Background to this inspection
Updated
19 January 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
A comprehensive inspection was carried out on 6 and 7 November 2018 and was unannounced. The inspection team consisted of two inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Prior to this inspection, on 27 November 2017, we looked at information we held, as well as feedback we had received about the home. Following the last inspection, we did not ask the provider to send us a Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. However, we looked at other information we held about the service. This included notifications. Notifications are changes, events or incidents that the service must inform us about.
During the inspection we spoke with seven people and eleven members of staff. These included the registered manager, regional manager, two registered nurses, five care workers, the activities coordinator and the chef. We also spoke to four relatives. During the inspection we spoke to two healthcare professionals about their experiences of the service.
We reviewed a range of records about people's care and how the service was managed. These included the care records for seven people, records of medicine management, recruitment records for staff, quality assurance audits, complaints management, training programme, incident reports and records relating to the management of the service. We spent time observing care and support in the communal lounges and observed the lunchtime experience that people had. We observed the administration of medicines and activities that were taking part in the service.
Updated
19 January 2019
A comprehensive inspection took place on 6 and 7 November 2018. The inspection was unannounced.
Bon Accord is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Bon Accord is a nursing home providing accommodation for people who are living with dementia and who may require support with their nursing and personal care needs. Bon Accord is registered to accommodate 41 people. Some of the rooms were designed as shared rooms; however, rooms had been converted and were now single occupancy. This meant that the home could accommodate a maximum of 33 people. There were 26 people living at the home at the time of the inspection. The home is a large detached property situated in Hove, East Sussex. It has three communal lounges, two dining rooms and communal gardens.
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 our last inspection in November 2017, the service was rated requires improvement. This was because the service was not at full occupancy and the provider could not demonstrate that existing staffing levels could be maintained if occupancy increased. We found that the provider was not always working in accordance with legislative requirements in relation to gaining consent. We also found that the provider had not always considered and recorded peoples end of life wishes. At this inspection on 6 and 7 November 2018 we found that the management team had taken steps to improve these areas. The overall rating for the service has improved to Good.
People, their relatives and staff spoke positively of the improvements made to the governance of the service. Quality assurance and information governance systems were in place to monitor the quality and safety of the service. Staff worked well together and were aware of their roles and responsibilities.
People and their relatives told us they had trust in the staff and felt safe and secure living at Bon Accord. Staff showed a good awareness of safeguarding procedures and knew who to inform if they saw or had an allegation of abuse reported to them. The registered manager was also aware of their responsibility to liaise with the local authority if safeguarding concerns were raised.
Staff remained kind and caring and had developed good relationships with people. People's privacy was respected and staff supported people to be as independent as possible. People were involved in making decisions about their care.
Risks relating to people's care were reduced as the provider assessed and managed risks effectively. People were encouraged to be as independent as possible. There were effective infection prevention and control measures in place.
People's medicines were managed safely by staff. People were supported by staff who had been assessed as suitable to work with them. Staff had been trained effectively to have the right skills and knowledge to be able to meet people's assessed needs. Staff were supported through observations, supervisions and appraisals to help them understand their role. The provider had ensured that there were enough staff to care for people.
People continued to receive care in line with the Mental Capacity Act 2005 and staff received training on the Act to help them understand their responsibilities in relation to it. People’s capacity to make decisions had been carefully assessed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People’s needs continued to be assessed and person-centred care plans were developed, to identify what care and support was required. People received personalised care that was responsive to their needs. People received compassionate support from staff at the end of their lives and staff were proactive in recording people’s wishes.
People were encouraged to live healthy lives and received food of their choice. People received support with their day to day healthcare needs and were encouraged to live healthier lives.
People were informed of how to complain and the provider responded to complaints appropriately. The provider communicated openly with people and staff. Staff worked closely with professionals and outside agencies to ensure joined-up support.
Managers and staff learnt from feedback and took action to improve service delivery following incidents, accidents and audits.