Archived: Bourne House

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.

Bourne House is a residential care home providing personal care to 25 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

Recruitment records were not always sufficiently robust to demonstrate staff were safely employed and the relevant paperwork was not always available in some recruitment records.

There were enough staff to meet the needs of people. We noted that the presence of additional staff would improve the quality and timeliness of the care being delivered and the provider was in the process of recruiting additional staff.

The home was clean and tidy and there were enough domestic staff and cleaning equipment to promote good infection prevention and control. PPE was available and we spoke to the provider about improving systems for checks and ensuring staff had the relevant practical skills.

People were supported to eat and drink, and staff and the cook knew about people’s specific dietary needs. Choice was given and there was enough stocks of food for the people living at the home.

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 requires improvement (published 15 February 2021) and there was a continued breach of regulation 17 (good governance). Following that inspection, the provider was asked to complete an action plan to show what they would do and by when to improve. This was not completed and returned to CQC as requested.

This was a targeted inspection following whistleblowing concerns received by CQC. The breach of regulation and the well led key question were not examined during this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about recruitment, staffing levels, and how people were supported to eat and drink. A decision was made for us to inspect and examine those risks.

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.

Enforcement

We have identified a continued breach in relation to how the provider maintains oversight to ensure safe recruitment processes are being followed.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bourne House is a residential care home in the Ashton-under-Lyne area of Tameside, providing personal care without nursing to 23 people aged 65 and over at the time of the inspection. The service can support up to 33 people. All rooms provide single accommodation, some are en-suite. There are communal areas including lounge and dining rooms, bathrooms and a secure garden area.

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

The provider had not always had systems for oversight that were effective. New processes and paperwork for checking the quality of service and driving improvement had been introduced but needed to be embedded. The manager was working closely to involve the people living at Bourne House, relatives, staff and external services in driving improvement within the service.

Some staff training was out of date, although staff were caring and understood how to meet people’s needs. There were plans to improve the mealtime experience and a new menu had recently been introduced. People’s needs were assessed and people were supported in line with their choices and preferences. 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.

Safe recruitment processes were in place, although we noted these could be more robust. People’s medicine was safely stored, and they were supported to take their medicines by staff who were competent to do this. The service was clean and tidy, staff had access to personal protective equipment and any shortfalls were addressed by the manager. People looked well cared for and paperwork had been implemented to assess people’s needs and mitigate risks where possible.

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 requires improvement (published 21 October 2019) and there was a breach 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 enough improvement had not been sustained and the provider was still in breach of regulations. Please see the well led sections of this full report. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 coronavirus and other infection outbreaks effectively.

We received concerns in relation to staffing and how people were supported with safe care and treatment. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. We found no evidence during this inspection that people were at risk of harm from this concern. 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

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.

We have identified a breach of Regulation 17 in relation to good governance as the provider did not have sufficient oversight to ensure the consistent good quality of service in the absence of the registered manager at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bourne House is a residential care home providing personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

We found a breach of regulation 17 (good governance) as the home did not have sufficiently robust systems to ensure of oversight of safe recruitment. The home took immediate steps to address this issues and further systems for checks had been implemented by the end of the inspection. People spoke positively about living at the home and management team. The home had an ongoing improvement plan in place and was committed to driving improvements and learning throughout the home.

People told us they felt safe living at the home and that staff knew how to support them safely. The home had appropriate assessments and maintenance checks in place to ensure a safe environment. We noted some areas for improvement in relations to recruitment and the management of people’s medicines which are discussed further in the well led section of this report. The home was quick to address these concerns and by the end of the inspection had implemented appropriate measures.

Care plans were very detailed and provided guidance for staff to support people with their care and support needs. These records were fully maintained and updated as required. People felt able raise any concerns and make complaints and these were always addressed by the registered manager. An activity co-ordinator was in place and a wide and varied range of activities were provided based on people’s preferences and interests. People spoke extremely positively about the activities. People and their families received exceptional support as they reached the end of life and staff continued to support families followed their loved one’s death.

