Archived: Bunkers Hill Care Home

People’s experience of using this service: People received safe care. Safeguarding policies and procedures were in place to protect people from harm and abuse. Management of people’s medicine was robust. Staff followed infection prevention and control practices. Staffing levels were monitored and there were enough skilled and experienced staff to meet people’s needs.

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

Staff received appropriate induction, training, and support and applied learning effectively in line with best practice. This led to good outcomes for people and supported a good quality of life.

Where risks to people’s wellbeing had been found detailed person-centred care plans and risk assessments were in place to inform the staff about the care people needed to receive.

People had their capacity assessed and were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring and kind. People we spoke with and their relatives confirmed this. Staff provided comfort and support if people became anxious or upset. Information was provided to people in a format that met their needs in line with the Accessible Information Standards.

Staff supported people to meet their health and nutritional needs. People were supported and encouraged to maintain their independence. Staff worked with health care professionals to maintain people’s wellbeing.

People felt able to raise concerns and were confident they would

be addressed. There was a good programme of activities in place. Dignified end of life care was provided at the service.

The service was well-led. The registered manager supported the staff team and they all worked well together. A range of quality checks and audits were undertaken to monitor the service provided. Action plans were created when shortfalls were found and corrective action was undertaken to improve the service

Continuous improvement, learning and innovation had been implemented at the service. Community links were promoted. People and relatives had the opportunity to provide feedback about the service. Data security was maintained.

Rating at last inspection: At the last inspection the service was rated requires improvement with two breaches of regulation (report published on 18/04/18). Following the last inspection we asked the provider to complete an action plan 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: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

Bunkers Hill Care Home is registered to provide accommodation, nursing and personal care for 78 adults of all ages. The service can provide care for people who live with dementia, who have physical adaptive needs and/or who have special mental health needs. There were 76 people living in the service at the time of our inspection visit. The accommodation was arranged on two floors and was divided into self-contained units. Two of these that were called Bluebell and Honeysuckle were on the first floor. They were reserved for people who needed nursing care and who lived with dementia. The units on the ground floor were called Primrose and Jasmine. They were used to accommodate people who only required residential care.

The service was run by a company who was the registered provider. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 10 September 2015 the service was rated, ‘Good’.

At this inspection the service was rated, ‘Requires Improvement’.

We found two breaches of regulations. This was because the registered persons had not suitably assessed risks to the health and safety of people who received care and treatment. In addition, they had not done all that was reasonably practical to reduce such risks. Furthermore, the registered persons had failed to suitably assess, monitor and improve the quality and safety of the service in the carrying on of the regulated activities. This was because quality checks had had not always resulted in shortfalls in the service being quickly put right. In addition, the arrangements used to consult with people and their relatives about making improvements in the service were not robust. You can see what action we have told the registered persons to take at the end of the full version of this report.

Our other findings are as follows. Sufficient care staff had not always been deployed and some background checks had not been completed before new care staff were appointed. However, nurses and care staff knew how to keep people safe from the risk of abuse including financial mistreatment.

Suitable arrangements had not always been made to enable people to receive effective care. Nurses and care staff did not consistently use national guidelines by seeking people’s consent for the care and treatment they received. In addition, some parts of the accommodation were not designed and adapted to meet people’s needs. However, there were arrangements in place that were designed to assess people’s needs and choices so that care was provided to achieve effective outcomes. In addition, nurses and care staff had received training and in practice they knew how to provide people with the assistance they needed. This included ensuring that people had enough hydration and nutrition to maintain a balanced diet. Furthermore, there were arrangements to help people receive a coordinated care when they moved between different services and people had been supported to receive on-going healthcare assistance.

Nurses and care staff had not always been given all of the resources they needed to provide people with a service that consistently promoted their dignity. However, people were supported to express their views and be actively involved in making decisions about their care as far as possible. In addition, people's privacy and independence were respected. Furthermore, confidential information was kept private.

People did not always receive responsive care and treatment including having information presented to them in an accessible manner. In addition, people had not always been offered sufficient opportunities to pursue their hobbies and interests and to engage in social activities. Furthermore, records did not show us that complaints and concerns had been properly managed and resolved. However, suitable provision had been made to promote equality and diversity. As part of this the registered persons recognised the importance of appropriately supporting people who chose gay, lesbian, bisexual and transgender lifestyles. Furthermore, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

The registered persons had taken a number of steps that were designed to develop the service’s ability to comply with regulatory requirements. In addition, the registered manager promoted a positive culture in the service that was intended to achieve good outcomes for people. Care staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. A number of measures were in place to promote the financial sustainability of the service. Furthermore, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

People told us they were happy living in the home and felt staff respected their decisions and wishes. They said they received a good quality of care and support which met their needs. They also told us they enjoyed a range of meaningful activities.

We spoke with the manager about the quality of some personal records in relation to signatures on care plans, medication plans, personal fire evacuation plans and end of life wishes. The manager said they would address this immediately.

We found there was enough qualified, skilled and experienced staff to meet people's needs. Relatives told us they thought staff had the skills to meet people's needs.

There was an effective system in place to monitor the quality of the services provided, which included seeking the views of people who lived in the home and their representatives.

We spoke with a number of people who used the service to gather their views about the care they received. However, some people had complex needs which meant they were not able to tell us about their experiences. Therefore we used different ways to help us understand if the care met their needs. For example, we looked at care records, we spoke with relatives, we spoke with the managers and staff who supported people, and we observed how they provided that support. We also spoke to visiting professionals, such as training assessors.

We saw people were supported to make choices and decisions about their lifestyles, and they were treated with dignity and respect.

In general we saw that people were supported by a knowledgeable care team, and they received the care and support they wanted and needed. Staff demonstrated a good understanding of their roles within the home.

People told us things like, 'Its wonderful here, I get everything I want,' and 'The staff are great, they really know how to help you out.'