Butterley House

Butterley House is a residential care home providing personal and nursing care to 14 people aged 65 and over at the time of the inspection. The service can support up to 37 people.

The accommodation is provided over two floors. The upper floor has bedrooms, toilet and bathing facilities. The downstairs also has bedrooms and toilet and bathing facilities with the addition of communal spaces, a conservatory, a lounge and a dining space.

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

The provider had made many improvements however some were not yet fully embedded to provide us with assurances to support sustainability.

People received personalised care in a homely environment. Areas of the home had been refurbished to ensure spaces were suitable for people to use. People were encouraged to make choices how they wished to spend their day, and these were promoted.

There were sufficient staff to support people and new staff had been recruited in accordance with safe recruiting processes. Staff felt supported and received regular supervision for their role. Staff had received training to enhance areas of care and understanding of some long-term health conditions. Staff had requested further training to develop their individual skill and in relation to end of life care.

People were supported to remain safe. Staff understood how to raise a safeguarding alert or concern. Any received had been investigated and any outcomes shared, this meant people the provider continued to make improvements to peoples safety. . Risk assessments had been completed to ensure measures were put in place to mitigate the risks. Referrals were made to obtain health and social care advice and we saw this was recorded and followed. Medicines were managed safely to ensure people received their prescribed medicine.

Care plans had been developed to ensure all aspects of people’s care was individualised and reflected people’s choices and preferences. Relationships had been maintained through the use of technology and a visiting pod on site.

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 enjoyed the dining experience and were given opportunities to be involved in the menu planning. Staff ensured peoples dignity was being respected and showed this through offering choices and understanding people’s needs.

The provider had developed a range of audits which were now being used to ensure quality was maintained and drive further improvements. The registered manager ensured we received notifications regarding incidents or events. There was a complaints policy and relatives felt able to raise concerns and were confident these would be addressed.

The provider had worked in partnership with health and social care professionals to ensure the environment and the care being delivered was in line with current guidance or best practice. Through these interactions, lessons had been learnt.

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 27 August 2020), 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned 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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

Butterley House is a residential care home providing personal care to 23 people aged 65 and over at the time of the inspection. The service can support up to 37 people.

The accommodation is provided over two floors. The upper floor has bedrooms, toileting and bathing facilities. The downstairs also has bedrooms and toilet and bathing facilities with the addition of communal spaces, a conservatory and a dining space.

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

The provider had not always provided us with assurances in relation to the governance of the home. There were insufficient systems in place to monitor the care and ensure people were safe from harm or risks mitigated.

Audits had not always been completed or used to develop improvements. Staff did not feel there was an open culture in the day to day running of the home or their concerns were addressed.

The systems in place to have oversight of staff training, medicines management and risk to people were not thorough enough to manage and improve the service. We found risk to people in relation to pressure care and falls management. We also found staff lacked the training and skills to support people in these and other areas of care.

Information about people’s dietary needs had not been shared and this placed people at risk of receiving a meal unsuitable for their needs. Care plans and risk assessments associated with dietary needs had not been completed

Opportunities to learn from incidents had not been followed and we saw this had impacted on the risk in relation to safeguarding and keeping people safe from harm.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Relatives felt they had been provided with information about the pandemic, however they were not always kept informed of day to day events about their relative.

Partnerships which had been established were now being used to affect environmental changes. Infection control was managed well, and the staff were following recent guidance.

Staff recruited to work in the home had received the required checks in relation to references and a police check. There was enough staff to meet the current occupancy of the home.

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

Rating at last inspection

The rating at the last inspection was inadequate (published 14 February 2020)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of regulations. The service remains in special measures.

Why we inspected

We received concerns in relation to the management of medicines, infection control and governance in the home. We reviewed the information we held about the service. We completed a risk assessment relating to the COVID-19 pandemic that was ongoing at the time this inspection was completed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Ratings from previous comprehensive inspections for the other key questions were used in calculating the overall rating at this inspection.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to risk management, safeguarding people from harm, and good governance at this inspection.

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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service

Butterley House is a residential care home providing personal care to 33 people aged 65 and over at the time of the inspection. The service can support up to 37 people.

The accommodation is provided over two floors. The upper floor has bedrooms toileting and bathing facilities. The downstairs also has bedrooms and toilet and bathing facilities with the addition of two large communal spaces, a conservatory and a dining space. The garden was well maintained and provided an accessible space which was safe for people to use.

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

The governance of the home was insufficient to ensure that people received support to keep them safe and maintain their wellbeing. Audits had not always been completed or used to develop improvements. Partnerships had not always been developed to enhance the care available to support people and the staff.

There was no current manager and the provider had invested in consultants to support the daily running of the home. However, they did not always know the people’s needs or manage the staff to ensure care was received in a timely way.

Staff and relatives had not been kept informed about the governance or changes to the home and people had not been consulted on their care needs We had not always been notified of events or the provider had not recognised when some incidents should have been raised as a safeguard.

Medicine management was not in accordance with national guidance and people were not always protected from the risk of harm or infection. Staff had been recruited, however not all the required checks had been completed consistently. There were sufficient staff to provide people’s care, however they were not always deployed to ensure these needs were met.

Bedrooms and communal spaces were cluttered, untidy and not always cleaned to the required standards. People did not always had access to a call bell to request support when needed.

People had a choice of meal, although they had not been consulted on the menu. Information about people’s dietary needs had not been shared and this placed people at risk of receiving a meal unsuitable for their needs which may place them at risk of choking.

People’s choice about their care needs had not been considered or supported. They had not been consulted on how they wished to spend their day and encouraged to follow their interests or hobbies.

Care plans were not consistent and some had not been reviewed since July 2019. Staff had not got access to the care plans and the information they required to provide people with their current needs. When people required support with their health care this was available, however the guidance provided was not always followed.

We have made a recommendation the provider should consider the national guidance on the environment for people living with dementia, recruitment and to review the support they provide for people in relation to people’s capacity.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service didn’t always supported this practice.

There was a complaints policy, however any received had not been recorded in accordance with this. There was mixed feelings about the culture of the home. Some people told us they had established positive relationships with the staff. The environment was not always suitable; however, the provider had made some improvements and was investing in further aspects of the home to ensure it was safe and welcoming.

The provider had displayed the previous rating.

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

Rating at last inspection (28 May 2018 ) –

The last rating for this service was Good. This was under the previous provider. This was the new provider's first inspection since their registration with us on 29 January 2019.

Why we inspected

The inspection was prompted in part due to concerns received about infection control, staffing levels and safe care and treatment of people. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements in all areas of the domains we report on.

Enforcement

We have identified six breaches in relation to people’s dignity, safety, person centred care, staff training and the oversight of the home at this inspection.

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

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.

Follow up

Immediately after our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report . In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk. Additional resources were also immediately deployed to the service. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.