Archived: Bindon Residential Home

Bindon Residential Home provides accommodation for up to 42 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. At the time of our visit 33 people were living at the service.

People’s experience of using this service:

• Systems and processes to monitor the service were not effective, did not drive improvement and the provider had poor oversight and had not identified this. As a result, the quality of care provided to people had deteriorated since the last inspection.

• People’s health, safety and welfare were put at risk because there were not always sufficient numbers of suitably qualified, skilled and experienced staff on duty.

• The provider had not ensured staff were suitably trained and sufficiently supervised. As a result, the staff team did not have the skills to support people effectively and people had been exposed to the risk of harm.

• The service was not safe because people were not always protected against the risks associated with medicines.

• People’s nutritional needs were not always identified and monitored. Nutritional care plans lacked detail or clear instructions for staff about how to support people in relation to eating and drinking, especially where they were at risk of weight loss. Records relating to people’s daily dietary and fluid intake were poor. This meant we could not tell in any detail what people had to eat each day

• People were at risk because accurate records were not consistently maintained. There were gaps in people’s repositioning and personal care records. We could not be assured people’s care needs were being met consistently.

• Care records did not always reflect the needs and preference of people using the service. They were contradictory in places. The lack of detailed and accurate care plans meant care and support may not be given effectively. Visiting healthcare professionals shared similar concerns.

• There was a lack of stimulation for people using the service. Several people said they would like to see improvements in this area. Very few activities were offered and those that were did not always take into account individual interests and preferences or consider individual’s abilities.

• Some equipment and aspects of the premises were not clean. Poor infection control standards were found throughout the service.

• Some environmental risk had not been identified.

• We saw positive interactions during the inspection, with staff being kind, friendly and patient when assisting people.

• People enjoyed the meals provided.

Rating at last inspection:

At the last inspection the service was rated as requires improvement (February 2018). The service had been rated as requires improvement for a third consecutive time. At this inspection we found the service had deteriorated and is rated as inadequate overall.

Following the last inspection, asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. We also met with the provider to confirm they were following their action plan to ensure improvements were made.

Why we inspected:

We brought this comprehensive inspection forward as we had received concerns from a variety of sources that included community health and social care professionals, anonymous whistle blowers and family members. Concerns included poor staffing levels, poor standards of personal care, poor management of risks, unsafe staff recruitment practices, poor standards of cleanliness and a lack of stimulation and occupation for people. As a result of the mounting concerns, Devon County Council implemented a whole service safeguarding process in January 2019. There were also several individual safeguarding investigations in progress. Placements to the service have been suspended by Devon County Council because of the safeguarding concerns. The provider has voluntarily suspended admissions of privately paying residents. At the time of the inspection we were aware of two incidents being investigated by third parties.

Enforcement

During the inspection we identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk from harm because the provider’s actions did not sufficiently address the ongoing failings. There has been ongoing evidence of the provider to sustain full compliance since 2015. Our findings do not provide us with confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations.

Follow up:

During the safeguarding process the service is being monitored through a combination of visits by health and social care staff, as well as multidisciplinary safeguarding strategy meetings. Due to concerns about fire safety, we made a referral to the Devon and Somerset Fire Service.

In addition, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

We brought this comprehensive inspection forward as we had received concerns about staffing levels, continence care and the quality of food. Devon County Council investigated one of the concerns under the safeguarding process and found this concern was not substantiated. We reviewed staffing levels and continence care. While staffing levels had been impacted on occasion in previous months due to short notice sickness, staffing levels were satisfactory at the time of the inspection. No concerns were found in relation to continence care or the quality of food.

The service was previously inspected in February 2017. No breaches were found at that inspection however we made three recommendations. We recommended the deployment of staff be reviewed to ensure people’s needs are met and monitored in a timely way. We recommended the service followed the National Institute for Health and Care Excellence Guideline (NICE), Managing Medicines in Care Homes which would help the service to ensure they maintained accurate medicine records. We recommended that good practice advice in respect of setting and achieving improvement plans is reviewed and implemented. We also found Deprivation of Liberty Safeguards (DoLS) applications contained insufficient information or identical information and were not ‘person centred or specific’. The service was rated as Requires Improvement.

At this inspection we found some improvements had been made. For example, staff deployment had improved. Some communal areas had been reconfigured to enable staff to have a regular presence in communal areas in order to provide timely support to people. Deprivation of Liberty Safeguards (DoLS) applications submitted to the local authority contained relevant and specific information. However, we found a breach in regulation as the management of medicines was not entirely safe.

The service has been rated as requires improvement for a third consecutive time. The Care Quality Commission will be monitoring improvements within the service.

