Buxton Lodge Care Home

We found the following examples of good practice.

The provider had been imaginative in their approach to maintaining good contact between people and their families. They had created an attractive visiting area with gazebo and weatherproof PPE station and side access to prevent visitors from having to go through the home. In addition, they had used a giant sized ipad on wheels for virtual calls. Relatives group meetings with the registered manager had also been held monthly via Zoom technology, so that people could chat and receive updates from the home. Relatives had asked the provider if this could be continued in the future due to its success.

Staff had produced colourful easy read posters and handouts for relatives and people to show them the PPE that they could expect to see staff wearing and the reasons why, and how testing is carried out. They were illustrated with photos of staff and people to make them more friendly and relatable. This had reduced people's anxieties around PPE and testing.

The provider had been proactive in giving staff who may have been isolating or shielding confidence for their return to work. They were given a choice of attending meetings physically or via Zoom, and their roles had been adapted where possible so that they felt reassured of their own personal safety due to being vulnerable. They were shown all of the measures that had been put in place by the provider to relieve some of their concerns.

Buxton Lodge Care Home is registered to provide accommodation, care support and nursing care for up to 44 older people some of whom may have specific needs and/ or are living with dementia. At the time of our inspection there was an experienced 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.

At our last inspection of the service on 28 June 2016 we rated the service overall as ‘Good’ and 'Requires Improvement' in Responsive. This was because guidance from healthcare professionals was not always being followed, daily notes and charts were not always being completed accurately and people's care records did not contain information of their medical conditions. Records were stored in multiple places and some staff did not have access to them. Following the inspection, the provider submitted a plan in which they told us that they would audit all files and change the way files are stored making them accessible to all staff. At this inspection we found improvements had been made and the service was meeting the regulations.

Risks to people were assessed and managed safely by staff. Medicines were managed, administered and stored safely. People were protected from the risk of abuse and staff knew what action to take to ensure people’s safety and well-being. There were systems in place to ensure people were protected from the risk of infection and the home environment was clean and well maintained. The home environment was suitably adapted to meet people’s needs. Accidents and incidents were recorded, monitored and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs in a timely manner.

There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. 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. People’s nutritional needs and preferences were met. People had access to health and social care professionals when required and staff worked well with health and social care professionals to meet their needs.

People were treated with kindness and staff respected their privacy and dignity. People’s diverse needs were met and staff were committed to supporting people to meet their needs with regards to their disability, race, religion, sexual orientation and gender. People were involved in making decisions about their care. There was a range of activities available to meet people’s interests and needs. The service provided care and support to people at the end of their lives. People’s needs were reviewed and monitored on a regular basis.

There were systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered. The provider worked in partnership with other professionals and agencies and in line with best practice to ensure people received appropriate levels of care and support to meet their needs.

Buxton Lodge Care Home is registered to provide accommodation and nursing care for up to 44 older people, many of whom were living with dementia. On the day of our inspection there were 32 people living at the home.

The home did not have 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 and associated Regulations about how the service is run. The interim manager assisted us with our inspection on the day.

During this inspection we followed up on seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which we found at our inspection in July 2015. At that time there were not enough staff working to respond to people’s needs, medicines were not being managed safely. Staff did not have the required training to be effective in their roles. Staff did not always seek appropriate consent from people and follow current legislation. Staff did not always respect people’s privacy and dignity. People’s care plans were not always person centred and important information was not always accessible to staff. Following that inspection we had received an action plan from the provider telling us what they planned to do in order to address the breaches of regulations. We found during this inspection the provider had taken the necessary action in relation to these breaches.

People were cared for by sufficient numbers of staff at day and night. This both ensured safety and ensured staff had more time to spend with people.

Medicines were administered safely. Recording was up to date but there was a discrepancy about how PRN (as required) medicines were recorded. The manager is speaking to the provider about this.

