Bedford Charter House

Bedford Charter House is a residential care home providing personal care to 53 people aged 65 and over at the time of the inspection. The service can support up to 72 people. Bedford Charter House has three separate floors, each of which has separate adapted facilities. One floor specialises in supporting people living with dementia. People had their own bedrooms with en-suite facilities and shared communal areas such as dining rooms, lounge areas and a large garden.

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

People and their relatives were happy with their care and support. One relative told us, ‘‘[Staff] are so lovely and treat [family member] so well. My family member is so happy living at the service and if they are happy then we are happy.’’

People were safe living at the service and staff had a good understanding of safeguarding and what to do if they had any concerns. Risks to people were assessed and measures were put in place to mitigate risks as far as possible. There were enough suitably trained staff to support people safely. People were supported safely with their medicines. Staff were trained and knew how to promote good infection control. Incidents an accidents were reviewed for any lessons that could be learned and these were shared with the staff team.

The provider and registered manager promoted a positive culture at the service. People, their relatives and the staff team were encouraged to feed back about the service and felt their suggestions were listened to. The management team completed audits to monitor the quality of the service and took action if areas for improvement were found. The staff teams worked with external professionals to promote good outcomes for people. People and their relatives were positive about the way the service was managed and the support that they received.

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 (report published 07 December 2019). We also inspected the service to look at IPC assurances and found no concerns (report published 09 March 2021).

Why we inspected

We received concerns in relation to staffing levels and the way in which people using the service were being supported to have their needs met. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

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 comprehensive inspection, by selecting the ‘all reports’ link for Bedford Charter House 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:

¿ Although the service was closed to visitors at the time of the inspection, arrangements were in place for when visits resumed, to ensure visitors were prevented from catching and spreading infection. This included the provision of PPE (personal protective equipment), handwashing facilities and bespoke safe visiting areas, both inside and outside of the home. Alternatives to face to face visits were also in place, including window visits and video calls. In addition, and where appropriate, relatives had remote access to their family member’s care records, meaning they could check on their progress whenever they wished. Meetings with relatives had also been set up using a video conference facility.

¿ Several steps had been taken to promote social distancing and shielding for people and staff within the building. This included allocating staff to work in set areas, with dedicated routes to travel round the building. All bedrooms are single occupancy and have their own ensuite bathrooms, so people were not required to share these facilities. People being admitted into the home were asked to isolate for 14 days in their room, as a precautionary measure.

¿ The home was clean, well ventilated and there was a safe process to manage people’s laundry.

¿ We observed staff wearing PPE correctly. They had received training in relation to infection control and the safe use of PPE.

¿ Staff and people at the home received regular Covid-19 tests in line with current government guidance. Most people, and several staff had also received their first Covid-19 vaccination.

¿ The provider was monitoring key aspects of infection protection control (IPC) to promote people’s safety. They demonstrated a good awareness of current guidance relating to registered care settings, in terms of preventing and managing a Covid-19 outbreak.

Bedford Charter House is a substantial, purpose built residential care home for up to 72 people. At the time of this inspection 70 people were using the service who had a range of needs including dementia and physical disabilities. Short term (respite) care was also provided and three people were receiving respite care.

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

People were happy with the service they received. One person told us, “I love it here, everyone is so friendly. The staff are all smashing, nothing is too much trouble…There’s nothing I’d like to change, I’m more than satisfied.”

This was echoed by another person who had provided their feedback in writing as follows, ‘One and all are fantastic. I can ask them anything. (Staff) help me and everyone with queries etc. The housekeeping team are great and keep our rooms fantastic and the laundry saves me the time of doing it, super-duper. The receptionists are super and I always have a laugh and chat with them. Everyone is super, great, fantastic. It is a pleasure being here, this is my home as I am not going home any more. Love it here. Staff and residents are great. The food is delicious, fantastic’.

People were safe. Staff understood how to protect them from abuse and risks to people were managed, to ensure their safety and protect them from harm. There were enough staff to meet people’s needs and the provider checked to make sure new staff were suitable to work at the service. Staff ensured people received their medicines when they needed them and ensured the premises were kept clean and hygienic.

Staff had the right skills and training to carry out their roles. They were caring and treated people with kindness, respecting their privacy and dignity too. People were supported to have maximum choice and control of their lives in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to stay healthy. Staff ensured people had a choice of food and had enough to eat and drink. They also helped people to access healthcare services when they needed to.

There were regular opportunities for people to participate in a variety of meaningful activities, both in and out of the service.

There was strong leadership at the service who regularly sought feedback from people, relatives and staff, to improve the service. Since the last inspection the provider had made several changes to improve people’s experience. This included a new electronic care planning system and changing the way staff are allocated to work at the service, to provider more consistency of care for people.

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 22 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Bedford Charter House is a substantial, purpose built care home providing a service for up to 72 people who have a range of care needs including dementia and physical disabilities. Short term (respite) care is also provided. During this inspection 64 people were using the service, and no one was receiving respite care.

