We carried out a review of the data available to us about Bushmead Court Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bushmead Court Residential Home, you can give feedback on this service.
We found the following examples of good practice.
• Staff in the service had made short films and taken photographs for new people and their relatives who were not able to visit the home prior to moving in. These visual aids acted as a virtual tour to enable people to look at areas within the service including their bedroom and see staff within the service.
• People were able to access an onsite hairdresser. The hairdresser had completed additional training in relation to infection control procedures during the Covid-19 pandemic. This enabled them to put into place strict cleaning schedules between appointments.
• The service used creative ways to ensure activities were still offered to people living in the service. On the day of our visit we were told that a singer was due to visit the service the following day. The singer was going to set up their stage in the garden so that people could watch them from the conservatory. The conservatory was arranged to ensure social distancing was in place.
Further information is in the detailed findings below.
The home can accommodate up to 27 older people who have a range of care needs including dementia and physical disabilities. The accommodation is arranged over three floors and can be accessed using the passenger and stair lifts provided. There are 23 bedrooms and a choice of communal areas, including accessible outside space. At the time of this inspection there were 21 people living at the home.
At the last inspection in October 2015, the home was rated Good. During this inspection, which took place on 18 January 2018, we found the home remained Good.
Why the home is still rated Good:
People were protected from abuse and avoidable harm. Staff had been trained to recognise signs of potential abuse and knew how to keep people safe. Processes were also in place to ensure risks to people were managed safely.
There were sufficient numbers of suitable staff to keep people safe and meet their needs. The provider carried out checks on new staff to make sure they were suitable and safe to work at the home.
People received their medicines when they needed them. Systems were also in place to ensure people were protected by the prevention and control of infection.
There was evidence that the home responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.
People received care and support that promoted a good quality of life and was delivered in line with current legislation and standards. Staff received training to ensure they had the right skills, knowledge and experience to meet people’s needs.
People were supported to have enough food and drink to maintain a balanced diet. Risks to people with complex eating and drinking needs were being managed appropriately.
Staff worked with other external teams and services to ensure people received effective care, support and treatment. People had access to healthcare services, and received appropriate support with their on-going healthcare needs.
The building provided people with sufficient accessible space and modified equipment to meet their needs.
The home acted in line with legislation and guidance regarding seeking people’s consent. People were supported to make their own decisions as far as possible.
Staff provided care and support in a kind and compassionate way. People were encouraged to make decisions about their daily routines and arrangements were in place to ensure appropriate support was provided for more complex decisions.
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 support this practice. People’s privacy, dignity, and independence was respected and promoted.
People received personalised care and they were given regular opportunities to participate in meaningful activities, both in and out of the home.
Arrangements were in place for people to raise any concerns or complaints they might have about the home. These were responded to in a positive way, in order to improve the quality of service provided.
People were involved in making decisions about their end of life care needs, so if the need arose, staff would be prepared and able to carry out those wishes.
There was strong leadership at the home which resulted in people receiving high quality and person centred care. The registered manager ensured that staff understood their legal responsibilities and accountability. This approach had created a positive culture that was open, inclusive and empowering for the people living there.
Systems were in place to monitor the quality of the service provided and to drive continuous improvement. The registered manager and provider worked in partnership with key organisations and agencies for the benefit of people living at the home.
Further information is in the detailed findings below.
This inspection took place on 29 October 2015 and was unannounced.
Bushmead Court Residential Home provides care and support for up to 30 older people, some of whom are physically frail and maybe living with dementia. There were 20 people living at the service when we visited.
The service 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.
People felt safe living at the service and staff had been trained to recognise signs of potential abuse and to keep people safe.
Processes were in place to manage identifiable risks within the service and to ensure people did not have their freedom restricted unnecessarily.
The provider carried out recruitment checks on new staff to make sure they were suitable to work at the service.
There were systems in place to ensure people were supported to take their medicines safely and at the appropriate times.
Staff had been provided with essential training and support to meet people’s assessed needs.
People’s consent to care and support was sought in line with the Mental Capacity Act (MCA) 2005.
Staff supported people with eating and drinking and to maintain a balanced diet.
People were registered with a GP. If required, they were supported by staff to access other healthcare facilities.
Positive and caring relationships had been developed between people and staff.
People were encouraged to maintain their independence and staff promoted their privacy and dignity.
Pre-admission assessments were undertaken before people came to live at the service. This ensured their identified needs would be adequately met.