Bindon Residential Home provides accommodation for up to 42 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. These are accessed by separate front doors or via the garden at the rear of the properties. At the time of our visit 34 people were living at the service, 22 of whom were living in Bindon and 12 of whom were living in Elmcroft.

Bindon is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

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.

The service was not consistently following safe practice in relation to medicines management. This meant people were at risk of not receiving their medicines as prescribed. Current quality assurance arrangements had not consistently identified shortfalls within the service.

People who used the service felt safe and we found staff knew how to recognise and report concerns about people’s safety and wellbeing. Guidance was in place to ensure risks were minimised without restricting people’s independence.

Sufficient staff were available to meet people’s needs. Necessary checks were carried out to ensure staff were recruited safely and were suitable to work with people at the service.

People were treated with kindness and respect. Staff were attentive and understood people’s individual needs. Staff were familiar with people’s likes, dislikes and preferences with regards to their care and support.

People were happy with the food. They received a nutritionally balanced diet and were offered sufficient fluids to keep them hydrated. People’s health care needs were supported with access to a range of professionals including GPs, district nurses and mental health professionals. Appropriate equipment was in place to meet people’s care needs.

The service was working in line with the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which helped to make sure people's rights were protected and promoted. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. Staff sought people’s consent before any care or support was given.

Staff received effective support in the form of an induction programme, on-going training and appraisals.

Care plans contained person-centred information and where possible people and their relatives had been consulted with regards to the support they required. A range of activities were offered. The registered manager and activities co-ordinator were keen to develop more activities which would be engaging and meaningful for people living with a dementia.

People were provided with information about how to make complaints. Complaints were documented and actions taken as a result.

People using the service, relatives, and professionals knew the registered manager. She had a visual presence within the service and knew people well. People, relatives, professionals and staff said the registered manager was approachable, listened to their feedback and responded to their concerns or queries.

Although we found areas for improvement at this inspection, we also recognised the provider and registered manager had made improvements to the service since the last comprehensive inspection. There were a range of audits and systems in place to enable the provider to monitor the quality of the service provided. However, we identified failings specifically in relation to the management of medicines.

We found one breach 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 version of the report.

Bindon Residential Home provides accommodation for up to 42 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. These are accessed by separate front doors or via the garden at the rear of the properties. At the time of our visit 36 people were living at the service, 22 of whom were living in Bindon and 14 of whom were living in Elmcroft.

We undertook a focussed inspection on 28 October 2016 in response to concerns about staffing levels and the possible impact this had on people’s care. We did not find evidence to support these concerns.

The service had a comprehensive inspection in November 2015 when it was rated as ‘requires Improvement’. At that inspection we found a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the recruitment procedures. At the focussed inspection in October 2016 we found recruitment procedures had improved and the service was fully compliant in relation to recruitment. A number of other improvements were identified during the November 2015 inspection. For example, there were times when there were delays in assisting people or monitoring the impact of people’s behaviour on others. Some areas of risk management needed to be improved to ensure risks were managed safely and consistently. There was a complaints process but written information was not readily available about the process and the timescales. People’s care needs were reviewed but not in a meaningful way which resulted in care plans not reflecting their current needs and the risks to their well-being. Improvements were needed to meet people’s social needs. Quality monitoring systems were in place but some audits had not identified areas for improvement. At this inspection we found improvements had been in some areas, but not in all.

A registered manager was 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.

The provider had quality assurance systems in place, including various audits. However the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process.

Most aspects of the environment were safe and the registered provider was taking steps to ensure the environment was safe in relation to hot water temperatures. The registered manager was working to ensure additional information was included in personal evacuation plans to make them informative and effective should a planned evacuation be necessary. Medicines were generally safely managed; however, we have made a recommendation to ensure all medicine records are accurate.

There were sufficient staff to meet people’s care needs. However staff were not always deployed in a way that kept people safe. We have made a recommendation that the provider review staff deployment to ensure people’s needs are met and monitored in a timely way.

The provider was taking steps to fully meet the Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. Staff were not fully informed about DoLS protection. However, the provider was in the process of taking the required steps to gain the legal authority to subject people to continuous supervision and control, including preventing them from leaving the building.

Several improvements had been achieved since the last comprehensive inspection in November 2015. For example, care planning records and risk assessments were more detailed and up-to-date. An activity co-ordinator had been appointed and a range of activities had been developed. People spoke highly of the activities co-ordinator and said they enjoyed the activities.

