We carried out a review of the data available to us about Basingfield Court Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Basingfield Court Residential Care Home, you can give feedback on this service.
Basingfield Court Residential Home is a residential care home providing personal care to up to 52 people. The service provides support to people aged 65 and over. The care home accommodates people in one adapted building over three floors. At the time of our inspection there were 40 people using the service.
People’s experience of using this service and what we found
People told us they were happy and safe living at Basingfield Court Residential Home. Relatives told us their relatives felt safe, and that the home was clean and well maintained.
We found the provider ensured people were supported safely. There were sufficient numbers of suitable, motivated staff. Recruitment files did not have all the safe recruitment checks at the time of inspection but the provider took immediate action to rectify this.
Processes and procedures were in place to store and administer medicines safely. Relatives told us they did not have any concerns regarding people receiving their medicines safely. We were assured appropriate infection prevention and control measures were in place to protect people against the risk of COVID-19 and other infections.
The service was well-led. The staff team told us they felt supported by the registered manager. People who used the service and staff were involved in how the service was managed. The registered manager had processes in place to monitor and improve the quality of service people received.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 03 May 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.
This report only covers our findings in relation to the key questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Basingfield Court Residential Home 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.
Basingfield Court Residential Home is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.
The service supported older people, some of whom were living with dementia. At the time of our inspection there were 49 people living in the service.
People’s experience of using this service:
¿ We received positive feedback about the service and the care people received. The service met the characteristics of good in all areas.
¿ People received safe care. Medicines were managed safely and there were enough skilled staff deployed to meet people’s needs and keep them safe.
¿ People were supported by skilled staff who had completed the appropriate training.
¿ Staff had respectful caring relationships with people they supported. They upheld people’s dignity and privacy, and promoted their independence.
¿ People’s care and support met their needs and reflected their preferences. The provider upheld people’s human rights.
¿ There was a positive, open and empowering culture. Staff roles and responsibilities were clear. Staff worked in partnership with professionals to deliver care and support and maintained links with the local community.
Rating at last inspection:
At the last inspection the service was rated Good overall with a rating of requires improvement in safe. At this inspection the service was rated Good overall.
Why we inspected:
This was a planned, comprehensive inspection of the service.
Follow up:
We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated Good. We will continue to monitor the service through the information we receive.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The service 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 2008 and associated Regulations about how the service is run.
On 2 and 3 April 2017 we inspected Basingfield Court Residential Care Home and judged the provider to be in breach of three regulations.
Although people told us they felt safe, we found there were shortfalls which compromised people's safety and placed them at risk from receiving unsafe care. These shortfalls amounted to a breach of Regulation 12 of the HSCA Regulations 2014 (Safe care and treatment).
The provider was served with a warning notice in relation to safe care and treatment which they were required to meet by 31 May 2017. We told the provider they needed to take action to meet the legal requirements of this regulation. They sent us a report setting out the action they would take to make necessary improvements to meet the regulation.
At this inspection we found the provider had taken the required action to meet the requirements of the regulation and to ensure people experienced safe care and treatment.
The provider had acted on the risks and shortfalls that had been previously identified to ensure people were safe. Whilst we recognised that improvements had been made to ensure people experienced safe care and treatment, many of the changes had not yet been sustained in the longer term to be fully embedded in practice. The improvements that have been made will need to be embedded to demonstrate that they are sustainable and can be maintained without the additional provider support and oversight. At the time of this inspection the service was only 75% occupied, therefore the provider needs to demonstrate that the improvements are also sustainable when there is an increase in the number of people living in the home. It is too early to state that the improvements are sustainable.
At our inspection in April 2017, the provider did not have effective systems and processes in place to assess, monitor and improve the quality and safety of the service provided. The provider did not maintain an accurate, complete and contemporaneous record for each person, including a record of the care provided and of decisions taken in relation to the care provided. There were shortfalls in the management of the home which compromised people's safety and placed people at risk from receiving unsafe care. This was a breach of Regulation 17 HSCA 2008 Regulations 2014 (Good governance).
The provider was served with a warning notice in relation to good governance, which they were required to meet by 31 May 2017. We told the provider they needed to take action to meet the legal requirements of this regulation. They sent us a report setting out the action they would take to make necessary improvements to meet the regulation.
