Bavani Care Home Limited Also known as Bavani Care Home

Bavani Care Home Limited can provide accommodation and personal care to a maximum of nine people in a single adapted building. At the time of our inspection seven people were living at the care home. The service specialises in supporting younger and older adults with mental health needs.

People’s experience of using this service

People told us they were happy with the standard of care and support provided at this care home.

People were cared for and supported by staff who knew how to manage risks they might face. However, although we found people were kept safe and not at risk of harm, we have made a recommendation about improving how staff develop and record people’s risk management plans.

The premises were kept hygienically clean and staff followed current best practice guidelines regarding the prevention and control of infection including, those associated with COVID-19. Medicines systems were well-organised, and people received their prescribed medicines as and when they should. The service was adequately staffed by people whose suitability and fitness to work in an adult social care setting had been properly assessed.

The provider ensured staff had the right levels of training and support they needed to deliver effective care and support to people living at the service. 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. People lived in a suitably adapted care home that met their needs. The care home was decorated and furnished to an adequate standard. People were supported to access food and drink that met their dietary needs and wishes. People were supported to stay healthy and access community mental and other relevant health care professionals as and when required.

People were treated equally and had their human rights and diversity respected. Staff treated people with respect and dignity and upheld their right to privacy. People were encouraged and supported to maintain and develop their independent living skills. People were encouraged to make decisions about the care and support they received and had their choices respected.

Care plans were in place for everyone who lived at the service, which helped staff meet their emotional, personal and health care needs. Staff ensured they communicated and shared information with people in a way people could easily understand. People were supported to participate in activities that reflected their social interests and to maintain relationships with people, that were important to them. People’s concerns and complaints were listened to and investigated by the provider. Plans were in place to help people nearing the end of their life receive compassionate palliative care in accordance with their needs and wishes.

The provider recognised the importance of learning lessons when things went wrong and were keen to continuously improve the service. The quality and safety of the service people received was routinely monitored by the services management team. The provider promoted an open and inclusive culture which sought the views of people living in the care home, their relatives, community health and social care professionals and staff working at the care home. The provider worked in close partnership with various community mental health and social care professionals and agencies to plan and deliver people’s packages of care and support.

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

Rating at the last inspection

The last overall rating for this service was requires improvement (published 24 July 2020). At this inspection we found enough improvement continued to be made and sustained by the provider to ensure they were now rated good overall and for all five key questions.

Why we inspected

This was a planned comprehensive inspection based on the previous rating.

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.

Follow up

We will continue to monitor the service and information we receive about them. If we receive any concerning information we may inspect sooner.

Bavani Care Home Limited is a residential care home providing personal care and support to nine people with mental health care needs at the time of our inspection. The service can support up to a maximum of nine people in a single adapted building.

People’s experience of using this service

Feedback we received from people about the service was positive. Typical comments included, “I really do like living here. The [registered] manager and staff are great” and “This is a very well run care home. The staff are always so kind, compassionate and patient with my [family member] who says they’re happy at Bavani.” Most people using the service, their relatives and staff all spoke positively about the relatively new registered manager and felt the service had definitely begun to improve in the last six months under their leadership.

The service was safe. At our previous two inspections of this service we found the provider had failed to ensure medicines were managed safely. This was because medicines records were not always appropriately maintained by staff, there were no processes in place to receive and act on medicines alerts and people’s allergy status was not recorded. At this inspection we found the provider had made enough improvements to ensure people received their prescribed medicines safely.

We also found enough progress had been made by the provider to ensure their fire safety arrangements were now suitably robust after we found at their last inspection not all their fire-resistant doors closed automatically when the fire alarm sounded.

Furthermore, the service was adequately staffed. There were systems and processes to protect people from the risk of abuse. People were supported by staff who knew how to prevent or manage risks they might face in a person-centred way. This kept people safe, while not restricting their freedom. The care home was kept clean and staff followed relevant national guidelines regarding infection control. There were sufficiently robust systems in place to assess and respond to risks regarding infection prevention and control, including those associated with Covid-19.

