We carried out a review of the data available to us about Buxton House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Buxton House, you can give feedback on this service.
Buxton House is a residential care home providing personal care to up to 61 people. The service provides support to older people including people living with dementia. At the time of our inspection there were 52 people using the service.
People’s experience of using this service and what we found
The provider had made improvements at the service since our last inspection. However, not enough time had passed for the changes to be fully embedded at the service. The Care Quality Commission (CQC) need to be assured going forward the provider's quality monitoring systems and oversight will continue, and effectively identify and resolve all concerns. Therefore, the governance and oversight of the service remains an area for improvement.
The provider had produced an action plan reflecting the improvements required by CQC. This was monitored and updated weekly by the provider’s representatives and management team. This plan had driven the improvements made and those needed moving forward.
There were improvements made in record keeping, communication and governance systems at the service. Notifications about significant events were now being made to CQC. The improved governance systems in place were identifying areas for improvement and these were now acted on.
Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic, were assessed and managed and safe visiting was supported.
There were enough staff to meet people’s needs and there was a core of staff and regular agency staff who knew people well. Staff understood and anticipated people’s needs which contributed to the calm and homely atmosphere at the home.
Any risks to people were now fully assessed and mitigated. People received the care and support they needed to keep them safe. Medicines were managed safely and effectively by staff who were trained and competent to do so.
Staff received training, support and supervision. Staff told us they felt well supported to carry out their roles and told us everyone worked very well together as a team for the benefit of the people living at Buxton House.
People had improved mealtime experiences and access to drinks and snacks. Staff supported people to eat and drink uninterrupted and in a relaxed and chatty atmosphere.
People were supported to maintain their independence and have maximum choice and control in their lives. Where people lacked mental capacity to make decisions, these were made in line with the Mental Capacity Act 2005 and staff supported people in the least restrictive way; the policies and systems in the service supported this practice.
Care plans were person centred and they detailed how people wished and needed to be cared for.
There was an open and positive culture within the home and people, their relatives, staff and professionals told us the management team were approachable, responsive and helpful.
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 25 May 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also served warning notices for the repeated breaches of safe care and treatment and good governance regulations. The provider was required to be compliant with those regulations by 9 August 2022.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last 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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Buxton House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Buxton House is a residential care home providing personal care to up to 61 people. The service provides support to older people including people living with dementia. At the time of our inspection there were 59 people using the service.
People’s experience of using this service and what we found
Some people could not be consistently confident that the risks they faced would be assessed, managed and monitored and the care they needed would be provided.
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; in the main, the policies and systems in the service supported this practice. However, some people’s legal representatives were not always making decisions for people and best interest decisions were not always reviewed or updated following changes.
There were continued shortfalls in the record keeping, communication and governance systems at the service. Feedback from the local authority quality and safeguarding was not included in improvement plans. Notifications about significant events had not always been made. The governance systems in place had not fully identified all of our findings at this inspection.
Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic were assessed and managed. Overall, staff followed recommended IPC practices with some minor areas for improvement. Safe visiting was supported.
The registered provider and manager took actions in response to our feedback and findings. However, we cannot yet be confident that this will impact positively on people living at the service.
People felt safe and were comfortable and relaxed with staff who supported them. Relatives told us they felt their family members were safe and overall were well cared for. Throughout the inspection we saw relaxed, kind and caring interactions between staff and people.
There were enough staff to meet people's needs and there was a core staff team who knew people well. Staff spoke fondly and knowledgeably about the people they cared for.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 22 November 2021).
At our last inspection we found breaches of the regulations in relation to risk management and governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.
At this inspection, we found the provider remained in breach of regulations.
Why we inspected
We carried out this inspection to follow up on action we told the provider to take at the last 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.
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 found breaches in relation to the assessing, monitoring and management of risks to people, involving people and/or their appointed representatives in decision making and people’s care plans were not consistently updated. There were also shortfalls in relation to record keeping, making notifications 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.
We have issued warning notices for the breaches of regulation 12, Safe care and treatment and regulation 17, Good Governance. The provider must become compliant with the regulations by 8 August 2022.
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.
Buxton House is a residential care home providing personal care to 61 people aged 65 and over at the time of the inspection. The service can support up to 64 people.
People’s experience of using this service and what we found
People lived in a home that had been through changes in leadership. The registered manager of Buxton House had returned to the home one week prior to our visit following a secondment. During this time, they had maintained contact with the home and deputy manager and visited the service weekly. For the duration of the secondment, the deputy manager had acted in the capacity of home manager with the support of the registered manager and provider.
There was mixed evidence regarding how well risks were managed in the home. We identified positive examples of how risks were identified and managed, however we found examples where actions were not taken in a timely manner and risks were not sufficiently monitored.