Staff worked closely with other healthcare professionals to ensure that people had the right type of support. Meal times were a calm and positive experience and staff provided all the support people needed with eating and drinking. 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 told us staff were very kind and caring. People said they felt well-treated by staff and that they and their families were involved in developing and reviewing their care. Staff supported people to maintain their independence and their privacy and dignity was always respected.

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 28 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement.

We have identified a breach of Regulation 17 in relation to good governance as the home did not have sufficiently robust systems to ensure oversight and that all recruitment checks had been completed before a member of staff started working at the home. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bourne House is situated in the Ashton-under-Lyne area of Tameside. The home provides care, support and accommodation for up to 33 older people who require personal care without nursing.

All rooms provide single accommodation and 19 of the rooms are en-suite. Bedrooms are located over two floors and the first floor is accessed using a passenger lift or staircase. There are three communal bathrooms, communal toilets, one lounge to the front of the home, one dining room to the front of the home and one combined lounge / dining room to the rear of the home.

At the time of our inspection 32 people were living at Bourne House, with one new admission planned. The registered manager told us that the service had a waiting list of 13 people who would like to be accommodated at the home.

There was a registered manager in post at the time of this inspection. 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 overall rating for the service following the last inspection was found to be ‘Requires Improvement’. This inspection was carried out to see if the required improvements had been made.

The service was last inspected in May 2016, at which time we found there were multiple breaches of the Health and Social Care Act (Regulated Activities) 2014. We found that significant improvements had been made since the last inspection and the breaches of Regulations identified in May 2016 had since been satisfactorily addressed.

People and their relatives told us they felt the care and support they received kept them safe and was of a good standard.

Staff we spoke with were aware and understood their roles and responsibilities in keeping people safe and protecting them from harm.

We found that medicines were managed safely and people were receiving their medicines in line with the prescriber’s instructions.

Care plans, risk assessments and all supporting documentation had been had been updated to a new format. This documentation identified assessed risk and the measures in place to minimise the risk. Personal emergency evacuation plans were in place detailing the assistance each person would need to safely exit the premises should there be an emergency situation.

The new care plans were detailed and person centred. The care plans we reviewed were all up to date, contained information and guidance from other health care professionals and had been reviewed on a regular basis.

The registered manager told us that since the last inspection of the service, each person had been assessed in line with the Mental Capacity Act 2005, and where a person had been deemed not to have capacity there had been a Deprivation of Liberty Safeguard (DoLS) applied for.

Staffing levels had been increased and sufficient staff were on duty at the time of this inspection to keep people safe and their support needs were being met in a timely manner.

Staff had undertaken appropriate training to make sure they had the skills and knowledge needed to carry out their job safely. The management team supported staff and provided them with individual supervision and appraisal meetings giving them the opportunity to discuss their personal development and performance.

Staff were supportive of people, patient and caring. People were treated with dignity and respect and staff supported people to maintain their independence where possible and were mindful to protect people’s privacy.

People and staff were complimentary about the qualities of the registered manager and senior staff team and told us they felt supported and able to approach the management team.

The service was previously inspected on 2 April 2014 when no breaches of legal requirements were found.

Bourne House is situated in the Ashton-under-Lyne area of Tameside. The home provides care, support and accommodation for up to 33 people who require personal care without nursing.

All rooms provide single accommodation and 19 of the rooms are en-suite. Bedrooms are located over two floors and the first floor is accessed using a passenger lift or staircase. There are three communal bathrooms, communal toilets, one front lounge, one front dining room and one rear combined lounge/dining room. The rear lounge/dining room overlooks the patio and large well kept, secure gardens with areas for people to sit outside. The building is a two storey detached house with a large, single storey extension to the rear.

At the time of our inspection 33 people were living at Bourne House Care Home and the registered manager told us that they were currently operating a waiting list.