At this inspection we found the provider had taken the required action to meet the requirements of the regulation to ensure people were protected from the shortfalls in the management of the home which had compromised people’s safety.
At our inspection in April 2017 the provider had failed to demonstrate that sufficient staff were always deployed to meet people's care and treatment needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing).
We asked the provider to send us a report detailing what action they were going to take to make necessary improvements. At this inspection we found the provider had made the required improvements to ensure sufficient staff were deployed to meet people’s needs at all times.
At this inspection we found that the service was currently well led and provider had acted on the risks and shortfalls that had been previously identified.
The plumbing system at the home had been repaired and now worked effectively, providing sufficient hot water whenever required to meet people’s needs. The provider had also reviewed their business continuity plan to ensure effective contingency plans were in place to ensure people’s safety, should there ever be a future recurrence.
People’s medicines were administered safely by staff who had completed the provider’s required training to do so. Staff had their competence assessed before they were authorised to administer medicines unsupervised. Staff were able to tell us about people’s different medicines and why they were prescribed, together with any potential side effects.
At this inspection the provider had reviewed their medicines policy and procedures. Staff had clear guidance, which ensured that people were supported in the administration of their prescribed insulin only by visiting District Nurses. This assured the provider that people received their insulin safely from external staff, who had completed the relevant training to do so.
People’s allergies had been reviewed and accurately recorded. Staff administering medicines were aware of people’s allergies. The provider had assured people were protected from the risk of receiving medicines to which they were allergic.
Care plans of people who had been identified to be at risk of developing pressure areas, contained relevant guidance from health professionals to mitigate these risks. Staff understood the action required to minimise these risks, which we observed being implemented in practice, in accordance with people’s pressure area management plans.
The provider had assessed the risk to people from the environment and equipment to ensure they would remain safe within the home. Equipment and utilities were serviced in accordance with manufacturers’ guidance to ensure they were safe to use. People were protected from environmental risks and those associated with the use of equipment.
The interim manager effectively operated systems to assess and monitor the quality of service provided. Complete, contemporaneous and accurate records were maintained for each individual, which clearly explained all decisions made in relation to the care they received. The interim manager had addressed shortfalls in the management of the home, which had placed people at risk of receiving unsafe care. Where incidents had occurred the interim manager had appropriately notified all relevant authorities when required. The interim manager had ensured staff received clear guidance and support to safely manage risks to people's health and wellbeing.
All of the actions identified by the provider’s Service Improvement Plan (SIP) in September 2016 had now been completed or were subject to constant monitoring for example; staff culture. Records also demonstrated that all of the actions identified in the provider’s SIP created in September 2017 had also been completed.
The provider took action to make improvements to the service identified through their auditing processes. The provider analysed call bell response times to assure that staffing levels ensured people’s needs were met safely in a timely fashion.
The management team had identified safeguarding incidents in relation to pressure areas and medicine errors. These had been correctly reported internally and externally in accordance with the provider’s policy, local authority guidance and government legislation. The management team had then implemented measures to improve the service and prevent a future recurrence of the incident. The interim manager analysed all incidents to minimise the risks of repetition and to keep people safe.
People’s care plans had been updated and reviewed to ensure they reflected people’s changing needs to enable staff to support them safely. Staff maintained robust records of the care that had or had not been provided to people to ensure their comfort, welfare and safety.
The provider effectively monitored the service to identify if actions were required to ensure people experienced care which respected and promoted their dignity.
The interim manager provided clear and direct leadership and was readily available and supportive when staff required support and advice.
Staff had the right mix of skills to make sure that people experienced safe care. The interim manager regularly reviewed staffing levels and adapted them to meet people’s changing needs. Staff had undergone pre-employment checks to assess their suitability to provide support to vulnerable people.
The service protected people from the risk of poor nutrition, dehydration, and other medical conditions that affect their health. The service had clear systems and processes for referring people to external services, which were applied consistently. Staff made prompt referrals to health professionals when required and acted swiftly on their recommendations.
People and their families had been consulted about decisions regarding the premises and their personal environment. Staff upheld people’s rights to make sure they had maximum choice and control over their lives, and support them in the least restrictive way possible.
