Archived: Bedford Care Home

Bedford Nursing and Residential Home is a large care home with 180 beds that is operated by BUPA. The home is divided into six different units, each with 30 beds. Astley and Lilford care for people who require personal care and support, Croft and Kenyon look after people with mainly physical nursing needs and Pennington and Beech care for people with dementia care nursing needs. The home is situated in a residential part of Leigh that is not far from the town centre.

There was a manager at the home who was in the process of registering with the Care Quality Commission. 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.

At the inspection we found a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to safe administration of medicines.

Despite significant improvements in the area of medicines there were still some inconsistencies across the units and some issues with administration and disposal of medicines.

Appropriate safeguarding policies and procedures were in place at the home and staff were aware of the reporting procedures and signs to look for. Staff were aware of the whistle blowing policy and felt confident to report any poor practice they may witness.

Staffing levels at the home had improved, due to a significant reduction in reliance on agency staff as a result of recruitment of permanent staff.

Staff were recruited safely via a robust recruitment procedure. Staff induction was thorough and training was on-going for all staff. Supervisions had not taken place for some time, but plans were in place to implement a programme of supervisions and appraisals.

Appropriate risk assessments were in place and falls management had improved considerably. Health and safety measures were in place at the home.

People were given a choice of food and staff were aware of people’s preferences and particular dietary requirements.

Care plans were person-centred and included relevant health and personal information. Reviews of care were undertaken regularly and records were complete and up to date.

The service had made some efforts to make the environment suitable for people living with dementia or some level of confusion. However, the environment would benefit from being more dementia friendly.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People we spoke with told us staff were caring and kind. We observed that staff responded quickly to people’s needs, gave explanations of what they were doing and were reassuring.

Efforts were made to include people who used the service and their relatives in reviews of care.

Staff were beginning to undertake training in end of life care to allow people to spend their last days in the place of their choosing.

There were some activities on offer and plans in place to increase the number and relevance of activities in the near future.

Care plans included a lot of individual, personal information to assist staff to care for people appropriately.

There was an appropriate complaints policy in place and complaints were responded to in a timely way.

Staff support had improved with the new acting manager now in post. Plans were in place to ensure all staff were supported with regular supervisions and team meetings.

Quality audits were now taking place although there was still some room for improvement in collecting meaningful data.

Areas such as falls and accident monitoring were now being looked at in more depth and incidents of falls with injury had reduced.

This inspection took place on 30 December 2015 and was unannounced. At our last comprehensive inspection the service was rated ‘requires improvement’ overall and there were no breaches of the regulations identified.

Bedford Nursing and Residential Home is a large care home with 180 beds that is operated by BUPA. The home is divided into six different named houses, each with 30 beds. Astley and Lilford both provided residential care; Kenyon and Croft provided general nursing care, and Beech and Pennington provided support and nursing care to people living with dementia. The home is situated in a residential part of Leigh and is close to the town centre and local amenities.

At the time of our inspection there was a registered manager in post. 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.

At this inspection we found there had been breaches of four of the regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing, safe management of medicines, assessing and mitigating risks to people using the service, need for consent, safeguarding and depriving people of their liberty without lawful authority. We are currently considering our options in relation to enforcement and will update the inspection report once any action has concluded.

Since our last inspection we received information that indicated a high number of nursing and senior staff had left the home. Staff working at all the houses other than Lilford consistently told us there were not sufficient numbers of staff deployed to meet people’s needs. Relatives we spoke with also expressed concerns that people were being put at risk as there were not sufficient numbers of staff to provide care safely.

We reviewed records relating to unobserved falls, including some falls that had resulted in injury. Both staff and relatives told us they thought insufficient staffing levels had contributed to such incidents. A nurse at one of the houses had asked a relative to report concerns that they were not able to support their family member according to their care needs, and insufficient staffing levels to the local authority safeguarding team. The provider arranged for one to one support for this person prior to the end of our inspection.

Staff told us staffing levels had not changed at the home, but that the needs of people living there had changed over time. People had dependency assessments in their care files. However, it was not clear how these were used to determine staffing requirements. Staff told us they had raised concerns about staffing levels at meetings but had been told the staffing levels were sufficient.

There was a reliance on agency nursing staff, particularly to cover night shifts. Some relatives and staff expressed concerns to us about this in terms of continuity and standards of care provided. We spoke with an agency nurse who told us they felt they were not adequately prepared before starting their shift.

We found some issues in relation to the safe administration of medicines. There were gaps in the administration records and we found evidence that two medicines had not been administered as prescribed. Records relating to the application of creams were inconsistently completed.

Accident reports had not always been completed for people who had sustained falls and risk assessments and care plans had not always been reviewed following a fall. This meant the service was not able to demonstrate that it was taking appropriate steps to manage and reduce risks to people.

Staff were aware of how to identify and report any safeguarding concerns. We found one concern that had been raised by a relative had not been referred to safeguarding as the service was waiting for a statement to be submitted. We were assured a safeguarding referral would be made if required.

Applications to deprive people of their liberty had not always been made to the supervisory body when they had been required. The service was also unable to demonstrate it had acted in accordance with the Mental Capacity Act 2005 when taking a decision to administer one person’s medicines without their knowledge (covertly).

We spoke with people living at the home and received comments such as:- " I like being in my room. I enjoy reading. I have a good view of comings and goings and I am well cared for." "I like it here. I have regular visits from the priest who gives us communion if we ask. I don't have anything to complain about, but if I did, I would deal with it myself and talk with the manager.' "I like living here I can still go out when I want " " I don't have any complaints, but when my daughter is well again she will deal with any problems." and " I don't have anything to complain about, but if I did, I would deal with it myself and talk with the manager.'

One person told us that the food was "very good food' and ' food is edible.' Another told us "the food is nice."

Relatives spoken with were positive about care received and made comments such as :- " my relative likes the food and can always choose something different if they don't like what is on offer.' "mother doesn't like tea and is very fussy about her coffee they have now brought her this jug of orange juice' and "the family feel that mother is being well cared for. We have no complaints.'

Two people we spoke with raised concerns about an aspect of their care at the home. We discussed the issues with manager and felt confident that would be dealt with appropriately.

The people we asked told us they felt safe and that they had no concerns about the staff or their care. One visitor told us "My relative has been here for a few years, staff seem to know what they are doing and I wouldn't change anything about the home.'

We found that staff were happy working at Bedford Nursing and Residential Home and that they had received relevant training for their role. We saw that there were appropriate systems in place to monitor the quality of care that people received at the home and we were told that the manager was approachable and responded to comments and suggestions made by people, their relatives and members of staff.