Bletchingley

Updated 12 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 16 October 2018 and was unannounced. The inspection team consisted of one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was older person services.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. We reviewed notifications of significant events the provider sent to us. Notifications are events that the provider is required by law to inform us of.

We spent time observing people in areas throughout the home to see interactions between people and staff. We observed people as they engaged with their day-to-day tasks, the care they experienced, including the lunchtime meal, medicines administration and activities.

We spoke with six people who lived in the service and with two visiting relatives. We spoke with the registered manager, the nominated individual, a registered nurse, a senior care assistant, the activities coordinator, a housekeeper and a staff member responsible for laundry. We also spoke with a visiting GP and visiting social worker. Following the inspection, we spoke with an occupational therapist involved in the care of some people living at Bletchingley. The professionals we spoke to gave us permission to include their feedback in this report.

We looked at the care plans and associated records for four people. We looked at people's medication records. We reviewed other records, including staff training records and training matrix, staff rotas, accidents and incidents, menu's, questionnaires, complaint records, policies and procedures and external and internal audits. Full records for two staff were reviewed, which included checks on newly appointed staff and staff supervision records.

Updated 12 December 2018

The inspection took place on 16 October 2018 and was unannounced.

Bletchingley was registered by the Care Quality Commission (CQC) on 13 July 2017. This was the first inspection of the service. New services are assessed to check they are likely to be safe, effective, caring, responsive and well-led when registering.

Bletchingley 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.

At the time of our inspection, Bletchingley accommodated 21 people. Bletchingley is registered to provide nursing care and residential care for 26 people with a range of care needs, including frailty of old age, specific health conditions and people living with dementia.

Bletchingley is a purpose-built building. The ground floor accommodated people who live at Bletchingley permanently. On the first floor the service had eight beds that were purchased by the local authority for reablement called Discharge to Assess (D2A). This programme provides people with care and rehabilitation support for up to six-weeks following discharge from hospital. The aim is to enable people to regain skills and confidence so they can return home with a package of care. The floors are accessible by a lift and stairway.

The service had a registered manager in place. The registered manager is also the manager of another service for the organisation, the other service is next door and the registered manager shared their time equally across both services. 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, processes and practices safeguarded people from abuse. Risks to people's safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. There were sufficient numbers of suitable staff to keep people safe and meet their needs. Background checks had been completed before care staff had been appointed. People were protected from infection and lessons had been learnt when things had gone wrong.

Suitable arrangements had been made to obtain consent to care and treatment, in line with legislation and guidance. Care and nursing staff had been guided to deliver care following current best practice guidance. People had sufficient to eat and drink to maintain a balanced diet. People had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. People benefited from living in purpose-built accommodation that had been adapted and designed in a way that met their needs.

People were treated with kindness, respect and compassion by staff that knew them well. We observed that staff were caring, patient and gave time for supportive interactions. A person told us “It’s like a holiday camp, it’s first class.” Another person told us, “I’m really impressed. The food is good and plentiful. I’ve met the manager and spoken with the nursing staff. I’ve joined in a sing-song downstairs. It’s been explained how to go out into the garden.”

People received personalised care that was responsive to their needs. They were also supported to express their views and be actively involved in making decisions about their care, as far as possible. Staff encouraged and promoted independence. People had maximum choice and control of their lives and staff support them in the least restrictive way possible; this practice reflected policies and systems in the home. Confidential information was kept private.

People's concerns and complaints were listened and responded to and used to improve the quality of care.

An activities coordinator had recently been recruited, to increase and vary the activities provided for people and include opportunities for them to go out into the community.

At the time of the inspection there were no people in receipt of end of life care. The registered manager had considered end of life care for people and was committed to ensuring people’s rights to die in their home were upheld, if they were able to continue to meet the person’s needs. Suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a positive culture in the service that was open and inclusive. People benefited from there being a management framework to ensure that staff understood their responsibilities so that risks and regulatory requirements were met. People who lived in the service, relatives and staff were asked for their feedback on the service and the provider acted on the responses to improve the quality of the service.

Checks had been completed to resolve issues identified and to innovate so that people received safe care. Staff worked well together and staff were supported to speak out if they had any concerns about people not being treated in the right way. The management team worked in partnership with other agencies and external professionals.