People were consistently treated with dignity, respect and kindness by staff who made them feel that they mattered. Staff noticed quickly when people were in discomfort or distress and took swift action to provide the necessary care.
The provider complied with the Accessible Information Standard by identifying, recording, sharing and meeting the information and communication needs of people with a disabi
The service had 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.
We were not assured that the potential risks to people from developing pressure ulcers were safely managed. Staff did not ensure professional’s guidance was always followed to ensure people received safe care. Staff had not received the required training to safely assist a person with an aspect of their medicines administration. We were not assured that potential risks to people when identified were always managed appropriately. Equipment had not always been maintained to an appropriate standard to ensure people’s safety.
People and staff told us there were insufficient numbers of staff always on duty to meet the individual needs of people using the service. There were not always sufficient staff deployed in the event of staff sickness and arrangements to cover staff sickness were not effective. This had resulted in insufficient staff being deployed on some night and day shifts. There were not always sufficient staff deployed to provide people with safe and timely care.
Staff stored medicines securely and within their recommended temperature ranges. Staff signed when creams had been applied to people. We were not assured that a person’s allergy information was consistent or correct to protect them from the risk of harm. People’s care plans for the management of anxiety did not describe when to use the prescribed medicines for people’s safety.
Processes in place to audit and monitor the service were not being used effectively to drive service improvement for people. We were not assured that full and complete data was supplied through the auditing and reporting processes to ensure the provider could effectively monitor the service. The failure to complete any trends analysis of incidents meant opportunities had been missed to identify any trends and patterns for people in order to minimise the risk of repetition. Robust records of people’s care were not maintained to ensure their safe care.
People told us they did feel safe from abuse. Processes and staff training were in place to safeguard people. Apart from one incident which was addressed during the inspection, processes were followed to ensure people were safeguarded from the risk of abuse. The provider ensured safe staff recruitment practices were followed.
Staff received an induction to their role; 88% of staff had completed the providers’ required training. The provider was aware that staff had not received supervision as required and plans were in place to address this to ensure people were cared for by staff who were appropriately supported in their role.
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 did not provide positive feedback about the quality or variety of foods offered. Records showed the issue relating to the quality of the meals was long standing. A person’s meal did not meet the requirements of their diet. However, people had a pleasant lunchtime experience and were supported by staff to eat their meals where required.
Staff supported people to see health care professionals as required.
People we spoke with felt that the staff were doing all they could and were kind and caring. We observed positive and respectful interactions between people and staff. Staff were heard to consult people about their care and respected people’s decisions. Overall people were treated with dignity and respect by staff.
People were not consistently positive about the level of stimulation provided. There were dedicated activities coordinators who were responsible for organising and supporting people to participate in activities. The level of contact people had with staff would have benefited from being more clearly evidenced in their records.
People had relevant care plans in place but these had not always been reviewed as frequently as required by the provider, action was being taken to address this for people.
It was not clearly evidenced how the needs of those living with dementia were being met. However, staff had either undertaken or were due to complete training to enable them to understand how provision for those living with dementia could be improved. We have made a recommendation about staff training on the subject of the provision of suitable activities for people living with dementia.
People reported they did not always feel listened to. Formal complaints were actioned. However, there was an absence of recording and reviewing of minor concerns so that the service could identify and monitor trends and identify any improvements needed for people.
People and their relatives provided mixed feedback on the management of the service. Staff did not provide positive feedback about the management of the service. Senior staff did not always carry out their roles effectively. The registered manager was now receiving the level of support, guidance and oversight they needed from the new regional manager and the new regional director to enable them to become an effective registered manager.
There was not an open, positive and person centred culture within the service. The registered manager, the regional manager and the regional director were fully aware of the cultural issues within the service and the need to address these to ensure staff began to work as a team to ensure people received good quality safe care and this work had commenced. Actions had been instigated to ensure staff understood both their responsibilities and were enabled to express their views of the service directly to the provider.
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the providers to take at the back of the full version of the report.
The inspection took place on 17 and 18 February 2015 and was unannounced.
Basingfield Court provides personal and nursing care for up to 52 older people, some of whom live with dementia, whilst others may have a physical disability or sensory impairment. At the time of our inspection 42 people were living at the home. The home is purpose built, with accommodation over three floors and most people have their own rooms with en-suite facilities.
