Archived: Bathampton Manor

About the service

Bathampton Manor is a care home which provides accommodation and support for up to 21 people over the age of 65. At the time of our inspection,17 people were living at the service.

People’s experience of this service and what we found

We were assured that people were protected by the prevention and control of infection.

Staff wore surgical masks correctly and in line with guidance. They put these on as soon as they entered the building and changed them as required. Personal protective equipment (PPE) was available throughout the building. This was used effectively and disposed of safely in foot operated, lidded bins.

Records of cleaning were kept to demonstrate what cleaning tasks had been undertaken.

The provider’s coronavirus policy was up to date and included accurate guidance and information. This ensured staff could follow guidance which was in line with government guidelines and best practice.

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)

The last rating for this service was requires improvement (due to be published 15/05/2021), and there was a breach of regulations. We served the provider with a warning notice under Section 29 of the Health and Social Care Act 2008 because of failure to comply with regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. We have therefore withdrawn the warning notice.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12, section (1) (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bathampton Manor is a residential care home providing personal care to people aged 65 and over. The service can support up to 21 people. At the time of the inspection 16 people were living at the home.

The service is a listed building, with extensive gardens and grounds. There were communal spaces downstairs including a conservatory, dining room and two lounges. There were well-maintained gardens with level access.

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

People were not fully protected from the risk of infection. Published guidance and best practice in infection prevention control had not always been embedded in the service’s policies and procedures to fully reduce the risk of transmission of COVID-19. Staff were not always following guidance on the correct use of masks.

Notifications of important events had not been submitted to the Commission as required. Although governance systems were in place these did not identify shortfalls in the management of safeguarding concerns and accidents and incidents.

Medicines were managed and administered safely. Risk assessments were in place for people and contained plans to guide staff on how to care for people safely. Staff were recruited following safe recruitment procedures.

People were happy living at Bathampton Manor and were supported to retain their independence. We received positive feedback from people and their relatives about staffing levels and the care received by people. People could access a range of communal spaces. There was a happy and calm atmosphere. People were able to enter the garden freely and enjoyed the outdoor space available.

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

The last rating for this service was requires improvement (published 13 November 2019). A targeted inspection was conducted (published 08 October 2020). At this inspection a previous breach in Regulation 12 (Safe Care and Treatment) had been met.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive comprehensive inspections.

Why we inspected

We conducted this focused inspection to assess if improvements had been made at the service in the domains of Safe and Well-Led. 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.

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.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bathampton Manor 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 12 (safe care and treatment), Regulation 17 (Good Governance) and Regulation 18 registrations (Notifications of other incidents) at this inspection.

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

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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bathampton Manor is a care home providing personal care to 20 people aged 65 and over at the time of the inspection. The service can support up to 21 people. The service is a converted older building, with extensive grounds and garden areas.

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

At our last inspection the provider had failed to robustly assess the risks relating to the health safety and welfare of people. At this inspection we found there had been a marked improvement in the assessment of risk to people. People experienced safe care and treatment which was identified in their care plans and communicated on a daily basis to care staff. One person told us they felt safe and well cared for.

People were protected by robust infection control policies and procedures. Staff had received training in infection control and the correct use of personal protective equipment [PPE].

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:

The last rating for this service was requires improvement (published 12 November 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the requirement in relation to Regulation 12 Safe Care and Treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices, requirements, or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bathampton Manor is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. One of the people was on a short stay at the home. The service can support up to 21 people. Some people had limited verbal communication, so we captured their views through observations.

The home is a listed building and each person had an individual bedroom. There were communal spaces downstairs including a conservatory, dining room and lounges. People always had access to the outside space during the inspection.

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

People told us they were happy living at the home and they felt safe. All people were comfortable in the presence of staff. Medicines were now managed safely, and further improvements were made around storage during the inspection. However, risks still were not always identified with ways to mitigate them for people with specific health conditions.

Improvements had been made for people who were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager had completed a range of audits to identify concerns and issues at the service. They strove to be open and constantly develop and improve the support people were received. When systems had identified issues, actions were being taken to rectify them. However, the provider was more informal in their approach of monitoring the service. The registered manager was aware of their responsibility to notify the Care Quality Commission of certain events in line with their statutory obligations.

Care plans had been improved since the last inspection. People had care plans which were personalised and provided a range of information for staff to use to support their needs and wishes. There were good links with other health and social care professionals which was important due to the complex needs of those living at the home.

People were supported by enough staff to meet their needs. Opportunities were created for people to participate in activities in line with their interests. Staff had received a range of training including specialist training in health and social care.

Staff were kind and caring and knew the people living at the home. Staff respected privacy and dignity throughout the inspection. Links had been developed with the community which had a positive impact for people. Independence was promoted, as were the values of treating each person as an individual.

