24 February 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.
This inspection took place on 10 February 2022 and was announced. We gave the service three hours' notice of the inspection.
24 February 2022
This unannounced inspection took place on 10 December 2018. We last inspected Boarbank Hall in July 2016. At our last inspection we rated the service as good.
At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
Boarbank Hall Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is owned and run by the Augustinian Canonesses of the Mercy of Jesus, a religious order dedicated to caring for others. The service provides long term and respite care for up to 27 people including palliative and end of life care and convalescent/post-operative nursing care. Boarbank Hall is in the village of Allithwaite overlooking Humphrey Head and Morecambe Bay. On the day of the inspection there were 26 people living there.
At this inspection we found the service remained good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. At this inspection we found that the service was continuing to improve and demonstrated characteristics of 'outstanding'. For example, the service was particularly skilled at caring for and supporting people and their families at the end of life, responding to changing needs, providing meaningful activities and working with other professionals. Professionals who visited the service said that it was well managed, professional and person centred in the care provided.
At the time of the inspection there was not a registered manager in post. However, this had been quickly addressed to ensure continuity and the new manager was already well on with the registration process. 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 new manager was experienced and had the skills required to effectively manage and knew the home well having previously held the registered manager’s post.
The service was currently undergoing accreditation for The Gold Standards Framework (GSF).) for end of life care in care homes. This accredited programme focused upon systems for using and developing high levels of holistic care at the end of a person’s life. Relatives and professional feedback was very positive and appreciative about this aspect of the service.
People who lived at Boarbank Hall told us they felt they were well cared for, were happy and felt safe and secure living at the home. People who lived at the home, relatives and visiting professionals expressed great confidence in the staff skills and knowledge and the management to keep people safe and happy and provide a high standard of nursing care. People told us staff were “very kind” and “really caring.”
We looked at the recruitment files for new staff members and each included required security checks, proof of identity and a minimum of two references. We discussed with the manager that where a person has previously worked with vulnerable people their reason for leaving their previous employment needed to be always clear. The new manager confirmed this would be formally included on all application forms in future.
Staffing levels were monitored and kept at a consistently high staff to person ratio with individual’s dependency kept under review so the service could be flexible to meet changing needs.
Medicines management systems were safe and staff had undertaken appropriate training in medicines administration. Staff were being appropriately trained for their roles and well supported by the registered manager. Systems were in place to give staff the opportunity to discuss their work and have appraisals.
The building was well maintained and was a clean, hygienic and homely place for people to live. We saw that equipment in use was regularly cleaned and had been serviced and maintained safely. We observed staff used personal protective equipment correctly and people being moved by staff in a safe and dignified manner.
People told us they were happy with the variety and choice of meals being provided and that there was always a choice.at meals. We saw that regular snacks and drinks were provided between meals to help make sure people received plenty to eat and drink.
The service had an effective safeguarding policy and staff had undertaken safeguarding training and could explain the process. The staff team were confident in reporting any concerns about a person's safety or wellbeing of anyone in the home.
The manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they worked within the law to support people who might lack capacity to make some of their own decisions. Discussions had taken place to involve people, relevant others and medical professionals in decisions made in any someone’s best interest.
People 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. We observed the daily routines and practices within the home and found people were treated equally and their human rights were being promoted.
Systems were in place to deal with any complaints or concerns raised about the service. The manager and staff treated all complaints and comments as an opportunity to learn and improve the service.
People were supported to express their views and supported to access advocacy services, should they wish to do so. An advocate is an independent person, who will act on behalf of those needing support to make decisions.
Quality assurance systems were in place to monitor the quality and running of service being delivered. People living in the home and relatives were being asked for their views on the service formally and informally. We saw there was a very positive open and supportive culture within the service. Relatives, staff and other professionals were very positive about the leadership of the service.
Further information is in the detailed findings below.