates on their action plans.

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”. We also followed up on progress against agreed action plans to address the breaches in regulation we found at our previous inspection in March 2018. 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.

Following our previous inspection a new registered manager had been recruited. 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. Two regional directors were also supporting the registered manager to make the required improvements we identified at our previous inspection.

When we previously inspected this service in August 2017, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not always receive personalised care, records did not always reflect the care people received and required and the provider’s quality monitoring did not always address all the risks in the service. We rated the service ‘Requires Improvement’ overall. The provider had sent a report to CQC detailing the improvements they would be making to address the shortfalls we found.

At this inspection we found some improvement had been made however, there had been some delay in addressing all the concerns due to another management and several staff changes. Although the provider has started the process to rectify these issues since the inspection, they have yet to complete the works to ensure people's safety. We have again rated the service ‘Requires Improvement’ overall.

The provider had employed a new clinical lead to support with monitoring people's nursing care. We found an increased scrutiny of people’s nursing care was taking place following our previous inspection. The clinical lead had a good understanding of people’s needs and regular nurses meetings were being held to track and evaluate people’s treatment. A range of checks and audits upon the quality and safety of the service were being completed on a daily, weekly and monthly basis. Some were effective and others required further work to embed them and to make them fully effective.

Action was being taken to improve people’s care records. However, we found time was needed before these improvements would be completed in all people’s care plans and daily records across the service.

The provider had not ensured that the required pre-employment information was available for all staff recruited to demonstrate their suitability for their role with people.

People received their medicines from nurses and senior carers as prescribed. However, improvements to medicine practices were needed to ensure medicine were managed safely in accordance with current best practice guidelines.

We found following our previous inspection improvements had been made to the activities and social opportunities available to people. The service was making progress in ensuring people's end of life wishes were promptly documented in accordance with the provider’s end of life procedures Throughout our inspection we saw examples of staff responding promptly to people’s needs. However, more time was needed to ensure people would always receive staff support when needed, without delay, especially during meal times.

Staff told us they felt increasingly supported. Following our previous inspection staff had received additional training, team meetings took place and plans were in place for supervision to be completed.

Improvements had been made to the meal options and people and their relatives told us the quality of the food had improved. Systems were in place to gain the views of relatives and staff and improve communication.

At this inspection, we found some improvements had been made. However, the service had not yet managed to fully meet the legal requirements of the two breaches of Regulations we found at our previous inspection. We also identified two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicine management and recruitment practices. You can see what actions we told the provider to take at the back of the full version of this report.

There was no registered manager in place as required by the provider’s conditions of registration. 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. However an interim manager was in place who was planning to submit an application to CQC to become the home’s registered manager until a permanent manager was recruited to ensure the provider would meet their registration requirements.

We inspected the home as we had received concerns about the quality of service being delivered to people who lived at Badgeworth Court Care Centre. These included concerns about the cleanliness of the home, the quality of food available, the support people received to eat as well as the number of staff available. This inspection was also prompted in part by the provider’s notification to CQC of a significant event. The information shared with CQC about the incident indicated potential concerns with the end of life care people received. This inspection examined those concerns and reported on the findings in the caring and well-led questions. This incident is subject to a separate coroner’s inquest and as a result this inspection did not examine the circumstances of the incident.

Our previous comprehensive inspection of the home was completed on 5 February 2016 and the home was rated ‘Good’ overall. At this inspection we found improvements were needed across all five domains and the provider had not maintained their previously awarded ‘Good’ rating. This is the first time the service has been rated Requires Improvement overall.

The provider had identified shortfalls in the service people received prior to our inspection.

A new interim manager had been allocated to the home by the provider to assess the care being provided and drive improvements across the home. They were being supported by specialist advisors from the provider as well as the regional manager. People, relatives and staff told us they were not always confident the improvements would be made, sustained and embedded in the home.

We found the interim manager and provider representatives understood the improvements that needed to be made to the service. They had started putting arrangements in place to reduce the impact the service shortfalls would have on people whilst the provider was completing their improvement plan. However we found these arrangements were not always effective and people did not always receive quality care whilst the provider’s monitoring systems were being embedded and improvements were being made.

We found that people who were at the final stages of their life could not always be assured that they would receive personalised end of life care. Delays in planning people’s end of life care meant people were not promptly given support to make decisions about their care preferences. Staff might therefore miss the opportunity to tailor people’s care at the end of their lives to their wishes.

People were supported to access health care services when their medical needs had changed and received their medicines as prescribed. We received mixed comments about the quality of food people received. We found that people’s dietary needs were catered for however people who lived with dementia were not always supported to have a positive meal time experience.

People living with dementia did not always receive personalised support that met their needs and were not always given opportunities to have a meaningful and stimulating day. People and their relatives were positive about the staff who cared for them. Staff ensured that people’s dignity and privacy was respected.

The provider did not keep a comprehensive record of the care people required and had received and the decisions taken in relation to their care and treatment. Action was being taken to review and update people’s care plans.

The provider was actively recruiting managers, nurses, care and non-care staff including housekeepers and an activity coordinator. However, people who used the service, their relatives and staff told us they were concerned the staff turnover and reliance on agency staff meant that people could not always be confident their care needs would be met. We found evidence that people had not always received personalised care that met their individual needs. This was confirmed by information from people and their relatives and we made observations to support this during the inspection.

