Archived: Bearwood House Residential Care Home

The service did not have 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. The provider had recruited a manager who had been working at the service since January 2017. They told us they were in the process of applying to register with us.

At our last inspection on 10 February 2016, we issued requirement notices in relation to reducing environmental risks for people and the need for consent. The provider sent us an action plan on 12 April 2016 that told us about the improvements they would make. At this inspection, we found that some improvements had been made, but further actions were required.

The provider had made improvements within the home that meant people who used the service were no longer at risk from the environment they lived in. However, we found that the provider could not ensure that people’s medicines were managed in a safe and proper manner.

We had also told the provider to ensure that when people were not able to make decisions for themselves, this had been assessed and decisions made in people’s best interests were evidenced. These required improvements had not been made. However, when people who lacked capacity were being restricted, the applications to ensure this was being done legally had been submitted.

People were safe and protected from harm by staff who understood how to recognise signs of abuse and knew how to report concerns. Risks to people were assessed, managed and reviewed. The environment had been improved so risks associated with this were minimised. There were enough staff to meet people’s needs and keep them safe and there were safe recruitment processes in place.

Staff received an induction and training to give them the knowledge needed to carry out their roles. People enjoyed their food and were supported to maintain a balanced diet. They were able to access healthcare services when needed and changes in people’s health were responded to.

People were supported by staff who were kind and compassionate. Positive relationships had been developed and staff knew people well. People’s independence was promoted and they were enabled to make day to day decisions about their care. People’s privacy was respected and staff treated people in a dignified way. Visitors were made welcome and people were able to maintain relationships that were important to them.

People were involved in the planning of their support, and the care they received was individual to them. There were opportunities for people to take part in activities they enjoyed. People knew how to raise any concerns and were encouraged to provide feedback about the care they received.

There was an open and positive culture within the home and communication was effective. Staff were supported to carry out their roles. The manager had systems in place to assess, monitor and review the quality of the service. These were used to drive improvements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service provides accommodation and personal care for up to 27 people. Twenty three people were using the service on the day of our inspection.

There was a registered manager in post. 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.

Environmental risks were not always managed to keep people safe. People that may be deprived of their liberty had not been assessed to ensure their rights were protected. Some areas where people needed support to make decisions had not been assessed to ensure the support they received was in their best interests.

Checks were carried out prior to staff starting work to ensure their suitability to work with people and staffing levels were monitored to ensure people’s needs were met. Staff were knowledgeable about people’s care and support and understood what constituted abuse or poor practice. Processes were in place to protect people from the risk of harm. People were supported to take their medicine.

Staff received training to meet the needs of people they supported. Staff received supervision, to support and develop their skills. People received food and drink that met their nutritional needs and were referred to healthcare professionals to maintain their health and wellbeing.

People were treated with care and kindness and staff were friendly and respectful. People benefitted from having support from staff who had a good understanding of their individual needs. People were positive about the way staff treated them. People were supported to maintain relationships with their relatives and friends.

Staff listened to people’s views and they knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and they were asked to express their views and be involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

You can see what action we told the provider to take at the back of the full version of the report.

In this report the name of a registered manager appears. They were not in post and not managing the regulatory activities at this service at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. A new manager was in post and were in the process of submitting their registered manager's application to CQC.

This was our fifth inspection since April 2013. We have closely monitored Bearwood House Residential Home to ensure that outcomes for people using the service improved. On this inspection we found sufficient improvements had been made to demonstrate people were suitably and appropriately supported.

People told us the staff responded well to their needs or concerns. Some people were able to tell us how the home had improved, one person said, 'They are good staff, they understand your needs more. The staff have been more positive and they are taking people to the toilet on a regular basis. We are getting a better choice at breakfast, lunch and tea and we now have regular activities.'

We saw there were enough staff available to meet the needs of the people using the service.

We saw the manager had systems in place to monitor and manage the care provided.

We did not look at the other areas of non-compliance seen on 7 August 2013 because although the provider's action plan recorded they would be compliant in these other areas, we needed to be confident compliance could be sustained. We will carry out a further inspection to ensure improvements in all areas have been made.

This inspection was unannounced, which meant the registered provider and the staff did not know we were coming. We looked at the evidence available following the action plan we received from the registered provider and spoke with some of the staff on duty.

We looked to see that improvements had been made and found that people were receiving their medicines as prescribed. We found that appropriate arrangements were now in place to manage the risks associated with medicines. This meant the provider was compliant in this area.

During our inspection on 17 April 2013 we took enforcement action regarding requirements relating to workers and care and welfare. This meant the provider had to make significant improvements because the lack of compliance had a major impact on people using the service. In June 2013 we saw improvements to the care and welfare for people using the service, but the provider was still not meeting the standards. We found that some people were not protected against the risk of receiving care or treatment that was inappropriate or unsafe. We saw that people's care records did not always contain up to date information.

We looked to see that improvements had been made in relation to requirements relating to workers. We saw recruitment records demonstrated there were systems in place to ensure the staff were suitable to work with vulnerable people.

We found that some people were not receiving their medicines as prescribed. We found that appropriate arrangements were not in place to manage the risks associated with medicines.

We found that the provider did not have effective systems in place to monitor the quality of the service provided.

We needed to check the care and welfare of people had improved because this was a major concern to us and we had told the provider improvements must be made by 7 June 2013. We could not inspect the other areas of non-compliance because the provider's action plan recorded they would not yet be compliant in these areas. We will carry out a further inspection to ensure improvements in all areas have been made.

The inspection was unannounced, which meant the registered provider and the staff did not know we were coming. We looked at the evidence available following the action plan we received from the registered provider, and we spoke with five people using the service, one visitor, the new manager, three night staff and six of the staff on duty, including the cook and deputy manager.

Some people using the service told us they were satisfied with the care provided; others thought further improvements were needed.

Staff told us they felt supported since the appointment of the new manager. They told us changes were being made and they could see improvement.

We last inspected this service in October 2012 and improvements were needed in medication management and assessing and monitoring the quality of the service.

People using the service felt comfortable with the staff, one person told us, 'The staff are very pleasant'. We found people using the service liked the staff.

We found care records were not always in place and some lacked important information and clarity. This meant care, treatment and support may not be delivered in a consistent way.

The recruitment of staff did not follow the necessary procedures meaning people using the service were not suitably protected.

There were not always enough staff on duty to meet the needs of the people living in the home.

We checked to ensure medication was stored and administered in a safe way. We found medication management needed improvement.

Some systems were in place to ensure the home could monitor the quality of care delivered but there was no evidence of action taken to improve the service. The registered manager and provider told us they knew that changes were needed to address the current situation

We saw the staff provided sensitive support, and people were treated with respect. The staff discussed any care required sensitively and discreetly. People using the service offered positive feedback and one person told us, 'Wonderful I couldn't be happier.' We were able to see that people received care and support that met their individual needs.

Staff ensured people were able to continue to go out and do the things they enjoyed. One person said, 'We choose where we want to go and how to spend our time.' People using the service confirmed the staff ensured they were stimulated and encouraged to participate in activities on a daily basis. Another person said, 'I never get bored and they encourage me to do things.'

We checked to ensure medication was stored and administered in a safe way. We found medication management needed improvement in a number of areas.

We looked at the recruitment for staff and found that overall suitable systems were in place to protect people using the service.

We looked at ways in which the home assessed its own quality and safety and found improvements were required to evidence how outcomes for people using the service were maintained or improved upon.