Archived: Bournedale House

Bournedale House provides accommodation for a maximum of 11 older adults who may be living with dementia. There were 11 people living at the home at the time of the inspection. Ten people were unable to verbally tell us about the care they received. We tried to determine their experience of the service by using our observation tool, and a variety of non-verbal communication methods.

The service has a registered manager who was present throughout the 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.

People told us they felt safe living at the service. Staff we spoke with were aware of how to recognise possible signs of abuse and the need to report any concerns.

There were not always enough staff available in the places people needed them to meet people's requests for support in a timely manner. The absence of staff to support and supervise people had resulted in people experiencing falls.

People could be confident that their medicines would be given safely.

The staff had been provided with training about the Mental Capacity Act (2005) but could not always explain how they put this into practice when supporting the people living at the service. Staff had received basic training to ensure they were aware about safe care and some of the people’s individual needs.

People could be confident that changes in their health would be identified. People did not always receive the support they required to maintain their nutritional and hydration needs.

Individual staff did not consistently treat people with dignity and respect, and systems and processes within the home did not promote good practice in this area.

Relatives gave us positive feedback about the care provided. Everyone told us that staff were kind and caring and knew people well. The majority of staff that we spoke with were enthusiastic about their role and could describe how people preferred to be supported.

There were very limited opportunities for people to join in with activities they liked, and which reduced the risk of them becoming socially isolated. Staff practice and the systems within the home did not promote people being seen as individuals. We have made a recommendation about increasing the focus on people using the service.

The service had ensured people maintained relationships with those who were important to them.

People living at the home and their relatives were aware of how to raise concerns and were confident that any concerns raised would be dealt with in a timely manner.

People, relatives and the staff were happy with how the service was managed. The registered manager had successfully improved some aspects of the service since our last inspection although this had not been entirely effective, and further work was still needed to ensure improvements to quality and safety continued and were maintained. We have made a recommendation about the ongoing leadership and development of this service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We also spoke with two relatives of people who were visiting the home at the time of the inspection visit.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. People, staff and visitors were protected against the risks of unsafe or unsuitable premises. The provider conducted regular maintenance checks and audits.

Care records showed that risks to people had been identified and appropriate plans put in place to protect people from harm. This ensured that the provider was able to identify that people were receiving the care they needed to keep them safe from the risk of harm.

Staff personnel records contained all the information required by the Health and Social Care Act. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

The registered manager sets the staff rotas, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people's needs are always met.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Prior to admission into the home people's needs were assessed to ensure that the home could meet their needs. Where necessary risk assessments had been undertaken and were used to help staff provide appropriate, safe and consistent support to people living in the home. Care plans contained information and guidance about people's specific conditions to enable care staff to meet the individual needs of the people who used the service.

The service supported people's human rights. People were supported to decorate their rooms as they wanted and maintain relationships which were important to them. We saw that people regularly visited their relatives at the home.

People were not always supported to express their views or make decisions about the care and treatment they received. There was no information in the public areas to inform people how they could raise concerns and we were told that not all the people who used the service had copies of their care plans. Therefore people were not always supported to comment on the effectiveness of the service they received because they did not always have enough information and in a format they could understand.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and ensure that all people using the service know about how to let the home know about any changes or comments they want to make about their care.

Is the service caring?

Through observation and from speaking with staff it was clear that they genuinely cared for the people they supported . We saw staff speak to the people who use the service with warmth, dignity and respect. People were supported to do things at their own pace with no pressure to hurry from staff. When a person asked for something or support with their care needs we saw that staff responded quickly and effectively.

Staff regularly asked people if they were alright and if there was anything they wanted. This included giving people choices about what they had to eat and where they wanted to eat their meals. People were supported to engage in the local community and practice their specific faiths and beliefs.

We spoke with three people who used the service and the relatives of two people who used the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example one person told us: 'They look after (relative's name) very well' and 'I can visit whenever I want. I am made to feel very welcome'.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was generally provided in accordance with people's wishes. However the provider did not always seek people's views or the views of relatives on what activities were on offer or what the person would have wanted to be involved in based on their previous interests.

We saw that care plans contained essential information about people's regular health assessments from other professionals. This ensured staff had access to information about people's needs and could provide the most appropriate care.

Is the service responsive?

The provider had a complaints policy although people could not always access information about how to make a complaint if they were unhappy. The manager was aware of the provider's complaint policy and knew how to respond to concerns. The service worked well with other agencies and services to make sure people received care in a coherent way.

People were not always able to comment on the care they received because the provider did not always share information with people about their planned daily care. People were not always given information in a format which met their communication needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people having access to information and support which enable them to express their views about the care and welfare they received.

Is the service well-led?

The provider regularly sought the views of the people who used the service, their relatives and staff. We saw evidence that they had introduced changes to how people were supported in response to comments received. The provider had not however established a robust system to ensure that appropriate information about the service was available to all the people who used the service.

The provider had ensured that relatives and people who were important to the people living at the home were able to be involved and were able to visit as often as they wished to help maintain existing relationships. The welcome extended to ensuring that, where people wanted, their visitors could join them at mealtimes in the home.

The provider had reviewed their systems to ensure that people were cared for and supported by staff who had been recruited and selected in a robust manner to ensure that they were skilled and appropriate to be engaged in providing care to vulnerable people. The provider had ensured that the process put in place was used when new staff had been employed.

The service has a quality assurance system and records showed that identified problems and opportunities to change things for the better were addressed. These included reviewing people's care records, the safety and suitability of the environment and equipment . Maintenance issues were addressed promptly. As a result the quality of the service was continuously improving.

There was evidence that the provider had ensured that learning from incidents or accidents took place and appropriate changes were introduced or implemented to keep the people safe from harm. We saw that the provider had regard to comments made in our last inspection report of the service, however we noted they had not yet reviewed people's activity plans as they stated they would.

People who used the service were involved in planning their care. They were supported to make choices about the care they received.

People received sufficient quantities of food and drink to meet their needs and were able to make choices about what they ate and drank.

The provider was able to protect people against the risk of unsafe care and treatment by regularly assessing and monitoring the quality of the service provided and introducing changes when required.

There were enough suitably qualified and experienced staff to meet the needs of the people who used the service. One person who used the service told us, "They've always looked after us. They're very good". However, we found that recruitment procedures were not sufficiently robust. The provider had not always checked that people were legally entitled to work in the UK or in some instances had not followed up concerns with people's Criminal Records Bureau Checks.

There were good arrangements for making sure that standards were monitored and improved, where necessary. These included audits of services and regular staff meetings.

Three people using the service were able to tell us about the care and support they received. They told us that that they were happy living there. Comments included: 'The staff are kind, we get on very well.' and 'I have been here a few weeks now. The staff have been very kind and helpful.'

We observed the care and support received by people using the service that were not able to communicate with us due to dementia. Staff supported people in a respectful manner and offered choices of how and where they wanted to spend their time.

People told us about the quality and choice of food and drink available. They told us that they were satisfied about the choice and quality of meals and that food and drink was readily available to them. Comments included 'Lunch was good, very nice.' and 'They ask us how many biscuits we want.'

People told us that they felt safe living at the home and that they would speak to the staff if they had any concerns.

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They told us that they had recently undertaken an inspection at the home. No concerns were identified about the quality of service being provided.