Staff understood their role in safeguarding people and we saw that incidents were being reported where appropriate. Staff routinely carried out risk assessments and created plans to minimise known hazards whilst encouraging people’s independence. We found that policies and procedures were in place to keep people safe in the event of emergencies. Fire drills and fire alarm tests were carried out along with regular audits of emergency and contingency planning.

Staff had appropriate training and support to meet the needs of people living at the home. Staff told us that they were well supported by management and had regular supervision.

People’s legal rights were protected as staff provided care in line with the Mental Capacity Act (2005). Correct procedures were followed when depriving people of their liberty.

Staff followed the guidance of healthcare professionals where appropriate and we saw evidence of staff working alongside healthcare professionals to achieve outcomes for people.

People told us that they enjoyed the food and we saw evidence of people being provided with choice and also being involved in writing menus.

Information in people’s care plans had improved. However, the manager is working to improve these further as they currently lack detail of people’s individuality. People were given the opportunity to provide feedback on the care they received through residents meetings and one to ones with staff. Issues raised by people were responded to by management.

People and relatives told us that they had a positive relationship with the interim manager.

Is the service safe?

People told us they considered the home provided a safe environment. One person said 'Safety is the main thing, this was clearly safer for me than returning to my home.' Another said 'The staff make it a safe place.' Safeguarding procedures were robust and staff understood how to safeguard the people they supported. The home had policies and procedures, including staff training, in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards, although no applications had needed to be submitted. Staff we spoke with demonstrated an understanding of working with people's consent, and following proper procedures where any possible deprivation of liberty was identified.

Recruitment practice was safe and thorough and helped ensure staff were deployed in sufficient numbers and with the qualifications, skills and experience required to meet the needs of people in the home.

Is the service effective?

People were involved in assessment of their health and care needs and in development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People told us their plans reflected their current needs and this was confirmed by our observations. One person said, 'I get the help I've requested. Independence is important to me and they help me maintain what I can. I feel I'm able to live as I did at home.' Another person said, 'The care I get is what I've agreed.' Staff showed they had a good understanding of people's care and support needs.

Most people in the home were registered with an individual GP, who visited the home at a fixed time every week. This meant non urgent issues could be listed for their attention during the routine visit. Records showed people got medical attention swiftly when needed.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People told us staff were very respectful of their privacy and dignity needs.

Is the service responsive?

People's needs had been assessed before they moved into the home. Care plans were reviewed every month, or more often in response to events or needs arising. The home employed two full time activities coordinators, which gave people access to activities that were of interest to them. All care plans considered whether there were communication challenges and, if so, how to address these. We saw examples of interactions where staff were sensitive and patient in establishing mutual understanding with people whose speech was compromised.

Staff and management were readily available to people in the home, and to visitors. People had portable call bell switches, so they could obtain assistance when needed. Staff responded readily to requests to move by people who were not independently mobile. Specialist health, mental health and social care resources were accessed when necessary. Care records showed specialist advice and care directions were incorporated into care plans and followed.

Is the service well-led?

The provider maintained regular contact with the service through visits from an area manager. They had direct contact with people living in the home and visiting family members, and undertook routine audits. Any identified shortfalls were rectified through monitored action plans.

The service had a quality assurance system that included an annual survey conducted by the provider and monthly residents' and relatives' meetings. Records showed identified shortfalls were addressed promptly. A visitor told us they did not attend the relatives' meetings but found the management very approachable. They said minor issues they had raised shortly after their relative's admission had been attended to. They said the approachability of the registered manager and teamwork approach of the staff group 'set the tone for how the home works.'

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and demonstrated they worked as a team. This helped to ensure that people received a good quality service at all times.

People told us they felt safe in the home and were treated with respect by the staff. They said staff knew them well enough to provide the care they needed. However, they said sometimes they would have to wait, sometimes for up to half an hour, for staff to come to them when they needed support to move around.

Staff and people who used the service said they were asked for their views about the service on a regular basis and were able to speak with the manager about any concerns they had at any time.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We found that generally people interacted positively with each other and with staff.