Bungay House

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

At the last inspection improvements were required to ensure that the principles of the Mental Capacity Act were followed. At this inspection we found that all required improvements had been made.

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 received person-centred care delivered by passionate and caring staff. People were supported to participate in the planning of their care according to their needs. People’s wishes were sought and respected, and people were supported to make decisions according to their ability.

People were supported to live full and active lives and participate in activities of their choosing.

The service was well-led, and this was evident at all levels. There was a comprehensive quality assurance system in place which was capable of identifying areas for improvement. We saw that areas for improvement identified by the system had been acted upon.

Medicines were stored safely within the home and administered in line with the instructions of the prescriber.

There were sufficient numbers of staff to meet people’s needs in a timely manner. Staff were recruited safely.

The service was clean and there were appropriate procedures in place to minimise the risk of the transmission of infection.

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 good (published 15 July 2019). At that inspection improvements were required to ensure that the principles of the Mental Capacity Act were consistently followed. At this inspection these improvements had been made.

Why we inspected

This inspection was planned to assess progress with shortfalls identified at our previous inspection on 15 July 2019.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.

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 information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• The provider was following best practice guidance in terms of ensuring visitors to the home did not introduce and spread COVID-19. All staff and visitors had their temperature measured, reviewed, and recorded on entry. Where any concerns were raised, visitors were provided with advice and guidance by the home management team.

• Staff, visitors, and people living in the home were tested regularly for COVID-19 infection.

• Staff were adhering to personal protective equipment (PPE) and social distancing guidance.

• People were supported to speak to their families on the phone or via video call. The service had purchased a large screen tablet computer to facilitate virtual visits. This had the impact of increasing the contact some people had with family compared to before the pandemic.

• Inside and outside visits had been risk assessed and risk reduction measures were in place for when these could recommence. The service had built a visiting pod with external access to facilitate easier and safer visiting.

• The service had arrangements to facilitate visits for people at the end of their life.

• The provider had robust isolation arrangements in place for people who were infected with COVID-19, or for people who had been admitted to the home from hospital or the community. There was clear information and procedures for staff to care for people who were isolating. This effectively reduced the risks of transmission of COVID-19 within the home.

• To ensure reduced risk of transmission of COVID-19, staff had breaks scheduled so that they were on their own and not mixing with others.

• The provider had ensured risk assessments had been carried out for any staff at higher risk of vulnerability to COVID-19 and made appropriate arrangements to protect staff and people.

Bungay House is a residential care home supporting older people and people living with mental health needs. The home is registered to provide accommodation and support for up to 20 people. At the time of the inspection there were 18 people living in the home.

Bungay House consists of a main building with an annex which houses self-contained living spaces for up to five people. The main building holds 15 further bedrooms some of which are ensuite. There is a main lounge and dining area and other smaller communal spaces which are used for activities but accessible to people at all times. The kitchen and laundry facilities are situated on the ground floor. There is a stair lift to the first floor of the building.

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

People living at the home had varying degrees of capacity. 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; policies in the service supported this but some systems and procedures in the service did not always support this practice. We found some high-level assessments required greater detail to support that decisions were made in people’s best interest. We have made a recommendation for the provider to improve this. Staff received good quality training and regular supervision. They was vailable information to show the provider worked well with partner agencies. People were very happy with the food and steps were taken to provide people with adequate nutrition and hydration. The building was developing to become an adapted and well decorated environment to meet the needs of people living there.

We saw risk assessments had been completed and were reviewed when people’s circumstances changed. Where there were gaps in collation of some information around risks to people, the registered manager was aware of the steps to take to ensure any additional action reflected in the support provided. However, not all risks were recorded effectively to include appropriate risk management. We have made a recommendation for the provider to improve this. There were enough safely recruited staff to meet people’s needs and safeguarding procedures were embedded to keep people safe from the risk of abuse. People’s medicines were safely managed and administered by competent staff as and when they were required.

There was comfortable and appropriate good humour in the staff relationships with people and we saw people living in the home knew staff well and vice versa. Positive relationships had been built and where people needed to ask for help and advice, they felt comfortable doing so. People told us staff treated them very well and knew when they needed additional support. Support was always provided in a dignified and respectful manner.