The service is required to have a registered manager as a condition of its registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 previous registered manager at Basingfield Court had been on leave since May 2014 and left the service on 31 January 2015. During the inspection we spoke with the manager who had been in post since 11 December 2014 and the provider’s regional director. They told us that they had begun the selection process and were hopeful to appoint a registered manager shortly.
We last inspected this service on 5, 10 and 11 September 2014 and judged the service to be in breach of four regulations, relating to people’s care and welfare, managing medicines, staffing levels and assessing and monitoring the quality of the service. The provider sent us an action plan showing how they would make improvements to address these concerns. At this inspection we found the provider had made the necessary improvements in all areas where there had previously been breaches in legal requirements.
Since the inspection in September 2014 the provider had recruited more suitable staff and had increased the daily staffing levels. People’s needs had been appropriately assessed and reviewed regularly.
We observed medicines were administered safely in a way people preferred, by trained staff who had their competencies assessed annually by supervisors.
The manager had demonstrated clear and direct leadership. They had ensured systems were operated effectively to identify and manage risks and had monitored trends from identified accidents and incidents. They had taken action to improve the quality of the service and ensure that necessary learning was passed on to staff.
People at Basingfield Court told us they trusted the staff who made them feel safe. Staff had completed safeguarding training and had access to relevant guidance. They were able to recognise if people were at risk and knew what action they should take if required.
People’s safety was promoted through individualised risk assessments. Where risks to people had been identified there were plans in place to manage them effectively. Staff understood the risks to people and followed guidance to safely manage these risks.
Staff recruitment processes were robust. There were sufficient staff deployed to provide safe care and treatment. Staff understood their roles and responsibilities to provide care in the way people wished. They were responsive to people’s specific needs and tailored the care delivered for each individual.
People’s health needs were looked after and any concerns were promptly escalated to health care professionals for advice and guidance, which was then followed by staff. Staff were trained to deliver effective care, and where required, followed advice from specialists. This included training in caring for people with specific health conditions.
Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. They were aware of a Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The manager had taken the necessary action to ensure staff recognised and maintained people’s rights.
People’s needs in relation to nutrition and hydration were documented in their support plans. People were supported appropriately by staff to ensure they received sufficient to eat and drink. Meals reflected people’s dietary needs and preferences. When necessary people had been referred to appropriate health professionals for dietary advice, which was then implemented by staff.
The provider aimed to enable people to maintain their independence and socialise as much as possible. People’s dignity and privacy were respected and supported by staff who were skilled in using individual’s unique communication methods.
When complaints were made they were investigated and action was taken by the provider in response. Complaints were analysed by the provider for themes and where these had been identified action had been taken.
The manager promoted a culture of openness and had made changes at the home to improve people’s care and staff morale. There was a clear management structure and systems in place to drive improvements.
On the day of our inspection 47 people were being supported in the service by 20 permanent staff and five bank staff. The provider had also recently begun to employ agency staff. The registered manager had been on leave since May 2014 so we spoke with the regional manager who had been in post since 7 July 2014. We also spoke with six people who use the service, four relatives of people, an advocate, the acting manager, two deputy managers, four senior care workers, eight care workers, three housekeepers and four agency care staff,
We considered our inspection findings to answer questions we always ask;
Is the service safe? Is the service effective? Is the service caring? Is the service responsive?
Is the service well-led?
This is a summary of what we found;
Is the service safe?
We found that people were not safe and their health and welfare needs had not been met by sufficient numbers of appropriately trained staff. Although the provider had completed a staffing needs analysis we found there were insufficient staff to meet their needs and keep them safe. The regional manager told us they currently had ten staff vacancies,
People we spoke with praised the commitment and dedication of the permanent staff. One person said, 'The girls are wonderful but they are so busy I don't like to impose on them.' Another person said, 'The bells are ringing all day. It's not fair on the staff because they are excellent but there just isn't enough.' A relative told us, 'I know they have increased the staff lately but the one's from the agency just stand around and don't seem to know what they're doing.' We have told the provider to take action to improve staffing.
