Archived: The Boltons

The inspection took place on 8 and 9 October 2018 and it was unannounced.

The Boltons is a care home without nursing and provides a service for up to 27 older people, some of who may have mental health needs. The services provided include respite care. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection there were 26 people living at the service.

There was a registered manager in place. 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 last inspection the service was rated Good overall. During this inspection we found two breaches. When there is a breach or more, the overall rating cannot be Good. There was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered manager did not ensure they recorded and kept a copy of actions taken as required in the Duty of Candour regulation when a notifiable safety incident occurred. We asked the management team about this on our first day of inspection. However, they were not able to provide evidence the provider’s policy was followed. There was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not ensure care and treatment was provided in a safe way.

The registered manager had quality assurance systems put in place to monitor the running of the service and the quality of the service being delivered. However, they did not always ensure all tasks were completed as part of the management of the service such as complete safety checks, medicine management and staff training. Thus, the quality assurance system did not always provide an accurate overview of the service. Without an effective system the registered manager would not able to make improvements where and when necessary so that people could receive the support and care they needed.

We found some errors with recording of the medicine. Where people's medicines were given covertly, the principles of the Mental Capacity Act had not always been adhered to.

Staff training records indicated which training was considered mandatory. Not all staff were up to date with their mandatory training and some were due their refresher training. The management team was overseeing and booking training when necessary to ensure all staff had the appropriate knowledge and skills to support people. We have made a recommendation for the management to refer to the current best practice guidance on ongoing training and monitoring for social care staff.

Some people’s records contained consent forms signed by the family members. However, it was not clear if staff had checked they had a legal right to do that. We observed staff asking people for their consent to deliver care, giving time for people to respond and respecting those decisions. Not all staff were aware of the MCA and their responsibilities to ensure people made decisions that were in their best interest.

The registered manager did not always ensure all maintenance checks and assessments were up to date. Some staff did not always follow good practice using personal protective equipment to maintain appropriate infection control. The premises and adaptations were not always dementia friendly. We made a recommendation to review guidance on making the environment more 'dementia friendly'.

The management carried out risk assessments and had drawn up support plans to ensure people's safety and wellbeing. We noted some information was contradictive throughout the support plans and dates of the updates were not always clear to reflect most current information. Not all people had opportunities for social engagement and meaningful activities according to their interests to avoid isolation.

People told us staff were available when they needed them most of the time and staff knew how they liked things done. The provider had a system to assess staffing levels and make changes when people's needs changed. Staff felt there were enough staff when they needed to support people appropriately.

The premises and equipment were cleaned and well maintained. The dedicated staff team followed procedures and practice to keep the service clean. We observed kind and friendly interactions between staff and people. People and relatives made positive comments about the staff and the care they provided.

The provider investigated and responded to people's complaints, according to the provider's complaints procedure. Annual questionnaires were sent to people and their relatives so they could share their views of the service. The provider encouraged feedback from people and their families, which they used to make improvements to the service. The service’s aim was to ensure people were protected against the risks of receiving unsafe and inappropriate care and treatment.

Staff had ongoing support via regular supervisions with their senior staff. They felt supported by the registered manager and senior staff and maintained great team work. Staff had handovers and meetings to discuss any matters with the team. There were appropriate recruitment processes in place. People and their families were involved in the planning of their care.

The management team and staff responded to changes in needs and risks to people who use the service. These changes were reported to the senior staff member to ensure a timely response and appropriate action was taken such as referral to professionals.

People felt safe living in the service. Relatives also felt their family members were kept safe and were satisfied with the care and support provided. Care staff knew how to identify potential abuse and understood their reporting responsibilities in line with the service's safeguarding policy. There were contingency plans in place to respond to emergencies.

People were supported effectively regarding their nutrition and hydration needs. Hot and cold drinks and snacks were available between meals. People were assisted with their meals where necessary. People had their healthcare needs identified and were able to access healthcare professionals such as their GP. Staff knew how to access specialist professional help when needed. The service worked well with other health and social care professionals to provide effective care for people.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards and to report on what we find. The registered manager had acted on the requirements of the safeguards to ensure people's rights and freedom were protected. They made appropriate applications to ensure people's liberty was not restricted in an unlawful way.

The management was working with the staff team to ensure caring and kind support was provided in a consistent way. People confirmed staff respected their privacy and dignity. Their choices were respected. Staff felt the management was approachable and supportive, and they communicated well to ensure smooth running of the service. People and relatives felt the service was managed well and that they could approach management and staff with any concerns.

You can see what action we have asked the provider to take at the end of the full version of this report.

The Boltons is a care home which is registered to provide care (without nursing) for up to 27 people. The people living in the home needed residential care and support from staff at all times and have varying needs. These included people with enduring mental health illness and people who live with dementia. At the time of our visit 22 people were using the services. The home is a detached building in a residential estate close to the shops and amenities of Reading. People had their own bedrooms and use of communal areas that included an enclosed private garden.

The home has a registered manager. 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.

The registered manager is also one of the providers’. The providers Mr & Mrs V Juggurnauth works full-time within the home to support the people who live there and the staff team.

People’s safety was promoted within the home. The recruitment and selection process helped to ensure people were supported by staff of good character. There was a sufficient number of qualified and trained staff to meet people’s needs safely.

Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse. There were risk assessments that identified risks associated with personal and specific health related issues. They helped to promote people’s independence whilst minimising any risks.

People’s medicine was managed safely.

People were provided with effective care from a dedicated staff team who had received regular supervision with their line manager to identify their development needs. Training was provided by external sources and in-house refresher training was provided. This made sure staff were supported to receive the training and development they needed to meet people’s individual needs.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people and their care.

Staff treated people with kindness and respect and had regular contact with people’s families to make sure they were fully informed about the care and support their relative received.

Meals were nutritious and varied to promote individual needs and people were encouraged to live a fulfilled life with activities of their choosing. These were structured around their needs and individual to each person. However, they were being further developed to promote individual interests and to minimise the risk of social isolation. The provider had approved extra staff hours to take this forward.

People told us that they were very happy with the care and support they received. They benefitted from living at a service that had an open and friendly culture. There were opportunities for people to be involved in decisions about the home through formal methods such as residents meetings, surveys and reviews. The provider had an effective system to regularly assess and monitor the quality of service that people received.

People were given a choice of meals each day. People we spoke with told us they enjoyed the food. One person told us, 'I am really looking forward to lunch today, the pudding is lovely.' People were given appropriate support to eat. The home regularly monitored people's weight to ensure they were not at risk of malnutrition.

We toured the building and saw up to date records in respect of the home's suitability, including maintenance records and equipment servicing. We noted some areas of the home were included in the homes refurbishment plan for 2014 including the kitchen.

Care workers were provided with training appropriate to their roles and were regularly supervised and appraised. Care workers we spoke with felt they had the skills needed when supporting people living at the home.

We found the provider kept up to date personalised care, treatment and support records for each person living at the home. Records were securely stored and could be located quickly

We observed people being spoken to with respect, and positive interactions between staff and people living at the home. One person we spoke with said, 'I have no complaints, people are nice to me and the managers are very approachable.' A relative spoken with told us, "I think it is fabulous here, I have not had a problem that was not dealt with professionally. They keep me updated on a regular basis and tell me if they think something is not quite right."

Care plans contained individualised information on people's needs, their personal preferences and risk assessments.

Staff had been trained in safeguarding protocols. We saw evidence the provider had responded appropriately to incidents and involved the local safeguarding team when necessary.

We spoke to the manager and viewed documents in regards to audits of the home. Audits included, care plans, medication, infection control, and health and safety.