People felt safe living at the service; relatives were also confident that people were cared for safely. Comments included, “I felt a bit worried when I first came here, but not now” and “I feel (relative) is safe because staff are caring. They don’t regard this just as a job but as something with reason and purpose…” Staff were kind, friendly and caring. Staff knew people well and support was offered in accordance with people’s wishes and their privacy was protected.

People were protected from abuse as staff had an understanding of safeguarding procedures. They were aware of how to report suspected abuse including how to report safeguarding concerns outside of the service. Recruitment practices were robust and helped to ensure people were protected from staff who were unsuitable to work in care.

People were supported to eat and drink and maintain a balanced diet. Staff, including the cook were knowledgeable about people’s nutritional needs and preferences. People had access to healthcare professionals to meet their health needs. Feedback from professionals showed the service worked in partnership with them for the benefit of people using the service.

Staff had opportunities for regular training to enhance their skills and knowledge of working with people at the service. Staff said they were well supported by the registered manager.

People knew who to speak with should they have any concerns or complaints. Up to date information was available to people about the complaints process.

We have made three recommendations for the provider to consider.

Bindon Residential Home provides accommodation for up to 46 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. These are accessed by separate front doors or via the garden at the rear of the properties. At the time of our visit 33 people were living at the home, 20 of whom were living in Bindon and 13 of whom were living in Elmcroft.

The service was previously inspected in November 2015 when the service was rated as requiring improvement. At that inspection we found a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the provider not fully effective recruitment procedures in place. At this inspection we found recruitment procedures were more robust. - There were systems to ensure checks were fully carried out before new staff were appointed to a post.

There was a registered manager in post who had worked at the home for a number of years in various roles. 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 monitored staffing to ensure it was sufficient to meet people’s needs. Staff were recruited safely with checks being carried out before they started working with people, to ensure they were suitable to work with vulnerable people.

Staffing levels at Bindon were generally found to meet people’s needs and expectations. However we were told about some occasions when people had to wait longer than they were comfortable with for personal care. The registered manager said they would monitor this and address any concerns.

During the inspection staff worked calmly and did not appear to rush people. However on some occasions, we observed staff being very task focussed and not always interacting with people in communal areas. Staff said they felt there were sufficient staff on duty to ensure they met people’s needs. Staff showed kindness and were caring to people when supporting them. People and visitors to the home said staff were very kind, however, they said described how on occasions, staff spoke in a foreign language to each other while providing care. The registered manager said this had been raised with staff in the past as it was not acceptable practice. They said they would ensure that staff were reminded about this again.

The provider had introduced a new computerised care record system which they said had improved the availability and access to care records. We saw evidence that staff used the system to check people’s care. Staff said they found the new system really helped them with more accurate and up-to-date records.

We had received concerns about what activities were available for people at Bindon. We found that there had been some improvements following a recent appointment to the role of activity coordinator. This meant people were being offered individual and group activities which included trips out, games and music sessions in the home as well as individual pampering. We saw evidence that this was the case.

A concern about malodourous smells in communal areas which had been raised prior to the inspection was not found to be evident. However, the provider was installing air fresheners in communal areas to reduce the risks of stuffiness and stale air.

We looked at a selection of care and medication records and staff communication records, as well as records relating to staffing levels, training and quality assurance. Prior to the inspection, we had also met with health and social care professionals who had recently visited the home as part of the safeguarding process. Since the inspection, the safeguarding process has been closed due to significant improvement in the standard of care.

Is the service safe?

We saw risks to people's health and well-being were monitored and regularly assessed. Systems were in place to make sure that people's care and welfare was monitored. This reduced the risks to people and helped the service to continually improve. The management team recognised their responsibility to ensure staff received appropriate training to promote people's safety. We saw staff moving people using equipment in a safe and caring manner. Staffing levels meant people were cared for in a safe environment where the atmosphere was calm.

Is the service effective?

Visitors told us they were happy with the care at the home and we saw people looked relaxed with staff and at ease in their surroundings. Some people were also able to confirm they were happy with their care. People's health and care needs were assessed, and staff knew when to seek external advice when people's care needs changed. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by friendly and caring staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw that staff were attentive to people's needs. For example, one person asked for a blanket and this was immediately given to them. The person said 'You are very kind, you all smile and that's good, thank you, I'm very cosy'.

Is the service responsive?

We looked at people's care plans and we saw the management team contacted health and social professionals appropriately when people's needs changed. When people raised concerns the management team responded promptly. Additional staff had been trained to provide extra support at busy times, such as providing support at mealtimes. The manager guided staff to change their practice to respond to people's individual need, such as how a person was supported with their meal when they chose to walk around while their ate.

Is the service well-led?

