Bafford House

Bafford House is a residential care home providing personal care to up to 19 people. The service provides support to older people, who may be living with dementia, mental health needs or learning disability. At the time of our inspection there were 13 people using the service.

The service accommodates people over 3 floors in one adapted building. Some bedrooms have en-suite toilet and washing facilities. People had access to a lounge on the ground floor, a dining room on the lower ground floor and a large garden. A lift enabled wheelchair access to all floors.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care:

While there had been improvements since our last inspection, we found people living at Bafford House were not always protected from risks related to the premises, potential risks from others, or risks related to choking. Staff had received training in some key areas including fire, infection control, first aid, moving and handling and dementia awareness. However, gaps in staff training and support remained which may adversely impact the safety and quality of care people receive.

Further improvement was needed to ensure the safety and quality of the service met expected standards.

People's medicines, incidents and behaviours were reviewed with health and social care professionals to ensure any restrictions were in people's best interests and people’s care and treatment remained appropriate. People’s ongoing physical needs such as chiropody, optical and dental care were met. Advice was sought from health care professionals to ensure people's more complex needs were met. Professionals told us their advice was followed.

Right Support:

People living at Bafford House had choices about how they spent their day, and while they were encouraged to spend time with others, to eat and socialise, their wish to be alone was respected. 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.

Several people had asked to go out, to the shop, library, hairdresser and bank, and these requests were met. However, wider opportunities for people to follow their interests and participate in meaningful activities were very limited, as there was no dedicated staff time for meeting people’s social and mental stimulation needs. Activities requiring little planning, such as ball games, skittles, arts and crafts and singing, were provided. Staff, relatives and professionals expressed concern about the impact this may have on people living with dementia or a learning disability.

Right Culture:

People told us they liked living at Bafford House and felt safe there, some people described staff as friends. A relative said, “It is a very loving and caring place.” The provider and deputy manager spent a lot of time in the service and were well known to people, relatives, staff and professionals. The provider worked openly and cooperatively with others and people were involved in key decisions that affected them, for example, discussions about end of life, or moving rooms.

The provider had employed a cook, cleaner and housekeeper since our last inspection and this had a positive impact on people and staff. The provider had also employed an external consultant, worked with the local authority medicines team and NHS infection prevention and control team to improve the service. They had taken initial steps to improve internal monitoring and oversight of the service, however, these systems were not yet effective in identifying and addressing shortfalls.

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 inadequate (published 2 December 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The overall rating for the service has changed from inadequate to requires improvement, based on the findings at this inspection.

The provider has not met regulatory requirements for the last four consecutive inspections.

The service has been in Special Measures since 2 December 2022. During this inspection we found ongoing breaches of regulations. While the service is no longer rated as inadequate overall, or in any of the key questions, the service remains in Special Measures.

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.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 November 2021 and breaches of legal requirements were found. Enforcement action was taken in relation to good governance and safe care and treatment and the provider was informed what action they must take by when to meet legal requirements. The provider also completed an action plan to show what they would do and by when to improve need for consent.

We completed an unannounced focused inspection on 30 May 2022 to check they had followed their action plan and to confirm they had met legal requirements. The provider had met legal requirements in respect of need for consent but had not fully met legal requirements in respect of good governance and safe care and treatment. We also found a new breach in relation to staffing.

We completed an unannounced focused inspection on 12 October 2022 to check the provider had followed their action plan and to confirm they had met legal requirements. The provider had not met legal requirements in respect of good governance, safe care and treatment and staffing. We also found a new breach in relation to fit and proper persons employed.

This comprehensive inspection was carried out to check for significant improvement, following action we took against the provider after the last inspection. The provider demonstrated significant improvement in some key areas, but we found evidence the provider needs to make further improvements and legal requirements remained unmet.

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.

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

The provider took immediate action to mitigate risks to people in response to our feedback at this inspection. Please see the safe and effective sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to good governance, safe care and treatment, staffing, fit and proper persons employed and safeguarding.

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

Where we find standards of care fall below those people have a right to expect, we do not hesitate to take action to protect people. In this case we took enforcement action to ensure people living in the service were safe.

Having satisfied ourselves improvements had been made to the service, and the provider accordingly agreeing to update a monthly action plan, in relation to actions taken to address regulatory concerns raised, the decision to cancel the providers registration was no longer deemed appropriate at this time.

Follow up

The service remains in ‘special measures’. This means we will keep the service under review and we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, we will take action in line with our enforcement procedures. This will usually lead to cancellation of the provider’s registration or to varying the conditions of registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

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 meet with the provider monthly following this report being published to discuss changes they are making to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Bafford House is a residential care home providing care for up to 19 people. The service provides support to people who live with conditions associated with older age and some people also live with dementia and mental health needs. At the time of our inspection there were 17 people using the service.

