Archived: Bebington Care Home

Bebington Care Home is a purpose-built care home with four units providing residential and nursing care for up to 87 people with varying needs. These include specialist nursing support, respite care, end of life care and general assistance with everyday living for people with dementia. At the time of inspection there were 32 people living at the home.

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

Medicines were not always managed safely. There were inconsistencies in the recording of stock balances and no guidance in place for the use of prescribed creams and for the safe disposal of medication. Health conditions of people were not always recognised in their care records.

Feedback we received from staff, people and relatives was mainly positive. The recruitment of staff was safe and there were enough staff on duty to meet people's needs. Equipment had been serviced and maintained. Accidents and incidents were recorded and reviewed in order to minimise the risk of reoccurrence.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were a range of provider and manager audits in place, however, medication audits were not always effective in identifying concerns and bringing about improvements.

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 requires improvement (published 15 November 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has failed to achieve a rating of at least good for the last four consecutive inspections.

Why we inspected

We received concerns in relation to the management of medicines, staffing and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions 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. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bebington Care Home on our website at www.cqc.org.uk.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe management of medication, management of risk and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bebington Care Home is a residential care home providing personal and nursing care to 58 people aged 65 and over at the time of the inspection. The service can support up to 87 people.

Bebington Care Home accommodates 87 people across four separate units, each of which has separate facilities. This included specialist nursing support, respite care, end of life and general assistance with everyday living for people living with dementia.

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

People and their relatives who we spoke with told us that there had been an improvement in the service since the interim manager had been in post. This inspection found that significant improvements had been put into place by the interim manager and provider.

During this inspection we found improvements in all areas however additional improvements were needed surrounding medication management and the recording of information.

Improvements were being made to the internal and external environment. There were various internal and external checks in place to ensure the home was safe. People’s personal emergency evacuation plans had improved and matched their care plans for the majority that we looked at.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were recruited safely and received regular training, received supervisions, attended staff meetings and had regular practice checks. Agency staff had appropriate processes in place surrounding induction.

Incident and accidents were analysed for patterns and trends. Risks to people were assessed safely and referrals were made to other professionals in a timely when people living in the home were in need.

Auditing systems the provider had in place were now being used appropriately and the findings were being used to drive improvements. Additionally, the electronic system the provider had in place for staff to record incidents was also now being used correctly. This meant the oversight and monitoring of the home had improved.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. infection control standards were monitored and managed appropriately.

Systems were in place to gather feedback from people, including meetings or surveys. People and their family members told us they felt confident to be able to raise any concerns they had with the management.

There were person-centred care plans in place that described what people needed and wanted to keep them safe and well. Activities had improved, and the activities co-ordinator had worked with the provider to implement systems to ensure people had access to meaningful and fulfilling activities.

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 inadequate (published 24 April 2019) and there were multiple breaches of regulation in relation to safe care and treatment, staffing, complains and governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. 9, 16, 17 and 18. However there was a continued breach of regulation 12 in relation to medicines management.

This service has been in Special Measures since April 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

People’s experience of using this service: The quality of care had deteriorated since the last inspection. The provider and manager had not assessed and managed risk, which placed people at risk of harm. People’s emergency evacuation plans had not improved and there were continuing issues with people not having access to their call bells.

There was an insufficient number of permanent staff to meet people's needs and a high use of agency staff. Staff had not been appropriately inducted into the home and the issues we identified during the inspection made us question the effectiveness of staff training.

There were concerns with staff practices regarding monitoring of people’s health and not acting on identified concerns. Medicines had not been managed safely.

Complaints were inadequately managed and accidents and incidents were not adequately reported by staff. People had assessments and plans regarding their care and support needs. However, the care plans lacked important information and were not always kept up-to-date. Quality assurance processes were inadequate.

The service was not well-led and there was a lack of effective governance and oversight by the provider and manager. Records were not always accurate and up to date.

Rating at last inspection: At the last inspection the service was rated requires improvement (January 2018)

Why we inspected: This inspection brought forward due to information of concern from the local authority.

Enforcement: The service met the characteristics of Inadequate in four key questions of safe, effective, responsive and well-led and Requires Improvement in caring. We are taking enforcement action and will report on this when it is completed.

Follow up: Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for Bebington Care Home is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

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. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our last inspection in December 2016 we found breaches of Regulation 12 and 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 where we had seen some people were not able to access emergency call bells in their bedrooms, documentation regarding nutrition had not been completed, checks had not been fully completed, staff needed additional training regarding pressure area care and people's privacy was not always respected. During this inspection we saw that improvements had been made and that two domains had improved to a rating of Good. However, we found that other areas needed improvement.

Bebington Care Home is a purpose built care home providing residential and nursing care for up to 87 people with varying needs. These include specialist nursing support, respite care, end of life and general assistance with everyday living for people with dementia. Bebington 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.

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 home had a registered manager in place.

