Background to this inspection
Updated
5 November 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by two inspectors on two days.
Service and service type
Buckingham House 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.
The service did not have a manager registered with the Care Quality Commission. The manager had applied to CQC for registration as manager. Registered managers and providers are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
We looked at information we held about the service and what people had told us. We contacted local authority safeguarding teams. We used all this information to plan our inspection.
During the inspection
We spoke with seven people who used the service and five relatives. We had discussions with the manager, a nurse, three care workers, two housekeeping staff, the chef and a community liaison officer.
We observed mealtimes in different parts of the home, part of a medicines round and part of an activity.
We looked at a range of records. These included six care plans, four staff recruitment files, the staff training matrix and staff meeting minutes. Medicines administration records were looked. We checked a sample of internal audits, audits by the provider, records of complaints, accident and incident forms. Other records included maintenance and upkeep of the premises, health and safety records, the results of a 2018/2019 independent survey.
After the inspection
We sought clarification about some of the evidence we found and reviewed information we asked the manager to send to us after the visit.
We contacted staff and community professionals by email, to invite them to provide feedback. We reviewed information relatives, staff and people who used the service sent to us.
Updated
5 November 2019
About the service
Buckingham House is a care home with Nursing. It can accommodate up to 53 people. At the time of the inspection 45 older people some of whom were living with dementia lived at the home. Accommodation was over three floors. The second floor had been opened in the summer to offer more independent living accommodation for people. People had access to a range of seating areas and well-maintained small garden area on the ground floor.
People’s experience of using this service and what we found
People and their relatives told us Buckingham House was “Homely,” " Welcoming, friendly and had kind staff.” Relatives told us the environment was “A breath of fresh air” and “The level of cleanliness is high.”
People were supported by staff who had been recruited to ensure they had the right skills and attributes to work at the home. The home had occasional support from external temporary workers. We found the service did not have a system in place to ensure temporary staff had the required skills. For instance, a nurse needed to have a current registration with their professional body. We have made a recommendation about this in the report.
People who required support with the administration of their prescribed medicines, had this provided by staff who had been deemed competent. We found records relating to people’s medicines were not always accurate. We found some stock levels were incorrect. Audits carried out by the service did not always reflect the amount of medicine held at the home. We found staff were not always provided with adequate information on medicines which were prescribed for occasional use. We have made a recommendation about these issues in the report.
People had care plans in place which reflected their likes and dislikes. However, care plans did not routinely hold information about people’s life histories and were not always updated in a timely manner when needs changed. We have made a recommendation about this in the report.
The service supported people with end of life care. However, we found mixed evidence about how the service recorded people’s wishes. We have made a recommendation about ensuring people’s end of life wishes are recorded.
People were cared for by staff who demonstrated kindness, compassion and respected individual's dignity. Comments from people and their relatives included “All staff behave in a professional manner,” “His care has been exemplary” and “I am impressed by the cheerfulness of the staff who do a difficult job with patience.”
People had access to a wide range of activities within the home and the local community. The home had regular visits from school children and people were supported to practice their chosen faith or religion.
People were routinely consulted about changes to the home environment, future activities and decisions about their care.
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.
The provider and management team had systems in place to monitor the quality of the service provided and used feedback to drive improvement.
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 good (published 9 March 2017)
Why we inspected
This was a planned inspection based on the previous rating.
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.