There was a complaints procedure in place to enable people to raise a complaint or concern if they needed to.
There was a positive, open and inclusive culture at the service.
There was good leadership and management demonstrated at the service, which inspired staff to provide a quality service.
There were quality assurance systems in place to monitor the quality of the service and to drive continuous improvements.
Is the service safe? Is the service effective? Is the service caring? Is the service caring? Is the service responsive? Is the service well-led?
Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.
If you wish to see the evidence supporting our summary please read the full report
Is the service safe?
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw evidence that the home had submitted standard authorisation requests applications to the supervisory body. The relevant paperwork had been completed and we found this to be in line with the legislation.
The rotas reflected that there were sufficient numbers of staff on duty to meet the needs of the people who used the service. A staff member said, 'We are never rushed, there is enough staff who know the residents' needs.' This meant that people could expect a consistency of care.
Is the service effective?
Care plans contained information relating to people's current care needs, preferences and choices for their end of life care, the level of support they required to enable staff to provide safe and effective care. We also saw evidence that people's preferred needs, how they wished to be addressed, ethnicity and religious needs were recorded. This showed that the home promoted people's diverse needs and values.
Is the service caring?
We found that people looked relaxed in the company of staff and they were seen having a joke and laugh with them. We observed lots of positive tactile interactions such as, staff and people hugging one another. One person said, 'I have never been so happy, staff are very good. They take care of me very well.' It was evident people felt that their care needs were met appropriately by staff who were compassionate.
We asked people for their opinions about the staff who supported them. Comments from people were positive. For example, one person said, 'The staff here are lovely and make the home feel like a homely place to live in.' Another person said, 'The staff here are excellent. They usually spend time with us and are accommodating.'
Is the service responsive?
We found that people's individual needs were regularly assessed to ensure that the care and support provided to them met their diverse needs.
Is the service well-led?
We found that the home had structured social activities in place that catered for people's diverse needs.
From discussions with staff it was evident that they felt supported by the registered manager and worked well as a team. A staff member said, 'I have only been working here a short time, the manager and staff have all been very supportive. This demonstrated that staff worked well as a team.
On arrival we found there was sufficient staff available to protect the health safety and well-being of people and that because of this, people felt relaxed in the company of staff supporting them.
As part of this inspection we reviewed the care documentation for four people in this home. We noted people's personal preferences and wishes had been sought and were recorded, and people told us that these were always considered when care was delivered.
We spoke with six people who used the service, and observed staff interactions with ten further people throughout this inspection. We observed staff were respectful and treated people with dignity. One person told us, "I was worried about coming into care before I came here, but it's so lovely, I don't worry anymore.'
We observed that although some people were out of bed at the time of our inspection, that this was detailed within their care plans. They told us they were happy and we observed that they were calm and relaxed in the presence of staff.
We found that medicines were administered safely. There were clear systems in place for the recording and receipt of medicines within the home. We noted that staff maintained a clear audit trail of the medication held in the home.
During our visit on 22 April 2013, we spoke with people about the care and support they received. People told us they were happy with their environment, the care provided and the support they were offered. One person told us,"I like living here, the staff are kind to me." Another resident said, "I like being here, I know that I can't be at home, but I am given time to do what I want and to make my own choices."
Due to the complex needs of some people, we also spent some time observing people. We saw they were actively engaged in activities of their choice and at a level that was appropriate to them.
Staff were respectful in their approach to people and treated them with dignity and respect. People were addressed by their preferred name and told us they were content with how staff treated them. We observed that there was a friendly atmosphere within the home.
We saw that relatives were kept updated with any changes in people's conditions. There was evidence of joint working within care planning so that individual and cultural needs were respected.
We spoke with three people living at the service who were able to tell us about their experiences. People told us that the staff were kind and they felt safe. One person told us "I have no complaints. I can choose if I eat here or in the dining room." Another said "It's good here. They look after us alright and the food's good."
We spoke with one relative and a person living at the service about their involvement in the care plan. Neither person was aware of the plan but said that staff were aware of the care they needed and they were generally happy with the way they were treated and cared for.
There was a medication policy in place and staff had received medication training before they administered medication. Various development opportunities were provided for staff such as training in food hygiene and nutrition, dignity and respect, health and safety, management of continence and managing people capacity to consent.
The provider had put in place a system for quality assuring the care delivered and regular audits were conducted and the outcome was recorded. Actions were taken to address any issues identified. The required records were in place to ensure that the service was managing information safely.