There was a registered manager in place. A registered manager is a person who has registered with the CQC 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.

This inspection was carried out in response to a regulation 28 report from the Coroner’s office. This is a report that is written after an inquest into someone’s death and the Coroner believes there is a risk of other deaths occurring in similar circumstances. The home is required to produce an action plan to ensure the prevention of a reoccurrence. We found that actions identified in the report had been completed by the home.

We identified 13 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

During this inspection we found that there were not always enough staff available to meet people’s needs. The registered manager told us they used an online tool to calculate how many staff should be on duty but this did not accurately reflect the level of the needs and dependency of the people we observed who lived at Bourne House.

The provider did not have effective systems in place to identify the risks to people’s health, welfare and safety. Care plans did not include comprehensive risk assessments to identify specific risks to people.

Accidents and incidents were not comprehensively reported, analysed or acted upon.

A full building/ environmental audit would have highlighted potential environmental risks, as identified during this inspection.

People, relatives, and staff spoke of the service; one person’s relative told us “Staff are caring and I am informed of any changes”.

Visiting professionals were complimentary of the service and were confident that staff follow their guidance when providing care. One visiting professional told us “It’s one of the better homes”.

Staff we spoke with were aware how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm. However, staff did not demonstrate an understanding of the legal safeguards around mental capacity.

Safe and appropriate recruitment and selection practices had been used to ensure that suitable staff had been employed to care for vulnerable people and staff received regular supervision and support from management.

Documentation at the home showed us that people received appropriate input from health care professionals, such as district nursing and their general practitioner, to ensure they received the care and support they needed. However, we found that people were not always appropriately supported to ensure they had their nutritional needs met in a specifically prescribed way.

People were supported by staff who were mostly kind and caring, however, often interactions between people and the staff who cared for them, were task-based and observations made showed us consent was not always sought before care was provided.

People had been able to personalise their own rooms and each bedroom contained information on the walls about the person and their likes and dislikes.

Communication systems between staff and management were effective.

People and staff were complimentary about the qualities of the registered manager and told us they felt supported and able to approach the management team.

Personal care plan records were in place for people and included comprehensive information around the care and support needs, however, information in the files was not always current and up-to-date and in some files we looked at, care plans had not been reviewed for a number of months and did not reflect the current care needs of people. This could lead to people not receiving the correct care and support; however, staff we spoke with were knowledgeable around people’s care needs.

Is the service safe?

People were treated with respect and dignity by the staff. People we spoke with and some of their relatives told us they felt confident in raising concerns with the staff team and manager and were confident that these would be addressed. The people we spoke with told us they felt that staff listened to them and respected their rights to receive care and supported them in a way that suited their individual needs and preferences.

There was a comprehensive training programme in place to ensure that staff had the relevant qualifications, knowledge and skills and experience to meet the assessed needs of people living in the home. Training included safeguarding adults, health and safety and moving and handling. This meant that people living in the home could be confident that their needs were being met by fully trained staff.

Systems were in place to make sure that managers and staff learned from events such as incidents, complaints, and safeguarding events. The manager told us that good practice was reinforced in one to one staff supervision, staff meetings and training sessions. Staff told us that when they identified a training need they only had to ask the manager who would arrange appropriate training so that staff had the skills they required for their role.

During our visit we looked at the premises which were fit for purpose. The home was clean and tidy and there were protocols in place to manage the ongoing maintenance of the home and ensure that staff followed health and safety procedures. management systems were in place to monitor and audit all aspects of practice such as checks on care plans and medication audits.

Is the service effective?

Prior to people being admitted into the home a member of staff visited people in their home needs to carry out an assessment of needs. This meant that people could feel confident that the service could meet their care needs when they moved into the home.

The manager of the home was pro active in ensuring that staff were kept up to date with current developments in adult social care and used a variety of means to do so. The service was involved with programmes which focused on 'living well with dementia', and auditing systems which included input from the Stockport NHS. These audits had resulted in the service being awarded a number of certificates including one for 'going the extra mile when working with people with dementia'.

