Banbury Heights Nursing Home

Banbury Heights Nursing Home is a residential care home providing personal and nursing care to up to 58 people. The service provides support to older and younger people with dementia, physical disabilities, sensory impairments, mental health needs, learning disabilities or autism in one adapted building, over 3 floors. At the time of our inspection there were 47 people using the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

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 did not support this practice.

Staff did not always have the information required to provide safe, effective care. Care plans and risk assessments did not always contain relevant, up to date information within them.

People were supported safely with medicines. We found improvements had been made to medicines management.

People were supported by staff who had been safely recruited. The provider completed police checks and gained references for staff prior to them starting work. Staff received an induction and training.

Right Care:

Risks to people had not always been mitigated. We found concerns with risk associated with skin pressure damage, health conditions and supporting people with distress or anxieties.

Unexplained bruising had not been investigated or mitigating strategies implemented to prevent the risk of reoccurrence.

Staff had received appropriate training to understand people’s individual needs and to follow the providers policies and procedures.

Right Culture:

Systems and processes were not always effective in ensuring the registered manager and provider had oversight of the service.

Systems were in place to gain feedback from people, relatives, and staff. Staff told us they felt supported within their roles and people told us they felt safe.

The registered manager and provider were open and transparent throughout the inspection. Updated records and new procedures were implemented immediately after the inspection. However, these will require time to become embedded into practice to reduce risks.

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 requires improvement (published 14 May 2022) and there were 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 the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to safety and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 not changed from requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management and management oversight 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

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Banbury Heights Nursing Home is a residential care home providing accommodation for, predominantly adults over 65 years, although it can support younger adults who also require this service. People were accommodated in one adapted building.

The care home has an agreement in place with local health and adult social care commissioners to support up to 17 people, who require further care and treatment directly following discharge from hospital. These short-term admissions are referred to as ‘hub’ admissions. At the time of the inspection, hub admissions were not taking place.

The care home can provide support to a maximum of 59 people. At the time of the inspection, 28 people were receiving support.

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

Medicines were not always appropriately managed which meant people were not protected from unnecessary risks and harm related to their medicines. Action was taken during the inspection to reduce medicines risks for example, some necessary guidance records were completed.

Processes designed to protect people from abuse had not always been followed. The provider acted during the inspection to improve their monitoring of notification submissions. Notifications must be submitted to the Care Quality Commission when incidents between people take place so that the actions taken to protect people can be followed up to ensure people are protected.

The provider’s quality monitoring processes had not always identified the shortfalls we identified during this inspection. Once informed about the shortfalls, the provider took action to make improvements. These improvement actions need to be sustained.

People told us they felt safe. There were processes in place to assess risks to people and reduce or mitigate these. This included risks from the environment, equipment used and emergency situations such as a fire. Successful and safe staff recruitment had ensured there were enough staff available to meet people’s needs. There were effective infection prevention and control arrangements in place and people lived in a clean environment. Situations which had not gone to plan were reflected on and learning taken from these to avoid recurrences.

The provider had strengthened its senior leadership arrangements and a more robust senior staff structure had resulted in better support and guidance being available for staff. Work had been done on team building and a predominantly new staff team, were working well together. Feedback had been sought from people, relatives and staff and once the results were fully collated, this would be used to help improve the service. The provider worked with partner agencies to ensure people could access the services of the care home when required.

People’s health needs were assessed prior to moving into the care home. People’s needs were met by staff who had appropriate skills and knowledge and in accordance with people’s protected characteristics and choices. People had access to a GP and other healthcare professionals when needed. People’s altering health needs were assessed and there were processes in place to recognise and act on people’s deteriorating health. Staff received relevant training and there were arrangements in place to support them with their learning and development needs. People received support to eat and drink enough and people told us could make choices about what they ate and drank. Technology was used to support the management of risks, such as those associated with falls. The environment had been adapted to support people’s needs.

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.

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 22 November 2019).

Why we inspected

We had received concerns in relation to how people’s nursing needs were monitored and met, staffing numbers and skills and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. Action was taken by the provider during the inspection to mitigate risks to people.

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

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 will take further action if needed.

We have identified breaches in relation to medicines management, reporting of events involving people (notifications) and the provider’s quality monitoring system at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We received information raising concerns about staffing and how people at the service were being kept safe. We shared these concerns with the local authority and raised with the provider to seek reassurance and inspected the service to gather additional feedback from people, their relatives and staff.

We found people were safe and any risks, such as around their mobility or skin integrity were assessed, recorded and regularly reviewed. People and their relatives praised the staff and how they adhered to good infection control guidance.

Staff told us there was good team work and praised the provider for their support during the pandemic. Staff appreciated the changes being implemented by the new manager, and whilst in general staff felt the changes made were definitely ‘better for the residents’ some staff felt there were too many changes happening at the same time which was a bit unsettling. We raised this with the management team who reassured us they would work with the team to find an appropriate pace of making the improvements.

As part of the government’s response to the coronavirus pandemic, the Social Care Taskforce has asked CQC to look at the preparedness of care homes in relation to infection prevention and control. We found the following examples of good practice in relation to infection control.

The provider ensured people’s relatives were able to visit people safely. The provider converted one of the lounges with access to the garden into a designated visiting room with a transparent plexiglass divider. We saw the room being utilised on the day of our visit. Where people were unable to use the room, other ways of contact were in place, for example by using technology such as video calling.

People were supported by the provider’s own team of staff and no temporary agency staff were being used. The communal areas we saw were clean and the service was free of unpleasant odours.