During our visit we spoke to two people who told us they were given pain relief when they needed it and we saw staff administering medicines to people in a safe way.
We observed care practices during our visit to the home and found staff responded quickly when people called, and were attentive and kind in their approach to people who needed support. We saw that people who were unable to tell us about the care they received, were well groomed and appropriately dressed.
People made positive comments about the staff who cared for them and said that staff treated them with respect.
Regular organised and impromptu activities were available for people living at this home. Some people told us how much they enjoyed the regular entertainers that visit the home. Others told us they chose not to join in the organised activities, but that these are offered. During our visits we saw various activities taking place. These activities included group exercises, manicures, puzzles, board games, writing and colouring. On both days we heard a lot of positive, noisy interaction and laughter during the quizzes that were held in the afternoons.
The people we spoke with said the manager was approachable and were confident she would address any concerns they raised.
Although the generally positive views were borne out by the care and interventions we observed, our report identifies concerns in relation to the management of medicines and the checks carried out while recruiting staff. The manager submitted a plan to us for addressing these areas and the impact of their actions will be assessed at our next review.
We saw that people who were unable to tell us about the care they received, were well groomed and appropriately dressed. We saw that staff were attentive and engaged people in various activities during the day.
People told us that most of the staff were friendly and kind. One person said the 'staff are all nice'; another told us the 'staff are mostly nice, but some seem a bit rushed.' We saw staff chatting with people when they were offering care and explaining what they were about to do.
Three of the people with whom we spoke about their meals told us that they were satisfied with the food and drink they received, that they were offered a choice of food, that there was 'always plenty of food' and that it was 'very nice'. We heard staff encouraging some people to eat and take nutritional supplements where these were prescribed. Care workers assisted people with their meals, chatting to them throughout. At the end of the meal the staff were seen to help them to freshen up and move to the lounge.
One person living in the home told us that another person, also living in the home, used to come into their bedroom during the early morning. They told us they were able to use a call bell system and the staff attended quickly when they called. We checked the file of the person who had entered the bedroom and found that a pressure mat had recently been installed beside the person's bed. This enabled staff to respond quickly, reducing the disturbance of other people during the night.
Throughout our visit on 31 May 2011 we heard people being given choices about various aspects of their daily life and care. We saw positive interaction between staff and the people living in the home. We saw that people were spoken to and treated with respect. Staff were seen to discreet and sensitive when providing personal care. On several occasions we heard staff explaining to people what was happening before care and support were provided.
We noted that the care records for one person indicated that they were at high risk of developing pressure sores. We observed this person sitting in a wheelchair throughout our visit. A pressure relieving seat pad was being used during this time; however, care plans and daily notes repeatedly reported this person to have a 'sore back'. No cushioning or protection was provided for this, with the person only having the support of the standard material backing of the wheelchair. On questioning the registered manager about this she replied, 'They don't like it.' We noted no reference within care records to support this statement that the person did not wish to have protection for their back. This failure in care provision resulted in an increased risk of deterioration in this person's health status and further discomfort.
Another person's record showed them to be significantly under weight and care records contained risk assessments that showed them to be at high risk of skin breakdown. We looked at this person's bed, which was a divan base with a hard plastic covered mattress. No consideration appeared to have been given to preventing skin breakdown or providing a comfortable and appropriate bed and mattress for this person. We raised this issue immediately with the provider due to our level of concern. The registered manager, during our visit, changed the mattress to one more suitable for this person.
In November 2010 a person admitted to hospital from this home had been dehydrated, which resulted in a safeguarding investigation led by Bedford Borough Council. This investigation concluded that there had been failings in the care of this person.
During a previous visit made to this home by the Care Quality Commission on 20 December 2010, non compliance in the outcome for nutrition was found. A compliance action was made for the provider to improve upon documentation, the serving of pureed food and the choices available for people living in the home.
At this visit, we saw improvements in the serving of pureed diets; however, the standard of documentation remains a concern. We also found that some people had not been receiving the food and hydration they needed. A person requiring a high calorie diet, as prescribed through a dietician, was not being offered this.
Their comments include:
'The staff work so hard.'
'It is friendly and there is always something to watch'
'staff are always busy'
'It's a lovely care home, so warm.'
'My daughter found this home she knows what she is looking for.'
'I feel so safe here'
' it always nice and warm'
' its tasty'
' I get plenty'
'we eat what is put down'
'I am unable to sit with a person of my choice'
'we don't have a choice but I always like what I am given'