The service was developing a quality assurance system to ensure identified shortfalls were addressed promptly. Since our inspection in February 2014, we have seen significant improvement in the quality of the service both on this inspection and on our inspection in April 2014. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and their role in promoting good practice and reporting concerns. This helped to ensure that people received a good quality service.

In this report the name of a registered manager for personal care and accommodation (Bindon Care Limited) appears. However, they were not managing the regulatory activity at this location at the time of the inspection. Their name appears in the report because they were still a registered manager on our register at the time of the inspection.

After the inspection in February 2014, the providers provided us with an action plan to demonstrate the improvements they had made. We met with the providers in April 2014 to discuss the action plan and the changes to the management team. We also discussed with them an anonymous concern relating to staff attitude, people's dignity and the management of risk. The providers have investigated these concerns and have not upheld them. We also included these concerns as part of our inspection.

The focus of this unannounced inspection on 30 April 2014 was to follow up on our enforcement action. Based on our discussions with people living at the home, staff and relatives, as well as on our observations and looking at care records we judged the quality of care had improved. We judged there had been improvements regarding ensuring people were treated with dignity and respect, and choice was promoted. We also judged that the management of people's care and welfare had improved. We saw staff caring for people in a calm and gentle way.

There were 30 people living at the home. The home consists of two areas of care called Bindon and Elmcroft. We spoke with 21 people, two relatives, six staff and the management team. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We looked at a selection of care records and staff communication records, and focussed on privacy and dignity, and care and welfare. Prior to the inspection, we had also met with health and social care professionals who had recently visited the home as part of the safeguarding process.

A further inspection will take place, which will be unannounced and scheduled. This means we will follow up on the two compliance actions made in February 2014 but we will also look at other outcomes, including the quality assurance system within the home. This will help us monitor that the improvements to people's care have been maintained.

In this report the name of a registered manager for personal care and accommodation (Bindon Care Limited) appears. However, they were not managing the regulatory activities at this location at the time of the inspection. Their name appears in the report because they were still a registered manager on our register at the time.

The home is divided into two buildings called Elmcroft and Bindon. We spent the majority of our time on Elmcroft as people living in this building presented as having more complex care needs. During our inspection, we spoke with 15 people who lived at the home but most people were unable to comment directly on the care they received. We therefore spent time in communal areas observing people's experiences and how staff interacted with them. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not comment directly on their experience of care. We also visited people who spent most of their time in their bedroom.

We spoke with five staff members and the deputy manager. The registered manager was on annual leave but the providers made themselves available to us, as did the registered manager from another home run by the organisation. We spoke with one visiting health professional. We looked at a selection of care records, and focussed on people's health and welfare. During our inspection, we saw evidence of people's dignity not being respected and we found staffing levels were not sufficient to meet people's needs. Some staff did not have the skills to care for people safely and appropriately.

We spoke with six visitors during the inspection about their views on the quality of care provided at the home and their views were generally positive. However, these opinions did not reflect our judgements on the quality of care. Care provided by the home needed to be significantly improved to enhance the lives of people living at the home. Our findings showed people's dignity, management of people's personal care needs and the management of identified risks were not being met. Staff lacked skills to effectively communicate with people and the way they assisted people to move was not always safe.

These examples of poor management of care and poor practice were promptly shared under a safeguarding process. Clear feedback was given to the providers about areas for improvement. A multi-disciplinary plan was drawn up by health and social care professionals to protect people's safety and well-being. This resulted in health professionals visiting the home as part of a safeguarding investigation and in a protection role.

There were 32 people living at the home, and one person on a short stay. We met people living at the home but on this occasion we did not ask them direct questions about the outcomes we were inspecting. Instead, we spot checked several bedrooms and communal areas, such as a lounge and toilets. We spoke with staff and the provider. We also looked at audit records, housekeeping records and care plans, as well accident records. We found that standards of hygiene and infection control had improved. People's rights regarding medication were well managed. While people's specific needs relating to moving and handling planning, and the management of diabetes were supported appropriately.

Three of the four outcomes areas we inspected were compliant. We saw that people's dignity and respect was maintained. Their health and wellbeing was assessed and care was provided in a way that suited people's individual needs. Although the maintenance of the environment and cleanliness was being maintained in Bindon there were areas in need of improvement in Elmcroft to manage the risk and spread of infection effectively. We also received information about areas of concern related to the environment and fire regulations and these were inspected after referral to the relevant agencies and found to be satisfactory with minor recommendations from those agencies.

We carried out a desk top review of medication looking at information provided by the service as requested and found that areas of non compliance noted at the previous inspection had been addressed.