Bloomsbury House

Bloomsbury House is a residential care home providing personal to up to 24 people. The service provides support to people living with dementia. At the time of our inspection there were 15 people using the service.

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

People were not always protected from the risk of harm; we found systems were not effective in reducing risks to people, particularly through monitoring and seeking external support for health needs. Systems in place to safeguard people from abuse were not robust and processes for learning lessons were not effective in driving improvements.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Quality assurance systems were not effective for people. This meant the action taken by the provider had not ensured people received consistently safe and high-quality care. Shortfalls identified at the previous inspection had not been remedied by the provider.

People's preferences and person-centred needs were not always fully considered and met. Group activities were facilitated by the service, but some people spent long periods without any social interaction.

People were mostly treated in a caring and compassionate way, by staff who knew them well. However, the systems in place did not always facilitate a caring experience for people. People’s independence and ability to make personal choices was not always respected.

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 30 April 2021).

We imposed conditions on the registration of the provider, with a view to ensuring the service made improvements towards meeting the regulations. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about how people were supported with moving and handling, how people’s health needs were managed and how people with dementia were safely supported. A decision was made for us to inspect and examine those risks.

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

Enforcement

We have identified breaches in relation to how people's safety was managed, how people were safeguarded from abuse, their rights promoted, people being treated with dignity and respect, how people's person-centred needs were met and how the service was run 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

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.

Bloomsbury House is a residential care home providing personal care to 18 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

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

People’s needs were not assessed by qualified health professionals where required and this meant that we could not be assured peoples’ current needs were being met appropriately.

The provider’s audits in place to monitor the quality of the service were not effective and had not identified the areas of improvement needed which we found during our inspection and as detailed in the report. Feedback about the registered manager was mixed; some found the registered manager approachable and easy to talk to and others did not and were worried to raise concerns.

There were no protocols in place to guide staff for medicines administered as and when required. However, staff we spoke with did know when to administer these medicines and we found that overall medicines were administered safely. Staff could explain the actions they would take to keep people safe from harm. The provider had a recruitment process to ensure they employed suitable staff to support people safely. The provider had an infection control policy in place and staff had access to personal protective equipment.

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 08 February 2018).

Why we inspected

The inspection was prompted in part due to concerns received. The allegations included poor standards of care, unsafe moving and handling practices and poor leadership. A decision was made for us to inspect and examine those risks and we undertook a focused inspection to review the key questions of safe, and well-led only.

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.

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 have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

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

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bloomsbury 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 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 safe care and treatment and good governance 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bloomsbury 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 care home is registered to provide accommodation and personal care to up to 24 people. The home provides care for older people, including those living with dementia. At the time of our inspection we were told that there were 21 people living at the home.

Bloomsbury House is required to have 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 and associated Regulations about how the service is run. At the time of this inspection a registered manager was in post. People knew who the registered manager was and felt able to speak with them to raise any comments or concerns they had.

There were some systems in place to monitor the quality of the service; however we found that some improvements were required to the oversight and management of the service. This included the need for continuous development, in accordance with evidence based practice, particularly relating to specialist dementia care.

We found that people were protected from the risk of abuse and avoidable harm because safeguarding systems and processes were in place and implemented effectively. People were supported by sufficient numbers of staff who had the knowledge and the skills they required to care for people safely and effectively.

People were also protected against any risks associated with their health and care needs because risk assessments and associated care plans were developed holistically, reviewed and monitored. This ensured that people received the support they required to remain safe. People and their relatives were involved in this process alongside any key professionals and care staff. This ensured that care was person-centred and any decisions made in respect of their care and support needs, were done so within their best interests and in accordance with the Mental Capacity Act 2005. Where people were assessed to lack the capacity to consent to the support they received, the provider had followed key processes to ensure that care was provided in the least restrictive ways possible. Applications had been made to safeguard people against the unlawful deprivation of their liberty, where necessary. People’s privacy, dignity and independence were respected at all times.

The premises and equipment were well maintained and clean but would benefit from being adapted to ensure people were supported to remain as independent as possible, particularly those living with dementia.

People received support from staff to take their prescribed medicines as and when required. Systems and processes were in place to ensure medicines were managed safely and only senior members of staff who had undergone specific training and supervision were permitted to administer medicines within the home.

People were supported to maintain a healthy diet and all health needs were met with the support from staff. It was evident that people had developed positive relationships with staff and there was a friendly, calm, relaxed atmosphere within the home. Staff knew people’s likes, dislikes and preferences well and the deployment of an activity co-coordinator meant that people had the opportunity to engage in activity. However, improvements were required to ensure that activities were age-appropriate and relevant to people’s hobbies and interests.

Systems and processes in place to monitor the safety and quality of the service included the involvement of people and relatives. The provider ensured that information was available in different formats to meet the needs of people and promoted their involvement in providing feedback on the care and support they received. Everyone we spoke with knew how to complain and were confident that any concerns they rose would be dealt with efficiently and effectively. Staff were complimentary of the leadership and management style of the registered manager and provider; they found them to be supportive and approachable with an ‘open-door’ policy.

We saw that people had good relationships with staff and when they asked for assistance staff responded to people in a discreet and friendly manner. Staff provided support throughout the day to people. All the people we spoke with told us that they were happy in the home and three people told us, "We are looked after well." This meant that people received the support they wanted and needed to ensure their health and care needs were met.

People's nutritional and hydration needs were met through varied meals and support so that they were able to eat and drink safely. One person told us, "There is soup and sandwiches for tea. Suits me just right."

Staff had been provided with the skills and knowledge to protect people from abuse.

The provider had systems in place to ensure the safe storage and handling of medicines but had not ensured that changes to medication regimes were implemented in the home quickly. This meant that people did not always get their medicines as prescribed.

Bedrooms were personalised, communal areas were comfortable and adaptations were in place to ensure people's needs were met. This meant the premises met people's needs.

There was a complaints procedure and suggestions box in place to enable people to suggest improvements to the service.

During our visit we spoke with four people using the service, two staff and the manager. People spoken with told us that they were given a choice about what they wanted to eat each day, snacks and drinks were available and if they wanted anything to eat at night they were asked what they would like. One person told us, 'The food is very good we get plenty to eat and drink any time we ask'.

At this inspection, we found that the provider had taken the necessary action to ensure people were provided with a choice of suitable and nutritious food and drink to meet their nutritional needs.

We saw that staff treated people with respect and dignity. Three of the five people spoken with told us, staff are very kind and considerate nothing is too much trouble for them.

All of the staff spoken with was able to tell us about people's needs so that they received care in a way that the they preferred. All five relatives told us they were consulted about their relative's care and kept informed about their relative's health so they felt involved in their care. All five people spoke with told us they felt safe living there.

People were not always supported to eat a healthy and nutritious diet to help keep them healthy.

Staff told us they had a range of training so that they have up to date knowledge and skills in order to support the people who live there.

The provider was in the process of seeking people views about the service provided. The manager told us when all the information had been collated and analysis would be completed to improve the service where needed.