Staff improved their hand hygiene practice following our initial visit to the home. With the exception of one member of staff they wore PPE appropriately. This was addressed by the registered manager.
There were enough staff deployed to meet people’s needs but the team had been chronically short staffed, and staff told us they were tired. This had an impact on staff morale. The senior team were aware of this and had been working hard to improve staffing. The senior team were confident that staffing had never fallen below safe levels.
We received mixed feedback from relatives about their confidence in the care provided for loved ones and the communication they had with staff in the home. The registered manager was working to address this.
People were being supported to see visitors safely, and to go out with friends and family in line with current government Covid-19 guidance.
People told us they felt safe and we saw that they were relaxed in the company of staff. They were supported by staff who understood how to identify and report safeguarding concerns.
People enjoyed the food and there were pleasant atmospheres at mealtimes; some lively and humorous, others calmer. Staff supported people to eat and drink well during the inspection. Where people were at risk of not eating and drinking safely or were at risk of not eating and drinking enough, staff liaised with appropriate professionals.
Health professionals spoke positively about people’s access to health care and the way the staff monitored people’s well-being and followed guidance.
People’s needs were assessed before they moved into the home. People were happy with the way their care and support was provided and staff were confident in their understanding of people’s needs.
People 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 but it was not always clear that representatives with the legal right to make decisions were making those decisions. The registered manager told us they would address this. We have made a recommendation about this. The policies and systems in the service supported good practice related to choice and control.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes this is through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). There was a robust system in place to ensure the oversight of DoLS and any conditions attached to them.
The environment had been adapted to meet the needs of people and to improve their experiences. A dementia strategy was about to be implemented that would further support the development of a dementia friendly environment.
The management team was responsive to the feedback throughout our inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 29 December 2017).
Why we inspected
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 received concerns in relation to staffing and risk management. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement.
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 Buxton House on our website at www.cqc.org.uk.
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.
Buxton House 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. The service is able to accommodate up to 64 people. At the time of the inspection there were 64 people living at the service.
There was a registered manager in post at the time of this 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 at the service told us they felt safe and that staff supported them well. People’s relatives also spoke positively. There were systems in operation to ensure that safeguarding concerns were identified and responded to timely. People’s risks were assessed and managed safely, and where risk management plans were in place we saw evidence this had been done in the least restrictive way. There was learning from adverse incidents such as accidents and falls. The premises and equipment was maintained to ensure it was safe. We received some mixed feedback on staffing and have made a recommendation on increasing the frequency of reviewing the staffing dependency tool. Recruitment was safe and people received their medicines when they needed them from competent staff. The service was clean.
People’s physical, mental and social needs were assessed. Nationally recognised tools for the identification of skin damage or weight change were used to achieve positive outcomes. People said they received effective care from staff. Staff had received appropriate training to meet the needs of the people they supported. New staff received an induction aligned with national accreditation and there was an ongoing programme of supervision and appraisal. People received support to eat and drink sufficient amounts.
Staff worked together to communicate people’s needs and people were supported moving between services. No concerns were raised by people or their relatives in relation the adaptation or design of the service. Staff understood their obligations under the Mental Capacity Act 2005 and we saw capacity assessments and best interest meetings had been completed where required. The service had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005.
People told us staff were caring and supported them in a kind and compassionate way. We made observations to support this. People’s relatives were mostly positive about the care provided in the service and were complimentary about staff. We reviewed a selection of compliment cards sent to the service that reflected the verbal feedback we received. Staff understood the needs of the people they supported and recognised the importance of using people’s care records to understand their care needs. People told us that staff treated them with dignity and respect and gave examples of how staff achieved this. People’s visitors were welcomed which reduced the risk of social isolation.
People said the care they received met their needs and that staff at the service were responsive. People felt involved in decisions about their care. Relatives told us they felt involved in care decisions and said the service kept them informed of significant change. Care records were personalised and reflected people’s needs. We made observations that care was being delivered in line with people’s assessed needs and preferences. The service provided activities and we saw examples of how people had been able to follow their interests and also examples of when people had accessed the wider community. There was a complaints system in operation people felt they could use. People were supported at the end of their life to have a comfortable, dignified and pain-free death.
The registered manager had a vision for the service aimed at delivering high quality care. Staff we spoke with felt valued and supported and commented positively on the proactivity and visibility of the registered manager. Staff felt able to contribute to the service and gave examples of how suggestions they had made had been implemented. People and their relatives were positive about the service management and were happy to approach senior staff if required. There were governance systems to monitor the health, safety and welfare of people. The service received provider level support in monitoring the effectiveness of internal governance systems.