There were varied activities taking place over the course of the inspection visit and people told us they could access the community when they wanted. We saw the new care planning system was being used effectively to record people’s needs and when those needs changed. People told us they were involved with reviewing their care and care was assessed and delivered in a person-centred way. There was an available complaints procedure but no complaints had been received. The registered manager was developing a procedure to monitor daily records if they identified people were not happy on a day to day basis.

The provider had a comprehensive suite of quality audits and assurance and this was being further developed to incorporate the new care planning system. Resident and relative meetings took place which were an open and honest forum for issues to be discussed. Staff told us they loved working at the home and felt involved with the journey of continuous improvement. There was a strong values base of equality and posters were displayed all over the home to portray this. When we asked staff if there was anything they would change they all replied, “Nothing.”

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 (6 January 2017).

Why we inspected This was a planned inspection based on the previous rating.

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

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

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.

At the time of this 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.

Risk assessments were in place to ensure that people could be safely supported at all times. Staff were knowledgeable about the procedures to ensure that people were protected from harm and would have no hesitation in reporting any concerns. People received and were administered their medicines as prescribed.

There were sufficient numbers of suitably qualified staff employed at the home. The provider’s recruitment process ensured that only staff, which had been deemed suitable to work with people at the home, were employed following the completion of satisfactory recruitment checks.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager and all staff were knowledgeable about when a request for a DoLS would be required. DoLS applications had been submitted to the relevant local authorities and they were waiting for these applications to be assessed.

Staff respected and maintained people’s privacy at all times. People were provided with care and support as required and people only had to wait a few minutes before having their care needs met. This meant that people’s dignity was respected and that their care needs were met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Care records were detailed and up to date so that staff were provided with guidelines to care for people in the right way.

People were supported to access a range of healthcare professionals. These included appointments with a range of healthcare professionals.

People were provided with a varied menu and had a range of meals and healthy options to choose from. There was a sufficient quantity of food and drinks and snacks made available to people at all times.

People’s care was provided by staff in a caring, kind and compassionate way. People’s hobbies and interests had been identified and were supported by staff in a way which involved people to prevent them from becoming socially isolated.

The home had a complaints procedure available for people and their relatives to use and all staff were aware of the procedure. People were supported to raise concerns or complaints. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.

There was an open culture within the home and people were able to talk and raise any issues with the staff. People were provided with several ways that they could comment on the quality of their care. This included regular contact with the provider, registered manager, staff and completing annual quality assurance surveys.

The provider sought the views of healthcare professionals as a way of identifying improvement. Where people suggested improvements, these had been implemented promptly and to the person’s satisfaction.

We saw that staff interacted with people in a respectful and professional manner. We spoke with two people who used the service who told us that they were happy living there. One person said, "It is lovely."

We looked at the care records of four people who used the service and found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We looked at the ways that the service managed medication, including medication storage and administration records of eight people who used the service. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We looked at the provider's records, including provider visit reports, audits, satisfaction questionnaires and health and safety records. We saw that the provider had an effective system to regularly assess and monitor the quality of service that people received.

During our inspection we spoke with two people who used the service. They told us that they were well cared for and happy.

However, the records examined did not provide sufficient or up to date detail about people's care and support. We found information missing about people's health and behavioural needs and their likes and dislikes. Action to address health issues had not been taken.

Medication records had improved but still contained errors in the way in which medication that was refused or not needed was recorded.

During our inspection we spoke with three people who used the service. They told us that they were happy with the care and support they received.They told us that their care and treatment was very good. One person said, "It's the best ever." They told us that staff helped them with day to day tasks like, "Getting washed and dressed." Another person said. "It's really good here."

We looked at the electronic care records used to guide staff in providing care and support. These were detailed but did not show how people's likes and dislikes were considered when supporting them. We looked at medication records and found there were some errors and omissions which meant that we could not be certain medication was being safely managed or administered.

Staff records showed that suitable recruitment processes were being followed to ensure that staff were suited to their role.

People who used the service were supported in making their concerns known and in making a formal complaint if this was necessary.