People lived in one adapted building, each with their own bedroom, some bedrooms included use a personal toilet and washing facilities and others a sink in the bedroom. People had access to a lounge and other areas to sit on the ground-floor and access to a dining room on the lower ground floor via a lift.

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

There remained ineffective arrangements in place for identifying and managing risks which may impact on people’s health, safety and wellbeing. Safety checks and actions which could help reduce and mitigate these risks were not always completed. In this respect the provider did not always follow their own policies, procedures and risk assessments.

People’s medicines were not managed safely, and people had been put at significant risk from the impact of medicine errors. Infection, prevention and control guidance had not been consistently followed.

There remained insufficient staff to support the routine work of the service. This was impacting on the standard of cleanliness, staffs’ availability to support people with meaningful and therapeutic activities and the managers abilities to fulfil their management responsibilities.

The provider did not operate safe staff recruitment practices and they did not have arrangements in place to ensure staff completed necessary training which included training in communication with people who lived with a learning disability.

People were provided with support to eat and drink enough and people’s food preferences were met however, people had limited opportunities to make mealtime choices.

There were inadequate arrangements in place to keep the environment suitably maintained.

The provider continued to operate ineffective quality monitoring systems and process which meant they did not assess, monitor and manage shortfalls in the quality and safety of the services provided. This meant people were placed at risk without suitable action being taken to reduce of mitigate risks. Shortfalls in record keeping remained and action had not been taken to address this.

Lessons had not been learnt from previous inspection findings, for example, in staff recruitment practices and there were no mechanisms in place to drive service improvement. The provider did not have a formal process in place to seek the views of people, their relatives, staff or visiting professionals to help plan future service improvement .

People had access to medical support and review by a GP or emergency services when needed. There were arrangements in place to support people’s ongoing health needs such as chiropody. Staff worked with community health care professionals to ensure people’s health needs were met. Relatives gave positive feedback regarding how people’s care needs were met.

People were supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were arrangements in place to acknowledge and address complaints and concerns although the provider told us they had not received any. Relatives told us they had not had cause to complain.

There were no formalised meetings with relatives or staff, but relatives and staff spoken with confirmed there were other arrangements in place for information to be shared. Relatives felt involved, supported and communicated with.

Managers of the service worked alongside health and social care professionals to ensure people could access the service as required.

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 6 July 2022).

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 the provider remained in breach of regulations and previously issued enforcement action had remained unmet.

At our last inspection we recommended that the provider review relevant oral health guidance and implement an oral health assessment. At this inspection we found this recommendation had not been met, although people received support to maintain their oral hygiene.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 November 2021 and breaches of legal requirements were found. Enforcement action was taken in relation to good governance and safe care and treatment and the provider was informed what action they must take by when to meet legal requirements. The provider also completed an action plan to show what they would do and by when to improve need for consent.

We completed an unannounced focused inspection on 30 May 2022 to check they had followed their action plan and to confirm they had met legal requirements. The provider had met legal requirements in respect of need for consent but had not fully met legal requirements in respect of good governance and safe care and treatment. We also found a new breach in relation to staffing.

This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-Led which contain those requirements.

This inspection was prompted in part due to concerns received about staffing, staff training, medicines administration, cleanliness and some aspects of how people’s care was delivered. A decision was made for us to inspect and examine those risks and to check if legal requirements in respect of good governance and safe care and treatment had been met.

We have found evidence that the provider needs to make improvements and we found legal requirements remained unmet. Please see the safe, effective, responsive and well-led sections of this full report.

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.

For those key questions not inspected, we used the ratings awarded at the last time these were inspected 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bafford 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 and will take further action if needed.

We have identified breaches in relation to the assessment and management of risks, management of medicines, infection, prevention and control, staff training, staff recruitment, record keeping and the governance of the service at this inspection.

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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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 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.

Bafford House is a residential care home providing accommodation and support for up to 19 older people and people living with dementia. At the time of our inspection there were 17 people using the service.

People are accommodated in one adapted building which provides people with single bedrooms with wash handbasin. There are communal toilet facilities and an adapted communal bathroom. There is a garden and parking to the front of the building.

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

We found the provider’s quality monitoring systems had not always enabled them to identify shortfalls in the service and action had not been taken to make all the required improvements following our last inspection. Despite this, we did find some improvements had been made since our last inspection in November 2021 and any continued shortfalls had not impacted on people’s safety.

Some action had been taken to improve people’s safety since our last inspection. However, action was still needed to ensure staff training was up to date and a people would be monitored at regular intervals for injury following a fall.

People’s risk management records had not been reviewed on a regular basis to ensure the agreed safety actions remained effective and appropriate. To help mitigate the risk of staff not having relevant information about how to manage people’s risks and care needs, staff and managers talked on a frequent basis about people’s risks and needs to ensure their support remained appropriate. Managers worked with staff daily delivering care so were able to monitor for emerging risks and changes in people’s abilities.

