Archived: Bourne House

Updated 5 October 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by one inspector.

Service and service type

Bourne House 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.

The service did not have a manager registered with the Care Quality Commission. The provider employed a home manager during the course of the inspection. The provider was 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 reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We visited the service and reviewed staffing levels and walked around the building to ensure it was clean and a safe place for people to live.

We spoke with three people who used the service and nine members of staff including care workers and auxiliary staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records including five people's full care records and multiple medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were examined.

After the inspection

We continued to review information provided by the provider and the local authority.

Updated 5 October 2022

About the service

Bourne House is a residential care home providing accommodation for people who require personal care. The service is registered to support up to 33 older adults and at the time of our first day on site there were 21 people using the service. All bedrooms are single occupancy, and some have ensuite facilities. There are a variety of communal spaces including living and dining areas, adapted bathrooms and outside space.

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

People were not being supported safely to have their medicines. Systems were not robust to ensure suitable amounts of medicine were available and stored appropriately and administered safely by trained staff. Risks were not always mitigated and appropriate assessments were not always in place. Current guidance regarding good infection control practise within care homes had not been effectively implemented. Records did not demonstrate that staff had been safely recruited and staff did not have all the training, checks of skill or support to meet people’s needs. Processes to ensure sufficient numbers of staff would be available as part of a contingency management plan were not robust. Where incidents, accidents or safeguarding’s had happened it was not clear that lessons had been learnt and action to reduce future risk had been taken.

Systems to ensure people’s needs were met were not effective as records were not accurate and detailed. There were no clear lines for responsibility, escalating concern and ensuring actions were followed up. We could not be certain that people were receiving the right modified diet, as staff had not received sufficient training in this area. Records did not demonstrate that robust action was being taken for those at risk of weight loss. Systems for oversight and checks of premises and equipment were not being documented and there were a number of shortfalls identified over the course of the inspection by us and the local authority who were supporting the home.

People were not supported to have maximum choice and control of their lives and staff did not 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. Capacity assessments and best interest decisions for people who had been assessed as not having capacity were not recorded.

The home was not being well run. At the time of the inspection, there was no home manager and the nominated individual was onsite dealing with the day to day running of the home. Systems to ensure oversight were not being completed and the actions we asked the provider to take on the initial days of inspection had not been completed when we returned to the home for a third day on site. The provider had not completed an action plan for CQC following the last inspection. We were not assured the provider would take the necessary action to drive improvement, despite the additional daily support of the local authority quality improvement team, or that any improvements could be embedded and maintained.

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

Our last inspection was a targeted inspection where we looked at specific concerns but did not rate the service (published 9 November 2021). The last rating for this service was requires improvement (published 15 February 2021).

The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve. This was not received.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

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. This included checking the provider was meeting COVID-19 vaccination requirements.

The inspection was prompted in part due to concerns received about a variety of safety issues including staffing levels, staff training, the management of medicines, and the management of the service and provider oversight. A decision was made for us to inspect and examine those risks. The inspection was also prompted in part due to information we received regarding a specific incident following which a person using the service had died. This incident is being reviewed to determine whether a criminal investigation may be needed. This inspection did not examine the circumstances of the incident.

As a result of the above concerns, we undertook a focused inspection to review the key questions of Safe, Effective 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 changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well led sections of this full report.

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

Enforcement and Recommendations

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 the provision of person-centred care; how people are protected from the risk of abuse; how people are protected from risk associated with infection, the administration of medicine and lack of robust risk assessment and management plans; the safe recruitment, training and number of staff to meet the need of the people living at the home; having a suitable environment and equipment; providing healthy diets that meet people’s needs; and ensuring the people are supported in line with the Mental capacity act (2005). We found a continued breach in relation to having effective systems of oversight to ensure the home is well run.

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 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.