Archived: Baxendale Care 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

This inspection took place on 7, 8 and 19 December 2017. The inspection was unannounced. The last inspection of the home was in December 2016 and the home was rated good at that time with no breaches of legal requirements.

This service 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.

Baxendale Care Home accommodates up to 57 people in one adapted building. This includes one separate six bed unit within the home for people living with dementia.

The home has 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. At the time of the inspection the registered manager was absent so was not involved in this inspection. The rest of the management team; two deputy managers and a housekeeping manager were available and helped throughout the inspection.

The provider is a Charitable Trust. There is a board of Trustees, some of whom form a House committee to oversee the service provided at the care home.

This comprehensive inspection was prompted in part by concerns reported to the Commission that the home did not have enough staff employed, particularly at night and there were concerns about night time care. We found that some of the concerns about staffing were valid. We did not find evidence of poor care at night but we did find staff were working under pressure and found it difficult to manage people’s needs at night.

People were safeguarded from abuse and felt safe in the home. They received their medicines safely and received support with their personal care. The home and equipment was well maintained, the standard of cleanliness was very good and people were protected from the risk of infection.

Staff training was good and equipped staff well to provide effective care. Staff worked hard, were committed to people living in the home and had formed good relationships with them. People told us that staff were kind and caring. People also felt their dignity and privacy was respected.

People received good support to access health services when they needed them. The food in the home was good and people said they were happy with their diet. They enjoyed some group activities. People with dementia and those who stayed in their rooms had less opportunity for social interaction.

People said they felt able to raise concerns if they needed to and thought they would be listened to. They had appreciated a recent residents meeting where they could give their views. Relatives gave us very positive feedback about the home and the standard for care.

The charity charged reasonable fees and paid staff well. They had made continuous improvements to the facilities and had plans for further improvements. The Trustees met monthly and met with the registered manager.

We have made five recommendations in this report. We have made a recommendation to provide activities for people living with dementia and also to seek advice on person centred care. We also made a recommendation about seeking training in following correct best interest decisions practice when making decisions on behalf of people who did not have capacity to make the decision for themselves. This was because there was a lack of written evidence that this process had been followed for one person. We have made a recommendation to review the way that medicines are moved around the home, assessing the risks for people who manage their own medicines and reviewing whether the door to West Wing unit needs to be locked.

We found three breaches of regulations at this inspection. One was about staffing levels and supporting staff. This was because staffing levels, particularly at night, did not always meet people’s needs fully. Another regulation breached was about safe care. Risks to the health and safety of people with high needs and those at risk of falling over had not been fully addressed. The monitoring of food and drink for those at risk of poor nutrition and/or dehydration was not effective. The deputy manager implemented some improvements in this when we raised it as a concern. The third breach of regulation was governance of the home as the quality monitoring by the provider and registered manager had not picked up the concerns we found. The monitoring of medicines and records of care provided had not been sufficiently regular or effective. Although the registered manager was away and not involved in the inspection the deputy managers were open and keen to make improvements. Some improvements were made immediately after the first day of the inspection. You can see what action we told the provider to take at the back of the full version of the report.

Baxendale Woodside Home is a care home for older people with dementia and physical frailty. The home has 57 beds. It is run as non-profit Charitable Trust. On the day we inspected there were 52 people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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.

People were positive about the service and the staff who supported them. People told us they liked the staff that supported them and that they were treated with dignity and kindness.

Staff treated people with respect and as individuals with different needs and preferences. Staff understood that people’s diversity was important and something that needed to be upheld and valued. The care records contained detailed information about how to provide support, what the person liked, disliked and their preferences. People who used the service along with families and friends had completed a life history with information about what was important to people. The staff we spoke with told us this information helped them to understand the person.

The care staff demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home. People told us they never had to wait for assistance. The atmosphere in the service was calm and relaxed and staff did not appear to be rushed.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Medicines were managed safely. Staff had detailed guidance to follow when administering medicines. Staff completed extensive training to ensure that the care provided to people was safe and effective.

There was an open and transparent culture and encouragement for people to provide feedback. The provider took account of complaints and comments to improve the service. A complaints book, policy and procedure were in place. People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and reports on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. The manager had knowledge of the MCA 2005 and DoLS legislation and appropriate referrals for DoLS authorisation had been made so that people’s rights would be protected.

The management team provided good leadership and people using the service, relatives and staff told us they were approachable, visible and supportive. We saw that regular audits were carried out by the management committee to monitor the quality of care.

Care staff received regular supervision and appraisal from their manager. These processes gave staff an opportunity to discuss their performance and identify any further training they required. Care staff placed a high value on their supervision and appraisal.

The provider employed an activities co coordinator who organised a range of activities that provided entertainment and stimulation for people living in the home.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We reviewed records for five people who used the service. All had care plans and most had risk assessments. We spoke with eight people who use the service and seven relatives. People spoke highly about the care they received from staff. People commented, 'the care is very good, we are well looked after,' 'we thoroughly enjoy everything about the home,' and 'I am very happy here.'

People were protected from the risk of inadequate nutrition and hydration. We saw that people were given a choice of food and drink at lunchtime.

The provider worked in co-operation with other professionals involved in the care of people. On the day of our inspection we spoke with the optician who told us that he made regular visits to the home to carryout eye tests and deliver prescription glasses. We saw evidence of appointments of other healthcare professionals, such as the GP, dentist, and chiropodist. This helped facilitate communication between different professionals involved in the persons care and to ensure continuity of care.

People were protected from the risk of abuse because the provider took appropriate action to prevent it from happening. Systems were in place to gather information about the quality of the service; however we were concerned that records for people were not always accurate or up to date.

Staff had the knowledge and skills needed to protect people from abuse. They received appropriate training and support so that they could deliver the care people needed. Medication was managed, administered and stored correctly. The service was regularly monitored by the provider in order to improve the quality of service and minimise risks to people receiving the service.