There were systems to communicate with people and their relatives to allow them to share their views and opinions of the service. There were systems to learn and improve and the service worked from a continual improvement plan based on feedback from the provider audits and external agencies. To support the service to continually learn, the registered manager was involved with external agencies and organisations. This included the adult and community services team from the local authority and the local Clinical Commissioning Group (CCG) forum with other registered managers and providers.
The inspection took place on the 9 and 10 June 2016.
Buxton House is registered to provide accommodation and personal care for up to 64 people in a residential area of Weymouth. At the time of our inspection there were 60 older people living in the purpose built home that was comprised of four separate units over two floors. The first floor of the building was designated for the care of people living with dementia and at the time of our inspection 28 people were living there.
There was a registered manager in post at the time of our 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.
The home was last inspected in August and September 2015 and found to be in breach of regulations relating to: the deployment and support of staff; safeguarding; how people were treated with dignity and inspect; person centred care; quality assurance and safe care and treatment including concerns about the safe administration of medicines. The provider told us they would make improvements and at this inspection we found that improvements had been made; people were receiving better quality care and staff felt supported.
We also found some areas where further improvement was necessary. We discussed these with the registered manager and senior managers and they described the plans they had in place to address these issues or took immediate responsive action.
The registered manager had not made appropriate checks on the agency staff who worked in the home. We highlighted this and the checks were put in place during the course of our inspection.
Audits whilst largely effective had missed some areas identified by inspectors. The registered manager and senior managers told us they would consider the scope of the audits to address this.
Staff used their knowledge of people’s preferences and communication skills to develop caring relationships with people. They also sometimes audibly discussed care tasks with reference to people in communal areas which did not promote dignity and respect. The registered manager described work that was being done to promote dignity and respect.
Deprivation of Liberty Safeguards (DoLS) had not been applied for when people needed their liberty to be restricted for them to live safely in the home. This had been due to recent changes in personnel in the home and was addressed immediately.
People felt safe but some people’s risks were not reduced effectively because their care plans were not followed or records were not kept to review how these plans were working. However, most people were supported in ways that reduced the risks they faced because staff who understood these risks and the care the person needed to reduce them. This was an area for improvement and the registered manager and senior managers described the measures in place to ensure these plans were monitored and reviewed effectively.
Staff understood how people consented to the care they provided and encouraged people to make decisions about their lives. They understood the principles of the Mental Capacity Act 2005 and described how they applied them in their work.
People had support and care when they needed it from staff who had been safely recruited. These staff understood people’s care needs and spoke confidently about the support people needed to meet those needs. They told us they felt supported in their roles and had undertaken training that provided them with the necessary knowledge and skills. There was a plan in place to ensure staff received the training they needed to stay up to date with the care needs of people living in the home.
People were at a reduced risk of harm because staff knew how to identify and respond to abuse. Information about how to report abuse was available to staff. People also told us they saw health care professionals when necessary and were supported to maintain their health by staff. People’s needs related to ongoing healthcare and health emergencies were met and recorded. People received their medicines as they were prescribed.
People were positive about the care they received from the home and told us the staff were kind. Staff were cheerful and treated people and visitors with respect and kindness throughout our inspection.
People described the food as good and there were systems in place to ensure people had enough to eat and drink. When people needed particular diets or support to eat and drink safely these were in place.
People were involved in a range of group and individual activities that reflected their personal preferences. Activities were provided by a team of activities staff who worked across the whole week and also by care staff.
Improvements had been made, and continued to be made, to the care of people and support of staff at Buxton House. People, relatives and staff were invited to contribute their views and staff in particular felt part of the process of improvement. Support from senior management from the provider organisation was evident. Staff, relatives and people spoke positively about the management and staff team as a whole.
This unannounced inspection took place on 18, 25, 28 August 2015 and 03 September 2015. The home is a residential care home and provides support, assistance and personal care for up to 64 older people, including people who have dementia. At the time of our inspection there were 61 people using the service. The home is purpose-built and comprised of four units spread out over two floors, a ground floor and a first floor, accessed by stairs and a lift. The first floor was designated for the care of people with dementia. There was an outdoor garden space and a court yard for people to use.
The home was last inspected on the 13 May 2013 and found not to be meeting the standards in the management of medicines and assessing and monitoring the quality of the service. People were not protected against the risks associated with medicines and care plan audits had not identified inaccurate information. A medication audit did not identify medication recording and procedural errors.
There was a registered manager who had recently started work at the service from 30 June 2015. The registered manager had begun to identify some areas for improvement and development at the home, including changes to shift patterns and shift handover sessions. 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.
There was not enough suitable staff to keep people safe and meet their needs. People were not receiving the care they needed because staff had left or were absent due to sickness or holiday and new staff had not been replaced in sufficient time. People and their relatives told us that staffing levels were not consistently sufficient to keep people safe or meet their needs.