The provider told us they continued to face challenges in recruiting and retaining staff. This had impacted on their ability to complete tasks which supported the effective governance of the service. Managers and care staff consistently needed to be redeployed to complete tasks in areas which remained inadequately staffed. Recruitment records needed to be completed when checks were undertaken.

We observed staff to be patient and kind with people, working in a calm way to support people’s wellbeing. People told us they felt safe and looked after. A person said,” You get all the help you need.” A relative explained their relative required a lot of support to live with dementia and said, “They have done a marvellous job.”

People had access to their GP as needed and staff ensured referrals for further support, for example, assessment for equipment or mental health review were completed. Staff worked with other services, such as NHS Rapid Response and the emergency services so people could receive support for unexpected ill health. We made a recommendation to support improvement of people’s oral care assessments.

People’s medicines were managed safely and in people’s best interests. People were provided with food and drink to support their health and help given to eat and drink where needed. People’s wish to remain independent was also respected.

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. Staff worked with people to ensure care was provided at times when people were able to provide verbal or implied consent.

Since our last inspection applications for deprivation of liberty safeguards (DoLS) had been completed and submitted for people who could not consent to live at Bafford House or here restrictions had been applied in a person’s best interest.

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 22 December 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

At this inspection we found the provider remained in breach of regulations in respect of good governance and some areas of risk management.

In respect of DoLS, 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 this regulation.

Why we inspected

We undertook this unannounced inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We found these had not been fully met and more time was needed to comply with these.

We found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of the full report.

We also inspected to check if the provider had followed their action plan in relation to a breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014. We found the provider had made improvements and had met this legal requirement.

This report only covers our findings in relation to the Key Questions safe, effective and well-led. The overall rating for the service has not altered from requires improvement based on the findings of this inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 Bafford 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 continued breaches in relation to good governance and safe care. We also identified a new breach in relation to staffing and staff training.

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

We took enforcement action in relation to the breaches of good governance and safe care at our last inspection and will continue to monitor improvement through the action in place.

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.

Bafford House is a residential care home providing personal and nursing care to 16 people aged 65 and over at the time of the inspection. The service can support up to 19 people.

People were accommodated in one adapted building. The service specialised in the care of people who lived with dementia and mental health needs.

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

Processes in place to ensure risks to people’s health and safety were not sufficiently assessed and action taken to mitigate risk was not sufficient. Environmental risks were not always mitigated.

The provider’s quality monitoring system was ineffective in supporting the provider to independently check and assess their compliance with necessary regulations. It did not support a pathway for sustaining improvement.

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. However, processes under the Mental Capacity Act and Deprivation of Liberty Safeguards had not been fully followed to ensure people who may be deprived of their liberty were protected.

Managers had faced unprecedented challenges in staffing the care home and recruiting staff. They had worked hard to ensure this had not impacted on people’s care. It had however, impacted on their ability to maintain adequate cleaning levels.

The recruitment of care staff had just taken place prior to the inspection, but the service still needed to recruit a cleaner.

We have made a recommendation about staff recruitment.

Some areas of infection, prevention and control required improvement and we signposted the service to system partners for further support on this.

There were gaps in staff training and support which meant the service was heavily reliant on very few staff with the level of skills and knowledge to be able to support less experienced staff.

We have made a recommendation about staff training and supervision.

Opportunities for social and stimulating activities had been limited to when care staff were able to support these, but an activities co-ordinator was due to start soon to make improvements to this.

People told us they felt safe and people’s representatives considered their relatives to be safe and well cared for.

People were supported to take their medicines and medicines were managed safely. People were supported to eat and drink safely and to have a choice in what they ate and drank.

People told us they liked the staff who looked after them and all relatives spoke highly of the staff saying they treated their relative with kindness, respect and dignity.

People were supported to maintain their independence and to make daily choices about their care. People’s representatives were kept well informed about their relative’s care and able to contribute in discussions about this.

There were processes in place for the management of concerns and complaints.

Managers were in frequent contact with people and their relatives and this provided opportunities for feedback about the service to be given. Arrangements had not been made by managers to formally request this, as part of the service’s quality monitoring process, since the pandemic started.

We have made a recommendation about seeking feedback.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This service was registered with us on 29 October 2021 and this is the first inspection.

The last rating for the service under the previous provider was Good, published on 16 July 2019.

Why we inspected

This was a planned inspection following the service’s registration but was also in response to concerns received about people’s care. 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.

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

We found people were at potential risk of harm and although the provider had taken some action to reduce risks to people, this was not enough for us to be assured that people were fully safe.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Gloucestershire. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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 maintaining people’s health and safety, adherence to the Mental Capacity Act and Deprivation of Liberty Safeguards and quality monitoring processes at this inspection.

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.