The service was well-led. At our last inspection we found the provider had failed to ensure their established governance systems to monitor the safety and quality of the service people received were not always operated effectively. At this inspection we found the provider had improved the way they operated their oversight and scrutiny arrangements.

People also benefited from living in a care home that was now much better managed. The new registered manager had installed an open, inclusive and person-centred culture at the care home. They also consulted people, their relatives and staff as part of their on-going programme of improving the service they provided. For example, when things had gone wrong, there were systems to learn lessons from this and prevent similar incidents from reoccurring. The provider worked holistically in close partnership with other mental health and social care professionals and agencies to plan and deliver positive outcomes for people.

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

Rating at the last inspection

We carried out an unannounced comprehensive inspection of this service on 19 and 21 November 2019. Multiple breaches of legal requirements were found. The provider completed an action plan following our last inspection stating what they would do and by when to improve the way they managed medicines and operated their governance systems.

Why we inspected

We undertook this focused inspection to check they had followed the action plan they sent us and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Is the service Safe and Well-led?, which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service therefore remains unchanged as requires improvement, despite improved ratings of good for both the two Key Questions we look at this time. The overall rating is based on the findings of this and the service's previous inspection.

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.

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

Bavani Care Home Limited is a care home providing personal care and support to 7 people aged thirty and over at the time of our inspection. The service can accommodate and support up to 9 people in one adapted building. The service specialises in supporting adults with mental ill health needs.

People’s experience of using this service

Most people using the service and their relatives told us the service had begun to improve in recent months since the new manager had taken over. However, although the new manager continues to take the service in the right direction the provider acknowledges the service remains a work in progress and that further improvement is required.

At this inspection we found people continued to receive their medicines as prescribed, but some issues regarding the management of medicines persisted. For example, some medicines records were not signed, there were no processes in place to receive and act on medicine alerts and people’s allergy status was not recorded. We also observed fire resistant doors in the communal areas would not close automatically should the fire alarm be activated, contrary to fire safety regulations. In addition, the provider’s governance systems had not picked up all the new issues we identified during this inspection.

Other issues we found at this inspection, included people not having enough opportunities to engage in meaningful leisure, educational and vocational activities that reflected their social interests and wishes. We have made a recommendation about improving activities. We also found staff working performances was not being formally appraised at yearly intervals and people were not being actively encouraged and supported enough to maintain and develop their independent living skills.

All the negative points described above notwithstanding, we found a number of positives during our inspection, including some improvements the provider had made.

The number of staff on duty at night in the service had been increased in the last six months. We saw sufficient numbers of staff whose suitability to work in adult social care had been checked were available to meet people's needs. People were cared for and supported by staff who were kind and compassionate.

We received positive feedback about the inclusive and approachable leadership style of the new manager from most people using the service, their relatives and staff. The new manager promoted an open and inclusive culture which sought the views of people using the service, their relatives and staff. The new manager also recognised the importance of learning lessons when things went wrong and working in close partnership with other health and social care professionals and agencies.

People were encouraged to make decisions about the care and support they received and have their choices respected. 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.

People's privacy was respected and their dignity maintained. People were treated equally and had their human rights respected. People’s care plans were personalised and up to date. Staff knew how to manage risk and keep people safe from avoidable harm. The training staff received remained relevant to their roles and responsibilities. We saw the premises was clean and staff followed relevant national guidelines regarding the prevention and control of infection. People were supported to maintain a nutritionally well-balanced diet. People were supported to stay healthy and well and have access to the relevant community physical and emotional headlight care professionals.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 14 May 2019) and there were multiple breaches 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 we found some improvements had been made, but the provider was still in breach of some regulations. The service continues to be rated requires improvement for their first two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns we received about a higher than expected number of police incidents and complaints made by neighbours about this service. This resulted in the local authority holding a provider concerns review of the service and imposing a placement embargo on the care home. This embargo remained in place at the time of our inspection. A decision was made for us to inspect and examine the risks and concerns described above by bringing the services next scheduled inspection forward by six months.