There were systems in place to ensure safe admissions, either by ensuring people had a negative test result or individual risk assessments and barrier nursing being used until the results had been confirmed. The management were aware of zoning guidelines.

The provider ensured there was a sufficient stock of personal protective equipment (PPE) and the staff had infection control training and understood the importance of using PPE. One person told us, “Because of the virus staff wear masks and aprons. Everybody is covered up!”

Regular testing for Covid-19 took place for both people living at the service and the staff. The provider had a contingency plan detailing what to do in case of an outbreak, this included winter planning and people and staff were encouraged to have their flu vaccine.

Further information is in the detailed findings below.

Rating at last inspection and update

The last rating for this service was Good (published 22 November 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing and how people at the service were being kept safe. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Banbury Heights Nursing Home 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. If we receive any concerning information we may inspect sooner.

Banbury Heights Nursing Home is registered to provide accommodation and personal or nursing care to people predominantly aged 65 and over, including those living with dementia. The service can support up to 59 people. There were 43 people at the home at the time of the inspection, this included 15 people staying in ‘hub’ beds. Hub beds are used for interim placements when people no longer need to stay at a hospital and require either additional support or further assessment before they are ready to return to their own home.

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

People remained safe at the home. They were supported by a sufficient number of suitably skilled and safely recruited staff. People were supported to have their medicines as prescribed. Risks to people's well-being and individual conditions were assessed and recorded. Staff followed good practice around infection control.

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. Staff knew how to apply the principles of the Mental Capacity Act. People remained well supported to maintain good diet and nutrition. Staff worked well with various external professionals to ensure people’s healthcare needs were met.

People told us they received caring support. Staff respected people's privacy and dignity. The team was committed to respecting people’s diversity, people’s individual needs, including communication needs. People were supported to be independent where possible and their confidentiality was respected.

People continued to receive support that met their needs. People’s interest and life history were explored, and this information was used when planning activities. People had access to a choice of in-house activities as well as outings. People knew how to raise any concerns and management audited complaints to prevent reoccurrence.

There was a new manager appointed earlier this year who was awaiting their registration with the CQC. The manager demonstrated an open and transparent approach. There were audits in place to ensure good standards of care were maintained, however these were not fully effective. The audits did not identify the provider had not sent us all statutory notifications as they were required to do. People and staff were consulted, and their views mattered. The provider worked well with a number of local social and health professionals to ensure people received good service.

Rating at last inspection and update:

The last rating for this service was Good (published 19 August 2017).

Why we inspected

The inspection was carried out sooner than set out in our re-inspection programme due to concerns we received. We were made aware of safeguarding concerns around people’s care. We also received whistle blowing concerns around a number of areas and these included staffing, management, infection control and dignity issues. A decision was made for us to inspect and examine those risks. We found no evidence to substantiate the concerns received.

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 last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

The provider had systems to monitor all aspects of the service delivery. Where an opportunity for improvement was identified this was being addressed. There was a drive for continuous development of the service. The team worked well with other professionals including local health and social care teams to ensure people’s needs were met.

People continued to be safe. Risk assessments were carried out and promoted positive risk taking to enable people to live their lives as they chose. People received their medicines safely.

People continued to receive support from staff that had the skills and knowledge to meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to meet their nutritional needs and they complimented the food. Staff supported people to access health professionals and any advice received was followed in practice and reflected in people’s care plans.

People were supported by kind and compassionate staff that knew them well. The staff ensured people were reassured and given relevant information that appreciated people’s individual needs. People’s dignity, privacy, diversity and independence were respected and promoted. Staff used the information about people’s likes and preferences to create meaningful and memorable moments for them.

People’s care plans were detailed and regularly reviewed. People were involved in reviewing their care and received support that met their needs. People had opportunities to benefit from activities and social events.

Provider had a complaints policy that was available to people. People were able to give their views about the service in various ways such as via surveys, suggestions cards or meetings and the provider acted on feedback received.

We spoke with nine people who used the service. One person said "I am happy here. The staff are fantastic". Another said "the food is good, lots of choice". We spoke with a couple who had lived at the home. They said "this had been a Godsend for us. Of course we would rather be in our own home but they have looked after my wife and I so well I don't know what we would have done without them".

We spoke with four care workers and two nurses. One said "the people are great. I wouldn't do any other job. This is so rewarding We get lots of training which helps us to care for people professionally"

We looked at the records and saw that care staff were recruited and trained appropriately. Disclosure and Barring Service (DBS) checks had been carried out and appropriate references obtained before care workers started work.

We saw that the provider audited and measured the quality of service. People's views and comments were listened to and acted upon. We also saw that people nutrition needs were being monitored and met.

People we spoke with were complimentary of the staff and the service. One person said the service was 'really good' and 'I'm looked after, it's alright'. Another person said 'staff are good, they're helping me to move back home'. We spoke with three friends and relatives. One relative told us they were happy with the care their loved one received and 'that they could not fault the provider'.

People told us they enjoyed the food and felt there was always choice. We received the following comments "food is lovely", "there is a choice of food and if I don't like it I can say'.

People we spoke with felt safe living in the home and said they would raise any concerns they had with senior staff within the home.

There were enough suitably qualified staff to meet peoples' needs. Staff and people and relatives we spoke with said there were enough staff on duty; 'there seems to be lots of staff'.

The service had a robust auditing plan and risk assessment process. We saw records of actions being taken and improvements being implemented as a result. People who used the service had their views sought and acted upon. One person we spoke with said 'If anything's wrong, they'll put it right'.