Archived: Baxendale Care Home

Updated 26 April 2019

The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: This inspection team consisted of two adult social care inspectors and three experts-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type: Baxendale Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Baxendale Care Home can accommodate up to 57 people in one adapted building.

The provider is a Charitable Trust. There is a board of Trustees who oversee the management of the service provided at the care home.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: This inspection was unannounced.

What we did: Prior to the inspection, we reviewed the information that we held about the service and the provider including notifications affecting the safety and well-being of people who used the service. We reviewed the Provider Information Return (PIR) which the provider had sent to us. A PIR is a form that asks the provider to give some key information about the service, what the service does well and the improvements they plan to make. We also looked at the action plan that the provider had submitted following the last inspection in December 2017 which listed the improvements they planned to make.

During the inspection we spoke with 12 people using the service and 13 of their relatives to obtain their feedback on the care and support that they or their relative received. We also observed interactions between people and care staff which included the delivery of care in practice.

We spoke with the nominated individual on behalf of the provider, the registered manager, deputy manager, one team leader, six care staff, the activity co-ordinator and two kitchen staff members.

We looked at the care records of five people who used the service and medicines administration records (MARs) and medicines supplies for 12 people. We also looked at the personnel and training files of six staff. Other documents that we looked at relating to people's care included risk assessments, staff meeting minutes, handover notes, quality audits and certain policies and procedures.

Updated 26 April 2019

About the service: Baxendale Care Home is a residential care home that provides accommodation and personal care to older people. At the time of this inspection there were 47 people living at the home.

At the last inspection in December 2017 we found the service to be in breach of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Issues found included inconsistent staffing levels at night, risks associated with people’s health and care needs had not been adequately assessed, people at risk of poor nutrition and hydration intake were not appropriately monitored and ineffective management oversight which did not identify the issues we found.

At this inspection, although we found that the service had made some improvements to staffing levels and risk assessments, we found some issues similar to those identified at the last inspection and other areas of concern that required further attention and improvement.

People’s experience of using this service: People told us that they were happy living at Baxendale Care Home. Their relatives agreed with this and told us that they believed their relatives received safe and good care.

People told us that they enjoyed the food provided at the home and were always offered snacks and drinks throughout the day.

People and their relatives found care staff to be kind and caring and attentive to their needs. We observed interaction between people and staff was positive. Care staff understood people’s needs well.

There were sufficient numbers of staff available throughout the day and night to safely and appropriately meet people’s needs.

Risks associated with people’s health and care needs had been identified. However, not all individual risks had been assessed to ensure staff were given the guidance and information on how to safely support the person with the risk.

The service was not working in line with the principles of the Mental Capacity Act 2005 (MCA). Where people had Deprivation of Liberty Safeguard (DoLS) authorisations in place and these had expired, there was no evidence that re-authorisation requests had been submitted prior to the current authorisation expiring.

At the time of this inspection the service was transitioning from a paper care plan to an electronic care plan system. Although care plans contained some person-centred information about people, care plans were not fully complete and were not consistent in the information recorded.

A variety of monitoring charts were in place for people which included charts for food intake and activities participation. However, these were not always appropriately and fully completed.

People living in the ‘West Wing’ with advanced dementia, had little access to appropriate activities or stimulation for positive well-being.

Checks and audits were in place to oversee medicines management and administration and health and safety. We were told that care plans were checked to see if they were current and reflective of people’s needs but these checks were not recorded. The service had not identified any of the issues we found as part of this inspection process.

Medicines management and administration was generally safe. People were seen to receive their medicines on time and as prescribed.

Recruitment processes followed by the service ensured that only those staff assessed as safe to work with vulnerable adults were recruited.

People and their relatives knew who to speak with if they had any complaints or concerns to raise and were generally confident that their concerns would be appropriately addressed.

More information is in the detailed findings below.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around the absence of current DoLS authorisations and the governance of the service. We have also made a recommendation for the service to consider activities for people living with dementia and ensuring care plans are person-centred. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published March 2018). This service has been rated as Requires Improvement for the second time.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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