Enforcement

We have identified two new breaches of regulation that relate to the unsafe management of medicines, poor fire safety arrangements and the ineffective operation of their quality monitoring and governance systems.

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, the local authority and police to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

• Bavani Care Home Limited is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

• This service provides support to people with mental health care needs. Some of the people using the service also have behaviours that might be considered challenging and/or a learning disability. The service was registered to support nine people. At the time of our inspection seven people were using the service.

People’s experience of using this service:

• This inspection was the service’s first CQC inspection and we found evidence to support an overall rating of ‘Requires Improvement’.

• This was because we found the provider had failed to ensure controlled drugs were always managed safely in terms of staffs’ safe management of medicines training and the way they stored and recorded the use of controlled drugs.

• Refer to end of full report for details of action we have asked the provider to take in response to this breach of regulations.

• Also, although staff were suitably trained to meet the needs of most of the people they supported, we found some gaps in their knowledge and skills.

• We have made a recommendation about improving staff training.

• Furthermore, although people could freely access their bedroom, the wider community and most of the communal, there was restricted access to the kitchen. This meant pope could not access the kitchen without staff support.

• We discussed this issue with the registered manager who agreed to keep sharp knifes in a locked space within the kitchen, therefore reducing the risk associated with people using knifes to cook. This would enable people to freely access their kitchen facilities unsupervised. Progress made by the provider to achieve this stated aim will be assessed at their next inspection.

• Finally, although the provider had established some governance systems to monitor the quality and safety of the service provided, they had failed to identify all the issues we found during our inspection (See above).

• We discussed this matter with the registered manager and owner who agreed to review and improve the effectiveness of their governance systems. Progress made by the provider to achieve this stated aim will be assessed at their next inspection.

• The negative points described above notwithstanding people using the service, their relatives and professional representatives all told us they were satisfied with the standard of care and support provided by Bavani Care Home Limited.

• People received support from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy.

• The service had safeguarding procedures in place and staff had a clear understanding of these procedures.

• Risks to people had been assessed and were regularly reviewed to ensure people’s needs were safely met.

• The provider had a culture of learning lessons when things went wrong.

• Appropriate staff recruitment checks took place before new staff started working for the service. There were enough staff available to meet people’s care and support needs.

• The service had procedures in place to reduce the risk of the spread of infection.

• Staff routinely sought the consent of the people they supported ensuring they had maximum choice and control of over their lives.

• People were supported to maintain a nutritionally well-balanced diet.

• People received the support they needed to stay healthy and to access physical and mental health care services as and when required.

• Staff met people’s spiritual and cultural needs and wishes.

• People were encouraged and supported to develop their independent living skills.

• Assessments of people’s support needs were carried out before they started using the service. People’s care plans developed from these assessments were personalised and routinely reviewed to ensure they remained up to date.

• People had been consulted about their support needs and involved in helping staff develop their care plan.

• People were supported to participate in meaningful activities at home and in the wider community that reflected their social, educational and vocational needs and interests.

• People were supported to maintain relationships with their relatives and other people that mattered to them.

• People's concerns and complaints were dealt with by the provider in an appropriate and timely way.

• People’s end of life care wishes were clearly recorded in their care plan.

• Management support was available for staff when they needed it.

• The provider promoted an open and inclusive culture which sought the views of people using the service, their relatives, professional representatives and staff.

• The provider worked in close partnership with other health and social care professionals and agencies to plan and deliver people’s packages of care and support.

Rating at the last inspection:

This service was newly registered with the CQC in April 2018 and therefore this inspection represents the first time they have been inspected and rated by us.

Why we inspected:

This unannounced comprehensive inspection was part of our scheduled plan of visiting new services within 12 months of them being registered by us. The inspection was carried out to check the safety and quality of the care and support they provided people using the service.

Enforcement:

At this inspection we identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 around the safe management of medicines.

Follow up:

The provider has a legal responsibility to send us a written report of the action they are going to take meet the breach of regulations we identified in this report, which we will follow up they have implemented at their next inspection.

In the interim, we will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates in keeping with our inspection methodology for services rated Requires Improvement overall.

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