A registered manager was 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.

We found some areas that required improvement:

There were sufficient numbers of suitable staff to keep people safe and meet their needs. However, some people told us they were left waiting when they called for assistance, particularly before and after the lunch time meal. The registered manager had made changes to the way staff were deployed in the home to ensure additional support in the evenings and new staff had been employed. It was therefore hoped that this would improve as the new staff gained confidence and experience. The registered manager also told us about changes he planned to make to enhance people’s dining experience in the future.

The provider carried out checks on new staff to make sure they were suitable and safe to work at the service. The majority of the required checks were in place however, we found some checks had not been carried out for all staff, such as obtaining a full employment history. The registered manager confirmed after the inspection that changes would be made to the existing recruitment process, to ensure all required checks were obtained in future.

We also identified many areas during the inspection where the service was doing well:

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service and staff were confident about reporting any concerns they might have. Processes were in place to manage identifiable risks within the service to ensure people were supported safely and did not have their freedom unnecessarily restricted.

Systems were in place to ensure people’s daily medicines were managed in a safe way. Improvements reported on at the last inspection had been sustained and as a result medication errors had decreased significantly.

Staff received the right training to ensure they had the necessary skills and knowledge to meet people’s needs.

Systems were in place to ensure the service worked to the Mental Capacity Act 2005 key principles, which state that a person's capacity should always be assumed, and assessments of capacity must be undertaken where it is believed that a person cannot make decisions about their own care and support.

People had a choice of food, and had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

The service worked with external healthcare professionals, to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times. Personalised care plans had been developed to record how people wanted to receive their care and support, and they were supported to have choice and control of their lives as far as possible.

People were given opportunities to participate in meaningful activities and further improvements were planned in this area.

Arrangements were in place for people to raise any concerns or complaints they might have about the service. These were used by the service as an opportunity for learning and improvement. We saw that people were given regular opportunities to express their views on the service they received and to be actively involved in making decisions about their care and support.

The management team provided effective leadership at the service, and promoted a positive culture that was open and transparent.

Systems were in place to monitor the quality of the service provided and drive continuous improvement.

During our inspection in February 2016, we identified concerns in terms of how people’s PRN (as required) and topical medication was managed. We identified that medication protocols for the administration of PRN medication were not always sufficiently detailed. In addition, medication administration records (MAR) charts did not always record the reasons for PRN medication being given, making it difficult to assess whether a person's healthcare condition had changed.

This was a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stating that improvements would be achieved by 30 June 2016.

We undertook this unannounced focused inspection on 7 October 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bedford Charter House on our website at www.cqc.org.uk

A registered manager was 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.

We reviewed the medication systems in place, and found that these had been strengthened. The processes in place were more robust and more regular audit checks were taking place of all aspects of the medication systems, including recording and disposal. Because of this issues were now identified and addressed in a timelier manner.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe at the next comprehensive inspection.

Bedford Charter House is a substantial, purpose built care home, which opened in February 2015. Prior to this, the service had operated from a smaller building on the same site. The new building provides a service for up to 72 people who have a range of care needs including dementia and physical disabilities. Short term (respite) care is also provided. During this inspection, 68 people were using the service.

A registered manager was 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.

Systems were in place to ensure people’s daily medicines were managed in a safe way and they got their medication when they needed it. However, concerns were identified in terms of how people’s PRN (as required) and topical medication was managed.

Processes were in place to manage identifiable risks within the service, and ensure people did not have their freedom unnecessarily restricted. We did find some anomalies in terms of how often risk assessments had been reviewed or completed however.

We saw that although people were given opportunities to be involved in making decisions about their care and support, their care plans were not always adequately robust, or reflective of their current needs.

We also found that the service worked to the Mental Capacity Act 2005 key principles, which meant that people’s consent was sought in line with legislation and guidance. However, this information was not always transferred into people’s care plans.

Despite this, we did see evidence of work that had begun to review everyone’s risk assessments and care plans, as a part of an improved care plan system that was due to be implemented.

The registered manager also had a plan to address gaps in staff training and supervision; to ensure all staff working in the home received the right support and training to carry out their roles and meet people’s assessed needs.

People felt safe living at the service. Staff had been trained to recognise signs of potential abuse and keep people safe.

There were sufficient numbers of suitable staff to ensure people’s safety and meet their individual needs.

The provider carried out proper recruitment checks on new staff to make sure they were suitable to work at the service.

People had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

People’s healthcare needs were met. The service had developed positive working relationships with external healthcare professionals to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff were motivated and provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

People’s social needs were provided for and they were given opportunities to participate in meaningful activities. It was clear that the provider recognised this as an important part of people’s lives.

A complaints procedure had been developed to let people know how to raise concerns about the service if they needed to.

There were effective management and leadership arrangements in place.

Systems were also in place to monitor the quality of the service provided.