The service had recently been awarded a grant following a detailed application tender submitted by the manager. The money received had been used to create a garden which had been designed with special features to compliment the work the staff carry out with the people living in the home.

Is the service caring?

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with their wishes.

When we spoke with people living in the home and some of their relatives we were told that the staff were skilled and competent and carried out their care duties in a caring way. During our visit we saw staff interact well with people and they used good communication methods when working with people. We saw that staff listened to people and support people in a way that suited their individual needs and preferences.

Is the service responsive?

When we spoke with families who were visiting they told us that they could approach the staff or manager with any concerns. They told us that they were confident that any concerns would be addressed immediately.

The service had systems in place to ensure that people were regularly consulted about their views and ideas on how the home should be run. This was done by means of resident and family meeting and feedback surveys. We saw evidence of these surveys being carried out on a regular basis and the analysis of the findings. Where action was required we saw documentation on how these were addressed, and all of this was reported to people in a monthly newsletter demonstrating that the service was open and transparent on the way the service operated. Good systems were in place to support people in using the complaints procedure. As a result of listening to people who use the service the quality of the service was continually improving.

Is the service well led?

The service worked well with other services to make sure people living in the home received appropriate care and assessment from the right professionals in a timely way. When we spoke with visiting professionals they told us that the staff worked well with them and made appropriate and timely referrals to them which resulted in home care instead of unnecessary hospital admissions.

When we looked at documentation we saw that there were good systems in place to audit and monitor all aspects of care practice in the home.

When we spoke with staff they spoke highly of the support they received from the manager and the senior staff. They told us that if a training need was identified this was arranged for them. There was evidence to demonstrate that all staff received regular supervision and support.

The manager worked well with other agencies and used every opportunity to develop and progress the service. Examples of this are using external agencies to add to the monitoring process and accessing grant opportunities to improve the environment for the people living in the home. The manager, senior staff and care staff had developed a good team approach where they worked well together. Staff made many comments about how they felt they worked well as a team. During this visit there was evidence of an enthusiastic approach and a willingness to continually develop the service. The manager was continually updating her own skills and knowledge.

These actions and innovations helped to ensure that people received a good quality of service at all times.

When we spoke with people living in the home, they told us they were happy and satisfied with the care and support they received from care staff. Comments included:

"It's a lovely refuge for me."

"The staff treat me with respect but they don't pry. They really respect my privacy but I know they are there if I need them."

"I get the feeling the staff are well trained, they seem good at managing difficult situations."

"The staff seem to know people well."

We looked at the care records of three people. These contained the relevant documentation and provided staff with the information they needed to provide safe care and support to people living in the home.

When we looked around the building we saw that polices and procedures were in place and staff adhered to them so that people living in the home benefited from a safe and clean environment.

Training records showed that the service prioritised training for staff. Training was relevant to the service and included dementia training.

Systems were in place to monitor and quality audit all aspects of care practice in the home.

Comments from people using the service included:

"The staff are lovely and kind. They are understanding and if there is anything wrong they help as much as they can."

"It's lovely here. I am really happy. I like the atmosphere and the staff are so caring."

Through discussion with people living in the home and observing how the staff provided care and support to them, we saw that people were encouraged to express their views and to lead a life that suited their individual needs and preferences.

We were told that when people were unable to make decisions independently, they received support from their relatives or advocacy services. Information on independent advocacy services were available to people and informed people about their choices.

Medication systems were robust and ensured that people received their medication in a safe way. Arrangements were in place for obtaining, recording, storing, administering and disposing of medication.

Staff had access to ongoing training and were supported by the manager and senior staff. People we spoke with expressed confidence in raising any concerns or complaints to the staff and management team. Systems were in place to record any concerns and to ensure that staff learned from any of the issues raised.