People were not protected from abuse because two staff did not recognise the signs of abuse and were unaware of the risks that some people’s behaviour presented. People were at risk from physical and psychological harm from each other yet two staff accepted that this was usual behaviour.
There were inconsistencies in how risks to individuals were assessed and care plans did not always reflect people’s current care and support needs. Risks relating to falls and poor balance had not been updated following changes to their needs.
Plans were discussed with staff, actions taken and changes were made in response to recent emergencies so that learning from these events improved safety.
Medicines were not being managed safely. Medicine charts for 12 people were found to have gaps, making it difficult to tell whether people had received their prescribed medicines on time.
In June 2015 a fire inspection by the fire service found that certain fire equipment and system checks had not taken place and fire drills and staff training was not adequate. However since the fire inspection findings, action was taken to resolve and address this.
People were cared for by staff that did not have up to date plans to develop their knowledge and skills. There were inconsistencies in staff’s experience of recruitment, training, supervision and support. Staff reported mixed experiences which meant that some staff received regular support and training while others did not.
People told us that the food was ‘excellent’. There was variety and choice of meals including fruit, nutritional snacks and refreshments throughout the day.
People were given support to maintain their health through regular contact with health professionals including dentists, occupational therapists and GPs.
Where people lacked mental capacity to make decisions for themselves they were assessed and staff were made aware of how to support people with their decisions. Staff explained that some people had best interest decisions made to help keep them safe.
On several occasions we saw staff from one unit carry out care that did not respect privacy or reflect dignity when supporting people with their meal and when checking someone’s skin. Staff comforted people when they were distressed. They asked people questions to clarify and understand their concerns and promote their well-being
People and their relatives told us staff respected them, acknowledged their choices and called them by their preferred name.
Some people did not receive individual care and support in a personalised way to meet their needs. Arrangements to regularly assess, record and review people’s care needs did not always take place. Care needs were not always reviewed and managed in a practical way to reflect changes.
Equipment and resources were made available to help people retain their independence. These included rim edged bowls and plate guards to help people manage their food and hand rails to support people when they moved about the home.
Written complaints had been investigated, explored and responded to, although some people and relatives told us that while their verbal concerns were acknowledged, these were not always fully addressed and resolved. Compliment letters sent by friends and relatives about people who had died or moved on expressed positive comments about peoples experiences.
While quality checks were used to measure, monitor and review the delivery of care not all checks identified gaps in care or changes that required redress. Emerging themes from quality checks were not picked up and follow up actions from these checks did not show how some gaps we identified were being addressed.
Care records and other records including staff training plans were not robust and did not sufficiently reflect what was happening on a day to day basis.
Staff told us there had been a lack of clear leadership and management of the home until recently and this had led to confusion about roles and responsibilities and low staff morale. People and their relatives expressed concerns about the changes in management and how this had affected their care.
The recently appointed registered manager was aware of the responsibilities involved in delivering an effective and well-led service and had started to address some of the challenges.
You can see what action we told the provider to take at the back of the full version of the report.
Medicines were appropriately stored, however the recording of some medicines administered was not specific regarding the dose given. We saw that the opening dates on some liquid medicines and inhalers had not been recorded by staff as required.
The home had systems to monitor the quality of service provided. However, the absence of the regular auditing of medication and care plan documentation had not ensured that certain documentation had been completed accurately by staff.
In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. There was no registered manager in post at Buxton House at the time of our inspection.
We spoke with five people about the care they received at the home. They told us that they felt safe at the home. They told us that staff respected their dignity and gave them choices about want they wanted to do. The people living at the home and people important to them told us there was enough staff to meet people's needs.
We observed that people were given time to complete tasks at their own pace for example to eat their meals in a unhurried manner. We observed staff interacting with people in a professional and empathic manner.
The management at the home told us about what they had improved by way of audits and assessments and the plans they had in place to ensure that the home complies with the national minimum standards.
People told us that staff ensured their privacy was maintained during personal care. One person told us that staff always knocked before entering their room. They also told us that staff support them with the things they find hard to do for themselves. We observed staff assisting people when they could and found that the interactions were empathetic and caring.
People who could tell us their views told us they felt safe at the home. We spoke to staff one told us of their safeguarding concern. We found that the home had not followed its own safeguarding procedures and had not reported these concerns to the local authority.
The people living at the home and people important to them told us there was not enough staff to meet people's needs. We observed a person waiting for up to 25 minutes to get assistance with their personal care needs.
We looked at care records and found that these were either incomplete or not up to date. The staff told us they did not have time to complete them. People were put at risk of unsafe or inappropriate care as the records did not inform staff how people's needs should be met.
People also told us that sometimes in their opinion there are not enough staff to support them in the way they want at certain times of the day and they have to wait.