Borovere

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

People told us they were happy and safe living at Borovere. Relatives told us their relatives felt safe, and the home was clean and well maintained.

We found the provider ensured people were supported safely. There were sufficient numbers of suitable, motivated staff. Recruitment files did not have all the safe recruitment checks at the time of inspection but the provider took immediate action to rectify this.

Processes and procedures were in place to store and administer medicines safely. Relatives told us they did not have any concerns regarding people receiving their medicines safely. We were assured appropriate infection prevention and control measures were in place to protect people against the risk of COVID-19 and other infections.

The service was well-led. The staff team were well supported by the registered manager. People who used the service and staff were involved in how the service was managed. The registered manager had processes in place to monitor and improve the quality of service people received.

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 good (published 12 February 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

This report only covers our findings in relation to the key questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Borovere 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.

We found the following examples of good practice.

People had been supported to keep in touch with their families throughout the COVID-19 pandemic. Staff provided support where necessary so that people could phone or video call their families. When visitors were able to come to the service, they used a designated outside area with a designated access to manage the flow of visitors. The expectations and procedures for visitors to the service were clear.

The service was receiving professional visitors to the home with robust infection control procedures in place. Visitors were received into the reception area on arrival where they were provided with guidance, personal protective equipment (PPE) and health screening was completed. Each visitor also had their temperature checked by staff on arrival.

The provider had developed policies and procedures in response to the coronavirus pandemic. These policies had been adapted to reflect differences between the different care homes in the group. The guidance and information for staff was clear with detailed safe systems of work for the home. Daily checks and regular infection prevention and control audits were in place. We also saw staff using the correct PPE when providing care and treatment to people who were isolated.

At the start of the pandemic, the trust appointed a small health and safety team to develop and manage COVID-19 guidance and procedures following national best practice. They supported the registered manager to ensure correct infection control standards and protocols were in place and being adhered to. The role also included regular communication with the head office to ensure full supplies of PPE and ensure the home was using the most up to date guidance and aware of best practice in an ever changing care environment.

We saw the mechanisms in place to support staff, risk assessments had been completed with staff or people who used the service and who were identified as facing higher risks. The manager was positive about the commitment staff had shown throughout the pandemic. Staff were regularly tested for COVID-19 and had received COVID-19 vaccinations in January 2021. Staff expressing a hesitancy in taking the COVID 19 vaccine were well supported in their decision-making.

People were supported in a person-centred way, when implementing the changes and procedures required to minimise the risk of COVID 19 in the home. We heard of examples of how individuals had been supported with real compassion and understanding when they had become distressed during this time.

Rating at last inspection

At our last inspection on 9 January 2017 we rated the service Good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Rating at this inspection

At this inspection we found the service remained Good overall, but the key area of safe has deteriorated to Requires Improvement.

Why the service is rated Good

People were safeguarded from the risk of abuse. Risks to people had been assessed and managed for their safety. Incidents were investigated, and any required changes made. Medicines were safely managed and administered by trained staff. The service was clean and well maintained to reduce the risk of people acquiring an infection. There were sufficient staff to meet people’s care needs in a timely manner.

Monthly nutrition and tissue viability charts for two people were not up to date, although people had received the care they required. The registered manager took swift action to rectify this, but further time is required to demonstrate their monthly completion has been sustained.

Relevant pre-employment checks had been completed. However, the registered manager had not followed the provider’s policy which required all staff to complete an annual declaration in relation to their disclosure and barring service check, to ensure no changes had occurred. They took immediate action to address this for people, but it will take time for them to be able to demonstrate this check has been sustained.

People’s needs were assessed prior to the offer of a service. Their care was delivered by staff who had the required skills, knowledge and experience. Staff ensured people received enough to eat and drink for their needs. Staff worked effectively together and across agencies to ensure people received the care and support they required and that their health care needs were met. People’s needs were met by the design of the premises. 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.

People were treated with kindness, respect and compassion by staff. People were supported to express their views and to be involved in decisions about their care and treatment. People’s privacy, dignity and independence were both respected and promoted by staff.

People received personalised care that was responsive to their needs and were provided with opportunities for social interaction and stimulation. People were provided with information about how to make a complaint if they needed to. People were appropriately supported by staff at the end of their life.

There was a positive person-centred culture. Staff understood their roles and responsibilities. People and staff were engaged and involved with the service. Processes were in place to monitor and improve the quality of the service provided.

Further information is in the detailed findings below

This was a comprehensive inspection to check on the provider's progress in meeting the requirements required following our inspection of 8 and 9 February 2016. During that inspection breaches of legal requirements were found in relation to medicines, premises and clinical governance. Following the inspection the provider sent us an action plan detailing how and by when they would meet regulatory requirements. At this inspection we found legal requirements had been met.