We found that the provider had not ensured that people had been protected from the risks of unsafe care because people's needs had not been appropriately assessed and reviewed. Care plans did not always contain enough detail to enable staff to meet the individual needs and preferences of people. The impact of needs assessments not being updated, together with high levels of agency staff, meant that the provider could not be assured that people's changing needs had been met. We have told the provider to take action to improve people's care and welfare.
The provider had not ensured that prescribed medicines had been administered safely. Since the last Care Quality Commission (CQC) inspection the service had notified four medication errors. Each error involved one person's medicine being administered to another person. We have told the provider to make improvements in relation to their management of medicines.
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the service to be meeting the requirements of the DoLS and the regional manager was reviewing whether any applications needed to be made in response to the recent Supreme Court judgement in relation to DoLS.
Is the service effective?
We found that the service had not been effective. Stock checks of controlled medicines had not been completed in accordance with the provider's policy. We noted recent audits had identified that staff had not carried out appropriate stock checks. This meant that the provider could not be assured that people had been protected against the risks associated with the unsafe management of controlled medicines.
We read people's daily notes which recorded appropriate staff interventions to support people, for example when they fell. However, we found that risk assessments had not always been completed to ensure effective prevention of further incidents.
Is the service caring?
People were mainly supported by kind and compassionate staff, who spoke with people in a caring manner. We saw that care workers gave encouragement to people who were able to do things at their own pace. Whilst talking about their care workers one person said, 'They always ask me how I am and make me feel special.' The care staff we spoke with enjoyed working with people they supported. One care worker told us, 'I know we are short staffed but I couldn't bear the thought of letting them down. You can't help developing a bond for people you care for.' However some relatives had been disappointed with the care provided by some of the staff, for example whilst people were being transferred to and from hospital appointments.
Is the service responsive?
We found that the service was not always responsive. In January 2014 the service notified the CQC of a serious event that stopped the service running safely and properly. The whole service initially had no hot water and according to the service records parts of the service had no hot water for over three weeks. One relative we spoke with had complained because their relative had been without water for five weeks. This meant that the provider had not responded effectively to the failure of a utility for over 24 hours and could not be assured that people's assessed needs had been met.
Is the service well-led?
The service had not always been well led. We looked at the provider's audit, completed on 5 August 2014, which identified that the service was not meeting standards in relation to people's 'personalised care, treatment and support'. The regional manager produced a service improvement plan dated 12 August 2014 to address the issues highlighted in the audit. One of the main concerns highlighted in the provider's audit was the urgent need to review care plans and risk assessments. During our inspection we found that only two of the 47 care plans and risk assessments had been reviewed. We have told the provider to make improvements in relation to assessing and monitoring the quality of the service.
We spoke with relatives of people who used the services. They told us they were happy with the services provided and were kept informed, were listened to and given the opportunity to give their view of the services provided.
We found staff were knowledgeable of people's specific health and personal care needs and had received training to update their skills and knowledge. Staff told us they felt supported by the provider and management team.
We looked at people's care plans and supporting documents. We found peoples care plans detailed their needs, and how to meet those needs.
The provider had ensured staff received appropriate professional development and support to safeguard and deliver care and support to the people who lived in the home.
We found people and their relatives had opportunities to contribute their views about the quality of the service. The provider had systems for monitoring services provided.
We saw that staff provided care in a person centred and respectful way and that they were meeting the needs of the people who lived in the home. People told us that although they sometimes waited quite awhile for their lunch, being able to choose their food at the meal time was ''worth the wait''.
Some staff told us that there was not always enough staff on duty to ensure that the people who lived in the home were given the best quality care. However people who lived in the home and their relatives told us that there were always staff available when needed. They told us that they were ''very happy with the standard of care'' and their call bells were always answered quickly.
People that were able to talk to us said that they were consulted about their care and support needs. They said that the home was always clean and tidy. Staff responded to peoples requests for assistance quickly. Everyone we spoke to said that although they had not needed to make a complaint, they felt confident that the service would respond positively should they need to do so.
Although people were happy about the way in which the service responded to their care and welfare needs we had concerns about how the service planned and responded to the care of people who were unable to clearly state their needs wishes and preferences. We also had concerns about current staffing levels. We recognised that the service is taking action to address both of these issues.