At this inspection we found breaches of Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider and manager had not taken the appropriate action to provide care in a safe way for people who lived in the home and had not ensured that an up-to-date plan of care was maintained for people living in the home. You can see what action we told the provider to take at the back of the full version of this report.

People received support with their health care. However, care plans and risk assessments did not always reflect the need of the person. Monitoring documentation was not always appropriately stored, this meant that a full picture of a person’s care would not always be available.

Emergency evacuation plans for people had not been updated, in some cases for over a year. This meant that people would not have been able to be safely evacuated by emergency services. This was acted on by the second day of inspection. However, these documents need to be regularly reviewed to ensure the ongoing safety of people living in the home. Documentation about covert medication showed that the proper processes were not always followed before people were given medication without their knowledge.

The home had quality assurance processes in place including audits and quality questionnaires. However, the issues we found during the inspection showed that some of the audits that had been completed were not always effective to ensure the quality of the service.

People we spoke with told us they felt safe at the home and they had no worries or concerns. People’s relatives and friends also told us they felt people were safe. The staff at the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful towards people. The home provided a range of activities to occupy and interest people.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The provider told us the majority of people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care.

People we spoke to were happy with the food being provided and we saw that people had a choice of nutritious meals and received support if needed to eat their meals.

People's GPs and other healthcare professionals were contacted for advice about people’s health needs whenever necessary. The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place and training to guide staff in relation to safeguarding adults. There were sufficient staff working at the home to meet peoples care needs.

The home 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. The registered manager, regional manager and deputy manager were in attendance at the time of the inspection.

People we spoke with told us they felt safe at the home and people’s relatives also told us they felt people were safe. During our visit, however we identified concerns with the service.

We found breaches of Regulation 12 and 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We saw that some people at the home could not access emergency call bells in their bedrooms for various reasons, documentation regarding nutrition, checks had not been fully completed, staff needed additional training regarding pressure area care and people’s privacy was not always respected.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed. The provider told us that DoLS applications had been submitted to the Local Authority for some people

All medication records were completed legibly and properly signed for. All staff giving out medication had been trained in medication administration and all medicines were stored safely.

We saw that infection control standards in the home were monitored and managed appropriately.

Staff were recruited safely and the majority of staff had been supervised and appraised. The registered nurses had the appropriate checks regarding their registration with the Nursing and Midwifery Council.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

On the day of our inspection we found the environment to be clean and fresh.

We found that protective equipment to minimise the risk of infection was available and staff had easy access to aprons, gloves and hand gels.

We saw enough staff on duty to meet the needs of the people who lived at the home.

We looked at the care records of seven people who lived at the home. We found that each care record contained assessment and support plan information that identified people's individual needs and risks in the delivery of care. Support plans gave clear information to staff on the care required by each person and these plans were regularly reviewed to ensure safe and appropriate care was provided.

One relative commented that they felt reassured their relative was safe when they left to go home.

Is the service effective?

People appeared calm and well cared for throughout the day. They told us that they were happy with the care and that their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew individuals well.

We saw training records which identified that staff received training relevant to the needs of the people who lived in the home.

Is the service caring?

We spent time in all areas of the home where we observed staff caring for people with dignity and respect. People living at the home appeared settled and well cared for. Nobody raised any issues of concern with us.

All the relatives we spoke with who were visiting the home told us they were happy with the care of their loved ones.

Is the service responsive?

People's needs were assessed before they moved into the home and records confirmed their preferences, interests and health needs which were recorded. We saw information recorded on 'Connecting with your community' booklets which informed readers of the person's life prior to moving to the home and gave staff the insight in supporting people compassionately.

We saw that when people's needs changed they had been referred appropriately to the relevant health professionals such as the G.P., dietician, tissue viability specialist nurses or others such as occupational therapists.

Is the service well led?

Staff had a good understanding of what was required of them in their role and the good standards of care that they were expected to deliver.

The manager is relatively new in post having previously been the deputy and is not yet registered. Staff told us that they found her approachable and supportive.

Staff told us that the manager supported them to attend training.

The manager had appropriate monitoring and audit systems in place to ensure the safety and well-being of people living in the home, visitors and staff.

Comments included;

'It is very nice here, the staff are good - wonderful.';

'Staff seem to know what they are doing'.

Relatives said;

'I am very happy with the care and very happy with the home.';

'Since the management changed it's much better.';

"They care because they want to, not because they have to."

We looked at a total of seven care records, four of which belonged to family members of relatives we spoke with. Information contained in the records about each person's care requirements reflected information told to us by their relatives. They showed that people consented to care and treatment when they were able and if they were unable to do this then a relative or advocate did so on their behalf.

We observed staff interacted in a familiar, knowledgeable and helpful way with people using the service and spoke with family members many times during the day.

We spent time with the registered manager and the provider and reviewed how they monitored and checked the service they provided. Regular audits were carried out and we saw action plans to address concerns that had been identified. Records were concise and contained clear information about people's needs and risk management. They were easily accessible and stored appropriately.