The service had a registered manager. 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 told us they felt safe and well supported. Staff had undergone safeguarding training and understood their role in relation to safeguarding and the actions they should take to keep people safe from the risk of abuse.

People told us there were always staff available when needed. Records showed sufficient numbers of competent staff were available with the right mix of skills to meet people’s needs. People were kept safe because the provider had robust recruitment policies and procedures.

The provider had ensured that the premises were secure and suitable for people. Plans were in place to ensure people were safe in an emergency. People’s records demonstrated that risks to them as individuals in relation to their care had been assessed and managed safely.

All of the people we spoke to said they received their medication on time and the provider ensured people received their medicine only from trained, competent staff. Processes were in place to ensure the safe management of medicines. People received their medicines safely.

People told us the staff appeared to be well trained, knew what they were doing and supported them in the way they liked. New staff underwent a relevant induction to prepare them for their role. Staff received regular supervision to support them in their role. Staff were required to undertake a range of training identified by the provider as necessary in order to meet people’s needs. Staff were also supported to undertake professional qualifications in social care.

People said the staff always sought their consent. Staff were able to demonstrate how the Mental Capacity Act (MCA) applied to their day to day work with people. Arrangements had been made to ensure staff were able to complete or refresh their MCA training. Whilst awaiting this training or training update the MCA had been discussed at a staff meeting and MCA pocket reminders of their legal obligations had been provided to staff. Where people were subject to the Deprivation of Liberty Safeguards (DoLS) legal requirements had been met.

People said the food provided was of a good standard. They were offered a choice of nutritious and appetising meals. People had nutrition care plans which provided staff with guidance about their nutritional needs. Risks to people associated with their eating and drinking had been assessed and relevant measures taken to manage these effectively.

People were supported to access a range of healthcare services to ensure they could maintain good health.

People told us the staff were caring and supported them in the way they liked. People experienced positive relationships from staff who received guidance about people’s communication needs and how to engage with them effectively. Staff provided people with relevant information to help them make informed decisions. People were observed to make decisions about their care across the course of the inspection. Staff were aware of and respectful of people’s rights to self-determination. Staff were mindful of peoples’ need for privacy and ensured people’s’ dignity was upheld in the provision of their care.

People had been consulted about the creation of their care plans and their care had been regularly reviewed with them or their representatives to ensure they continued to meet their needs. Staff had a good knowledge of people’s care needs and received training in working with people living with dementia to enable them to support them appropriately. There were two activities co-ordinators employed which enabled people to participate in two activities a day, seven days a week. People’s needs for social stimulation were met.

People we spoke to said they knew how to raise a concern. People’s complaints were investigated and responded to appropriately. People’s views on the service were sought and they were able to provide their input to proposals on how to improve the quality of the service provided.

The service promoted a culture of openness and transparency. There were easy and accessible lines of communication between staff, people and their relatives.

People said that they thought the service was well led and that the registered manager listened to them and acted upon what they said. Staff told us they felt the registered manager was good, supportive, and approachable and felt able to raise any concerns with them. The registered manager demonstrated a good understanding of the challenges for the service, such as recruitment which they were addressing for people.

Audits were used to drive improvements in the service for people. The operation manager’s monthly visits were used to identify areas of the service for improvement and these were actioned. People’s views on the service were sought through surveys and action taken in response to the feedback received. People’s records were accurate, completed in a timely manner and stored securely.

The service had a registered manager. 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 and staff gave mixed views about the adequacy of staffing levels. Assessments of people’s level of care needs were completed and this information was used to determine the level of people’s fees but not the staffing needs of the service. Staffing levels for the service were fixed. There was no budgetary allowance for agency staff and management had to cover shortfalls where possible. There was not always a professionally qualified member of care staff on duty, on-site, to ensure suitable staff were deployed within the service at night. On-call senior care staff were available to be called upon if required. There had not always been a qualified first aider on-site at night as required. The registered manager made arrangements to ensure people’s safety whilst night staff underwent first aid training immediately following the inspection. Although no harm to people resulted from this, there was a risk of harm the longer this situation continued.

There were not robust arrangements in place to ensure staff were qualified and competent to administer people’s medicines. The registered manager took immediate action following the inspection to make sure night staff undertook medicines awareness training to ensure people’s safety. Records in relation to people’s medicines were not always complete. Processes to ensure medicines were stored at the correct temperature were not robust. Staff had failed to ensure people’s liquid medicines were always in date. Processes to monitor the quantity of medicines were not robust. Staff did not always administer people’s medicines safely.

