Archived: Badbury Care Home

Badbury 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.

Badbury Care Home is registered to accommodate 33 older people. The home was split over two floors with the first floor having access via stairs or a lift. On the ground floor there are various lounges, smaller seating areas and a dining room. There was level access to the outside patio and garden areas. There were 24 people living at the service at time of inspection.

At our last inspection in November 2017 we rated the service ‘requires improvement’. At this inspection we found that improvements have been sustained and further positive developments have been made.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to if abuse was suspected.

Staffing levels were adequate to provide safe care and recruitment checks had ensured staff were suitable to work with vulnerable adults. Staff had received an induction and continual learning that enabled them to carry out their role effectively.

Staff received regular supervision and felt supported and confident in their work.

When people were at risk staff had access to assessments and understood the actions needed to minimise avoidable harm.

Medicines were administered and managed safely by trained and competent staff. Medication stock checks took place together with daily and monthly audits to ensure safety with medicines.

People and their relatives had been involved in assessments of care needs and had their choices and wishes respected including access to healthcare when required. The service worked well with professionals such as doctors, occupational therapists and social workers.

People had their eating and drinking needs understood and were being met. People had mixed views about the quality, variety and quantity of the food.

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.

The registered manager actively sought to work in partnership with other organisations to improve outcomes for people using the service.

People, their relatives and professionals described the staff as caring, kind and approachable. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they could communicate their needs. Their life histories were detailed and relatives had been consulted.

The home had an effective complaints process and people were aware of it and knew how to make a complaint. The service actively encouraged feedback from people, their relatives and professionals.

People’s end of life needs were assessed. The records showed that people and their relatives had been involved in these plans. Feedback received by the service showed that end of life care provided was of a good standard.

Activities were provided and these included staff, people and their relatives. Individual activities were provided for those that preferred them.

Relatives and professionals had confidence in the service. The home had an open and positive culture that encouraged the involvement of everyone.

Leadership was visible within the home. Staff spoke positively about the management team and felt supported.

There were effective quality assurance and auditing processes in place and they contributed to service improvements. Action plans were carried out and lessons learnt.

The service understood their legal responsibilities for reporting and sharing information with other services.

Badbury 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.

The care home accommodates up to 33 people across two floors, each of which has separate adapted facilities. At the time of our inspection there were 23 people living at the service.

At our last inspection on 13, 14, and 17 July and 22 August 2017 we found there was a lack of consistent, effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. People's identified risks in relation to skin damage had not been consistently managed or actions taken in order to minimise the risks.

Systems were not in place to ensure people received their medicines safely. Stocks were not always available to ensure people received their medicines when required. People were at risk of malnutrition because food and drink records were vague and did not reflect how much people had actually eaten or drank. Service users were not always treated with dignity and respect. Service users did not always receive personalised care that responded to their individual needs and reflected their preferences. Care records were not always completed accurately or consistently. Care plans and grab sheets did not reflect people’s DNAR preferences. Systems and processes in place to assess, monitor and improve the service were ineffective. The provider had not notified us of all notifiable events.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led. We found that during this inspection the action plan had been followed but although improvements had been made, some improvements were still required.

Fire procedures for visitors and signage was not clearly displayed in the home. The provider acknowledged this and told us they would address this as a priority. Following the inspection evidence was shown which identified measures had been taken to ensure signage was clear.

People, staff and relatives described that the home had been through a challenging period. They were all confident that the provider had secured change and stability.

Although improvement had been made to ensure medicines were managed safely, there remained a risk that people may not receive their medicines when required as stock levels were not maintained. This meant people could be at risk of not receiving their medicines when required. Medicines were, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines.

People were happy with their care and they shared appreciation and confidence in the registered manager and staff team. Professionals confirmed that improvements had been made. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

People felt safe. They were protected from harm because staff understood the risks people faced and how to reduce these risks. Measures to reduce risk reflected the person’s preferences. Staff knew how to identify and respond to abuse.

People described the food as good and there were systems in place to ensure people had enough to eat and drink. Where people changed their mind about what they wanted to eat they were offered alternatives. Where people needed support with fluid and food this was provided. The new on line care system alerted staff if identified needs such as turns or fluid intake were required.

There was mixed feedback regarding staffing. The provider informed us they had sufficient staff to meet individual needs. People and their relative told us although they felt there was sufficient staff they were “Busy”. During the inspection staff were observed to be task led and busy which meant that there was limited time to spend with people on a one to one level.

The service had a suitable recruitment procedure. Recruitment checks were in place and demonstrated that people employed had satisfactory skills and knowledge needed to care for people. All staff files contained appropriate checks, such as two references and a Disclosure and Barring Service (DBS) check.

The service had a clear management structure. The registered manager reported to the provider. There were senior staff in place who made day to day management decisions. Staff told us communication had improved, one member of staff told us, “Handovers are much better now”.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Improvements had been made in relation to the completion and assessment of capacity assessments and best interest decisions.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with on going care needs. Records we reviewed showed that people had recently seen the GP, district nurses and a chiropodist.

People and their relatives knew how to raise a concern or make a complaint. There were systems in place for people, staff and visiting professionals to give their feedback on the service. Staff felt able to approach their managers and raise any concerns.

The home is registered to provide accommodation and residential care for up to 33 people. At the time of our inspection there were 24 people living at the home, some of whom were living with a diagnosis of dementia. The home is set out over two floors. Access to the first floor is by stairs or passenger lift. The ground floor provides access to a secure garden area.