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

The last rating for this service was requires improvement (published 7 September 2018) and there were multiple breaches of regulation. The provider had positive conditions on their registration and were reporting monthly to us on the improvements they had made. At this inspection the provider had made improvements in most areas. Although, risks for people with specific health conditions were not always mitigated.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified one breach in relation to risks for people with specific health conditions at this inspection.

We have also made a recommendation in relation to external scrutiny by the provider.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bathampton Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bathampton Manor accommodates up to 21 people in one adapted building across three floors. People have single rooms, with some en-suite. At the time of our inspection there were 19 people living there. There is a choice of three communal spaces, a dining room and outdoor seating. The home is set in extensive landscaped grounds.

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 (HSCA) and associated Regulations about how the service is run.

At the last inspection we found two breaches of the HSCA in respect of person centred care and safe care and treatment. We asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) safe, effective, responsive and well-led to at least good. We found that the provider had not achieved this. Some improvements had been made, however these were not sufficient to meet the relevant requirements.

At our previous inspection in January 2017 we found people were not always protected from unsafe management of medicines. We also found this at the inspection in December 2015. At this inspection, we found people were still not always protected from unsafe use of medicines.

In January 2017 we found the provider did not ensure that people received person-centred care based on an assessment of their needs and preferences. At this inspection, we found that improvements had not been made and people’s care records did not contain assessments of some needs such as nutrition and skin care. People’s care records did not contain information about how they preferred their care to be delivered.

The provider did not always ensure people were supported in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Some people may not have had capacity to consent to treatment such as medicines, but best interest decisions had not been recorded to demonstrate the provider was acting lawfully.

The provider had systems in place to monitor the quality and effectiveness of the service. However these systems were ineffective and had not identified the shortfalls, particularly in respect of records, we found at our inspection.

People and their relatives were extremely complimentary about the quality of the care at Bathampton Manor. Many of the staff had worked at the service for several years and knew people, their needs and preferences well. The provider relied on this knowledge to maintain a high standard of personalised care. We observed warm and friendly relationships between staff and people living at the service. There was a range of activities delivered by both staff and external entertainers.

There was a clean, comfortable environment with a choice of communal areas. People could freely access the landscaped gardens.

The food was of good quality and people were encouraged to eat in the dining room.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Bathampton Manor provides accommodation for up to 21 people who need support with their personal care. There were 19 people living at the service at the time of our 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 registered manager told us that a new manager has been appointed. They will be taking over the responsibilities of the current registered manager. The registered manager told us they intend to de-register and the new manager will submit their registered manager’s application form.

At our last inspection we found people were not consistently protected by safe systems for managing their medicines. We found insufficient improvements had been made.

At our last inspection we found peoples’ rights were not upheld in accordance with the Mental Capacity Act (MCA) 2005. Although we found sufficient improvements had been made, this area of the service requires further development.

At our last inspection we found people were at risk of being cared for by staff who were not fit to work with vulnerable adults. At this inspection we found sufficient improvements had been made.

Although care plans contained risk assessments which had all been regularly reviewed, associated plans in place to inform staff how to reduce the risks to people were not always in place.

Staff were supported through an adequate training and supervision programme.

Staff in the main had a good awareness and understood their responsibilities with regard to safeguarding people from abuse. Appropriate arrangements were in place for reporting and reviewing accidents and incidents.

People’s nutrition and hydration needs were met. Staff demonstrated a good understanding of people’s needs and specific dietary requirements.

People and their relatives told us that staff were caring and respectful. People felt comfortable with the staff. People said they were treated with respect.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

People and their relatives spoke highly about the registered manager and the newly appointed manager. People were encouraged to provide feedback on their experience of the service to monitor the quality of service provided. People told us they felt listened to.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the second inspection that the provider of Bathampton Manor has not fully met all the regulations. You can see what action we told the provider to take at the back of the full version of this report.

We found that people's health and welfare needs were being met and the support they received was appropriate to their needs. We saw that people were being well treated and there were systems in place to protect them from possible abuse. There had been an improvement in medication management since our previous visit to the home and practice was safer.

Staff were found to be competent in their support of those living at Bathampton Manor and they received appropriate training and support in order to be able to meet people's needs. People were being asked about the service they received and the quality of the service was being monitored. We found that systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.

Staff described how they work together as a team, and a visiting health professional also commented on the effective leadership that existed in the home. There were sufficient staff on duty to meet people's needs, and people described how staff were alert edto any deterioration in peoples' health.

The home's policy regarding mental capacity and how to include 'best interests' in decision-making was unclear, although people that spoke with us confirmed that staff were supportive.

Recording of medication administered to people using the service did not follow good practice guidelines, although people confirmed that they were happy for staff to manage their medication for them.

The home was observed to be very clean and people commented on the 'homely' atmosphere.

Feedback from quality assurance surveys was positive, and people using the service and those acting on their behalf, clearly felt that Bathampton Manor offered excellent care and services.