Risks to people from the environment had not been adequately assessed and managed. There was the potential that people could leave the building without staff’s knowledge or be placed at harm through staff not securing unsafe areas of the service, such as the sluice. The garden was not safe and the perimeter was not secure. The registered manager was taking action in relation to the safety of the garden and took action during the inspection to ensure people could not access high risk areas of the service to ensure their safety.

The provider’s quality monitoring systems were not robust or effective. Some issues had not been identified or where issues had been identified they had either not been rectified or had not been addressed promptly. There was the potential that people might experience harm and opportunities to improve the service were not used effectively.

The management of records within the service was not robust. People’s personal care records were not stored totally securely to prevent any potential access by unauthorised people. Other records including people’s daily care records had not been completed at the time the care or support was provided, or there were gaps. People’s medicine records were not always secured when staff administered medicines to people.

People’s records demonstrated that risks to them as individuals in relation to different aspects of their care had been assessed and managed. Staff had access to written guidance about risks to people and had taken appropriate action to mitigate them.

People and relatives told us they felt safe. Staff had undergone relevant safeguarding training and understood their role in relation to safeguarding people and the actions they should take to keep people safe from the risk of abuse. Staff had undergone relevant recruitment checks as part of their application process to ensure their suitability to work with people.

Staff underwent an induction upon the commencement of their role. Unless an issue was identified which needed to be addressed during their induction period new staff did not receive one to one supervision until after their induction. There was a lack of evidence to demonstrate how this policy would adequately support staff to meet the requirements of the ‘Care Certificate’ which is the industry standard induction for new staff. There was the possibility that new staff may not have felt fully supported in their induction to ensure they could provide people’s care effectively.

Where people lacked the mental capacity to make specific decisions, staff were guided by the principles of the Mental Capacity Act 2005. This ensured any decisions made were in the person’s best interests. Not all staff had undergone relevant training but they had access to relevant guidance. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLs applications had been submitted for people where required. People’s liberty was only restricted when this was legally authorised.

People were offered a choice of nutritious meals. People had nutrition care plans that provided staff with guidance about the person’s nutritional needs. People’s weight was monitored regularly.

Staff were observant to changes in people’s presentation and took the required action to ensure they were referred to a healthcare professional if needed. People were supported to access a range of healthcare services to ensure they could maintain good health.

People told us staff were kind and very caring and that they were happy with the staff. People told us they were supported by staff to receive their care when they wanted it and that their wishes were respected. They also told us staff upheld their privacy and dignity when providing their care.

Staff had access to information about people’s life histories and communication needs in their care plans. They used this information to communicate with people in a caring and kindly manner.

People were supported by staff to express their views and to make decisions about their care where possible. For example, they were shown the platter of vegetables at lunchtime so that they could choose what and how much they wanted to be served.

Staff were aware of people’s needs, which were assessed, recorded and reviewed appropriately. Staff supported people to be independent where possible. Staff told us they hoped that one person would shortly be assessed by the GP as able to be supported out of their bed to sit in a chair. However, they were concerned that they would not be able to provide this level of care to the person with the current staffing numbers; this would not promote their independence.

People appeared to enjoy the activities being provided. However people told us that sometimes there was “Nothing to do” when the activities co-ordinator was not available, which was on four days one week and on three days the alternate week.

There was a process for people to make complaints about the service but not everyone spoken with was aware of how to complain. Where complaints had been received appropriate action had been taken to investigate the complaint and make any required changes.

Overall people were happy with the management and one person commented “The manager is lovely.” However, a person’s relative told us the home had changed and that “Management was not as dynamic as it was.” There was a clear management structure in place. Staff told us the management team was supportive and was available to them. The registered manager often worked alongside staff in the provision of people’s care.

We found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We found that people gave consent to care and staff understood how to gain people's consent before offering support. The provider all considered the Mental Capacity Act and acted appropriately and in people's best interests. People said they were given choices and could refuse care if they wished. For example, one person said, 'You are quite free to do what you like. [This is] your home.'

People experienced safe and appropriate care, based on an assessment of their needs and preferences. We saw that the provider planned people's care and took appropriate action when people's health or wellbeing changed.

People were positive about the food. We heard comments such as,'[It's] good food, plenty of choice and plenty of vegetables.' People's specific dietary needs were understood and catered for and the provider supported people with their nutritional intake.

Staff recruitment was robust and the provider had systems in place to monitor the quality of the service and identify and manage risks.

The registered manager and the deputy manager have liaised with the safeguarding team and effective links have been established for raising issues of concern. This has been confirmed by Hampshire's adult services.

The service has also confirmed that all staff have completed basic safeguarding training, with supervisors and managers taking advanced safeguarding courses.