Archived: Baugh House

Since the last inspection there had been a series of changes within the management team at the service. At the time of our inspection there was no 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. The current manager explained they had been in place as an interim measure since March 2017, following the recent departure of the previous manager. They told us the provider was in the process of recruiting for the registered manager post.

At this inspection we found significant concerns amounting to a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people had not always been adequately assessed, and where areas of risk had been identified, action had not always been taken to manage them safely. Medicines were not safely managed because we found issues in the way medicines were recorded, stored and disposed of. Staff responsible for medicines administration had not always been assessed to ensure they were competent to do so, and were not always up to date with training relating to the safe management of medicines.

People were not always protected from the risk of abuse, because potential abuse concerns had not consistently been reported to the local authority safeguarding team, in line with local protocols and the provider’s safeguarding procedure. Sufficient staff were not always appropriately deployed within the service to safely meet people’s needs. There was also a high level of agency staff usage which meant staff did not always have detailed knowledge or experience in supporting the individual needs of the people living in the home.

Staff were not always up to date with training considered mandatory by the provider. People told us staff did not always seek their consent when providing them with support and we found there was a risk that care and treatment may be given to people against their wishes. The provider had not always complied with the Mental Capacity Act 2005 (MCA) in making decisions on people’s behalf where they had been assessed as lacking to do so themselves. People were not always lawfully deprived of their liberty under the Deprivation of Liberty Safeguards.

People had care plans in place, but these were not always up to date and accurate. People’s preferences in the way they received care were not always met. The provider’s systems for monitoring and improving the quality and safety of the service were not always effective and had not addressed the issues we found at this inspection. Audits undertaken by senior staff did not consistently identify or address areas of concern. The provider’s systems for seeking and acting on people’s feedback were not effective in driving improvements.

You can see the action we have asked the provider to take in respect of these breaches at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also identified areas that required improvement. Complaints were not consistently managed and responded to in line with the provider’s complaints procedure. Whist we observed a number of caring interactions between staff and people, we also noted interactions which were not caring or staff failing to interact with people when they were in distress. People were not always involved in day to day decisions about their care and treatment. A range of activities were on offer to people at the service but improvement was required to ensure appropriate social stimulation was offered to all of the people living at the home.

The overall rating for this service is ‘Inadequate’. Immediately following the inspection the provider GCH ( Kent ) Ltd applied to cancel its registration. This application has been granted and a new provider, GCH (South) Ltd has been registered to provide the regulated activities ‘Accommodation for persons who require nursing or personal care’ and ‘Treatment of disease, disorder or injury’ at this location. CQC decided that we could only permit GCH (South) Ltd to operate this service subject to a number of conditions to address the concerns found at this inspection and to ensure the continued monitoring of the safety of the service. GCH (South) Ltd agreed to accept those conditions on its registration.

There were also some areas of good practice at the service. Appropriate recruitment checks were made on new staff before they started work. People were supported to access a range of healthcare professionals when required and we received positive feedback from visiting healthcare professionals about the support people received during our inspection. People told us their nutritional needs were met and that staff respected their privacy.

There was a registered manager at the home. 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 the last inspection on 8 October 2014 we found the provider was not meeting the regulations in relation to carrying out quality assurance checks, the training and supervision of care staff and maintaining appropriate information on staff recruitment background checks. We asked the provider to submit an action plan detailing the improvements to be made.

These actions have been completed and on this inspection we found that the relevant requirements were being met.

People’s feedback about the safety of the service described it as good and that they felt safe. People were safe because the service had provided training to staff and had systems in place to protect them from bullying, harassment, avoidable harm and potential abuse.

Staff protected people’s dignity and rights through their interaction with people and by following the policies and procedures of the service Feedback from people and their relatives was that staff were caring in their attitude and responsive to people’s needs. A caring attitude was observed during the inspection and personalised care, dignity and respect formed part of staff training.

Staff training and supervision had improved since the previous inspection. There was a structure and system in place for regular staff supervision and each member of staff had a training record which was relevant to their role.

The service managed the control and prevention of infection well. Staff followed correct policies and procedures and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene. Medicines were well managed, with staff displaying a sound understanding of the medicines administration systems, recording and auditing systems.

Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were understood by the manager and acted on appropriately.

People at risk of poor nutrition and dehydration were sufficiently monitored and encouraged to eat and drink. The quality of the food was good, with people getting the support they needed and the choice that they liked.

Care, treatment and support plans were seen as fundamental to providing good person centred care. Care planning was focussed upon the person’s whole life, including their goals, skills, abilities and how they prefer to manage their health.

The service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and companionship. The service enabled people to carry out person-centred activities within the service or in the community and encouraged them to maintain hobbies and interests.

This was supported by policies and procedures which emphasised the rights of people and developments in care planning which included people’s life histories written from their own perspective, which enabled staff to work in a person-centred way.

People described the responsiveness of the service as good. People received personalised care, treatment and support and were involved in identifying their needs, choices and preferences and how they are met. People’s care, treatment and support was set out in a written plan that described what staff needed to do to make sure personalised care was provided.

Improvements had been made to quality assurance systems to ensure that people’s views were sought and that quality audits take account of the experience of people living at the home. People described the registered manager and her team as having a positive impact on the management of the service. People were also positive about the way activities were coordinated, saying that they demonstrated an understanding of people’s abilities based on consultation with people and their relatives.

Records and personal information were kept in a secure and confidential manner.

We carried out this inspection to follow up on concerns identified with the care and welfare of people, staff induction and training identified at our previous inspections, and we found the provider had made the required improvements. People whose records we looked at had been adequately assessed and their care planned appropriately. In addition we found people received the care that was planned for them. We found improvements had been made to the way staff were inducted and the majority of staff had completed mandatory training.

People who used the service were overall happy with the care that was provided to them and people told us they liked the staff. One person told us "I have no complaints and the staff are good". One person's relative we spoke with told us their family member "receives good care, and I think he is looked after well enough". Some other relatives we spoke with were not as satisfied with the service. One person's relative told us, "the care is varied, I don't think things have improved enough". They felt that there were "some excellent staff", but felt some staff were not adequately trained.

Since our last inspection, we found the provider had made some improvements in involving people and their relatives in planning and reviewing their care, offering choices and promoting dignity and respect. We also found some improvements had been made with record keeping. However, we found that some areas had not seen sufficient improvements including some aspects of care planning and care delivery, and staff induction and training. We have asked the provider to implement the required improvements quicker than they had originally intended to ensure people receive appropriate care by staff who are adequately trained and supported.

We carried out this inspection due to concerns that had been raised by the local authority. Although the home had an improvement plan in place which the local authority was monitoring, we found there were continuing shortfalls identified in some areas. We found that people were not always given choices in relation to their care, and care was not always delivered with people's privacy and dignity in mind. People's care was not always appropriately assessed or planned, and care was not always delivered in line with their care plans. Staff were inadequately trained in some key areas and we identified problems with record keeping which put people at risk of receiving inappropriate care.