When the service was last inspected in October 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. Regulation 12 Safe care and treatment. People's identified risks in relation to skin damage and malnutrition had not been consistently managed or actions taken in order to minimise the risks. Regulation 17. Good governance. Auditing systems had not recognised areas that required improvements to ensure safe care of people. As a result of our findings of the inspection in October 2016 we imposed conditions on the provider’s registration in that we required the provider to report to the Care Quality Commission (CQC) about the safety of people's care Although people and relatives said they felt safe, the risks people faced were not consistently managed. We found examples where people were at risk.

This inspection was brought forward because concerns had been raised by the local authority safeguarding team, health care professionals and a number of safeguarding alerts received by the Care Quality Commission. Regular action plan progress updates had been sent to the Care Quality Commission following the last inspection. Information we received did not reflect the concerns and risks found during this inspection. At this inspection we found concerns about the safe care and treatment for people living at the home, consistent with concerns raised prior to the inspection taking place.

We found there was a lack of consistent and effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. This was evidenced by the continued breaches we found at this inspection. We identified five breaches in regulations, staffing, safe care and treatment, safeguarding, person centred care, and good governance. Two of these were repeat breaches over the previous two inspections.

People's identified risks in relation to skin damage had not been consistently managed or actions taken in order to minimise the risks. Some people needed to be supported by staff to change position regularly in order to relieve pressure on their skin. Clear instructions were recorded in care plans. However these instructions were not always being followed.

People were at risk of malnutrition. Food and fluid records were kept in people’s rooms. They were vague and did not reflect how much people had actually eaten or drank, yet there were clear instruction in records for staff to ensure people ate and drank well.

Systems were not in place to ensure people received their medicines safely. Stocks were not always available to ensure people received their medicines when required.

The requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were not being met as we found conditions which had been applied to DoLS authorisations had not been complied with. Quality monitoring and audits had failed to identify that areas of service provision were not meeting the requirements of the law.

When other health care professionals had given the provider specific instructions on how to care and support people these were not consistently followed putting people at risk of unsafe or inappropriate care.

People and their relatives knew how to raise a concern or make a complaint. There were systems in place for people, staff and visiting professionals to give their feedback on the service. Staff felt able to approach their managers and raise any concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are considering the action we are taking and will produce a further report.

The overall rating for this service is 'Inadequate' and the service therefore in 'special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service is registered to provide accommodation and residential or nursing care for up to 33 people. The service does not providing nursing care. At the time of our inspection the service was providing residential care to 27 older people some of whom were living with a dementia. The home is over two floors and bedrooms have en-suites. People have access to a number of sitting areas including a TV room and a music room. Access to the first floor is by stairs or passenger lift. The ground floor provides access to a secure garden area.

The service has 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’s identified risks in relation to skin damage and malnutrition had not been consistently managed or actions taken in order to minimise the risks. Assessments had not been reviewed regularly and when referrals had been made to health practicioners these had not been followed up. Food and drink charts were being completed but the information was not being reviewed to establish people’s risk of malnutrition. Equipment was in place to support people at risk of skin damage but this was not being used correctly. Staff did not always have up to date information about changes to people’s risks.

Auditing systems were in place but they had not always recognised areas that needed improvement. When areas had been identified actions had been taken to improve outcomes for people.

People, their relatives and visiting professionals told us there were not always enough staff to support people in a timely way particularly at weekends. Staffing hours had been assessed using a dependency tool and were higher than the tool calculated. However this was not reflective of people’s experiences. We have made a recommendation about staffing levels.

People were supported by staff that had been recruited safely and had been trained to recognise any unsafe practice or potential abuse and understood their role in reporting this. Staff received an induction and on-going training that enabled them to carry out their roles effectively. Staff felt supported in their roles and had regular supervision. Opportunities were available for staff’s personal development.

People’s medicines were ordered, stored and administered safely by competent staff that had completed medicine administration training. Peoples prescribed creams were being administered but not always recorded correctly. People had access to healthcare when it was needed.

Staff supported people’s ability and choices about their day to day care and obtained consent in line with the principles of the mental capacity act. People and their families knew how to make a complaint and felt they would be listened to and any actions needed would be taken.

Peoples eating and drinking needs were understood by care staff and the catering team and included specialist diets and allergies. The menu offered a variety of main meals and snacks and catered for individual likes and dislikes.

Care staff were kind, patient and friendly and respected people’s privacy and dignity. They had a good understanding of peoples communication needs and used different techniques to ensure that people were involved in decisions. Staff had a good understanding of people’s interests, likes and dislikes. This meant that staff could have conversations with people about things that were important and of interest to them.

People had care and support plans that detailed how they wanted to be supported. People and their families were involved in decisions related to their care and advocacy services were available if needed. Reviews hadn’t been consistently carried out albeit improvements had been made in the two months prior to our inspection. Handovers provided information to staff about changes to peoples care and support needs. A wide range of activities was available to people both inside the home and within the community. Staff respected the decisions people made on how they wished to spend their time. Where people were at risk of social isolation actions had been put in place to minimise this.

People, their families, staff and visiting professionals all described the registered manager as open and transparent. They felt they would listen to them and take any appropriate actions. Staff felt appreciated and understood their roles and responsibilities. They were included in discussions about future plans for the service and felt included in the service development.

You can see what action we told the provider to take at the back of the full version of the report.