The interim manager had put systems and meetings in place to capture the views and concerns of relatives. Time was needed to ensure relatives’ complaints would be resolved effectively in accordance with the provider’s complaints process.

Staff shared with us concerns about the support they had received. The interim manager had put plans in place to ensure people were being cared for by staff who had been adequately trained or supported to meet their needs. Systems were being put into place to gain the views of relatives and staff and improve communication and assess the quality of the service being provided.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.

This inspection took place on 28 February 2017. Badgeworth Court Care Centre provides accommodation for 65 people who require nursing and personal care. 53 people were living in the home at the time of our inspection.

Badgeworth Court Care Centre is set over two floors. The home has three units which support people with different needs. Each unit has a lounge and dining room with an adjacent kitchen. People have access to a secure garden, coffee area as well as a hair salon.

A registered manager was in place as required by their conditions of registration; however they were unavailable on the day of our inspection. The clinical lead therefore supported us during the inspection. 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’s nutritional and dietary needs had been assessed and were catered for. People’s risks of choking or malnutrition had been assessed. Control measures had been put into place to eliminate any risks such as soft diets or fortified foods. Their care plans provided staff with the guidance they needed to support people with food and drinks. People were weighed regularly to ensure they maintained their weight. Where needed people’s food and fluid intake was monitored. People were referred to the relevant health care services if they experienced changes in their wellbeing and nourishment.

There were sufficient staff on duty to support and monitor people eating their meals. Staff were knowledgeable about people’s specialist diets and preferences. We observed people being offered a choice of meals and being provided with a meal to suit their dietary needs or preferences. The kitchen staff were aware of those people who required a specialised diets such as soft texture or diabetic diet. Most staff had been trained in food safety and supporting those people who were at risk of choking.

Whilst we found good practices in relation to people’s dietary needs, we have not changed the ratings of this service as we did not inspect all areas of the domain. Therefore this report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Badgeworth Court Care Centre’.

Badgeworth Court Care Centre is set over two floors. The home has three units which support people with different needs. Each unit has a lounge and dining room with an adjacent kitchen. People have access to a secure garden, coffee area as well as a hair salon.

A registered manager was in place as required by their conditions of registration. 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 registered manager had been in post since August 2015.

People told us they enjoyed living at the home and they felt safe. Their support needs and risks were mainly managed well. There were sufficient numbers of staff to meet people’s basic needs; although some people were not always effectively monitored. However the registered manager and provider took immediate action to increase the staffing levels and put formal systems in place to monitor people who were left unsupervised or who were at risk.

The employment and criminal history of most staff had been suitably checked and vetted, although there were gaps in recruitment procedures of two staff files. However, new staff were appropriately supported and mentored in their probation period to ensure they were suitable to care for people. Staff told us they felt supported and trained and supported to carry out their role. Staff had access to additional training if required.

Systems were in place to ensure people’s medicines were ordered, stored and administered as prescribed. However the home’s medicines policy did not reflect practices of people who required different support with the management of their medicines or those who may require medicines as required.

The home was undergoing a refurbishment programme. On-going plans were in place and being implemented to provide an environment and items which would help orientate and stimulate those people who lived with dementia. The home was regularly maintained and cleaned to ensure people were free from harm and the risk of the spread of infection. Staff were aware of their responsibilities and systems to ensure people were safe.

Both people and their relatives complimented the caring nature of staff. We received many positive comments about the home. Staff delivered compassionate care which was focused on people’s individual needs. They were knowledgeable about people’s wishes and preferred way to be supported. Staff respected people’s decisions and provided support when requested.

A wide range of activities were provided for people in and out of the home. Most people were encouraged to partake in activities, however some people felt socially isolated in their bedrooms

People told us they enjoyed the meals and food provided. Their dietary needs and preferences were catered for.

The registered manager and senior staff had a good understanding of their role and how to manage the quality of the care provided to people. Quality monitoring systems were in place to check and address any shortfalls in the service. People’s complaints and concerns were taken seriously. Where concerns had been raised by people and their relatives these had been investigated into and discussed with the complainant.

We found people had detailed care plans and risk assessments in place for all assessed needs. These were kept under review and updated as required. People had access to external professionals, for example, GP's, social workers, dentists and chiropodists.

There were arrangements in place for monitoring the services provided.

Before people received any care or treatment they were asked for their consent and the service acted in accordance with their wishes. Where people did not have the capacity to consent, a system was in place to make sure any decision was made in their best interest.

People said they enjoyed good food and had lots of choice. We also tasted the food and found it to be very good and well presented. We observed on one of the units that people received 'finger foods' as well as the same choices as other people, this was due to their complex needs. The staff said they also joined people for meals.

People had access to a varied activities programme that included group sessions and one to one time. People said they could choose if they joined in the activities.

Where able people were included in the decisions about their treatment and ongoing care, records were maintained of this. Care records were personalised and care plans and risk assessments were in place for all assessed needs. These were kept under review and updated as required.

We followed up on three compliance actions issued at the last inspection in June 2011, these had been met and the home is now compliant.