Background to this inspection
Updated
1 June 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on the 27 and 28 April 2016. The first day of the inspection was unannounced.
The first day of the inspection consisted of a team which included one inspector for adult social care, a pharmacist inspector, two specialist advisors and an expert by experience. The second day the inspection team included an inspector for adult social care and two specialist advisors. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Specialist Advisors (SPA) are people employed by CQC with specialist knowledge in the area.
Prior to the inspection we reviewed the records held on the service. This included the Provider Information Return (PIR) which is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed previous inspection reports and notifications. Notifications are specific events registered people have to tell us about by law.
During the inspection we spoke with 10 people and six relatives. We reviewed eight care records in detail and spoke to people where possible about their care. This was to check they were receiving their care as planned. We observed how staff interacted with people. We also spoke with 13 staff and reviewed nine personnel records and the training and supervision records for all staff. We spoke with the registered manager and a manager from another of the provider’s services.
Other records we reviewed included the records held within the service to show the registered manager reviewed the quality of the service. This included a range of audits, complaints, thank you cards, minutes of meetings and policies and practices. We also reviewed the accident / incident system, maintenance requests.
Throughout the inspection we spent time on each of the five units (three nursing and two residential). We looked around the premises and observed how staff interacted with people.
Before, during and after the inspection we spoke with the local authority quality team and during the inspection we spoke with four social workers.
Updated
1 June 2016
The inspection took place on 27 and 28 April 2016 and was unannounced.
Bickleigh Down Care Home (known as Bickleigh Down) is a purpose built nursing and residential home caring for a maximum of 77 people. At the time of the inspection 53 people were living at the service. Bickleigh Down is part of the corporate group Four Seasons (DFK) Ltd. The service is divided into five units, three nursing units and two residential units. Bickleigh Down provides care for older people who may have dementia and physical health needs.
Bickleigh Down Care Home was owned by Four Seasons (DFK) Ltd at the time of the inspection. The service had been sold to Harbour Healthcare Ltd. The new owners were in the process of registering as the new providers during the inspection process. This was due for completion at the end of May 2016.
A registered manager was employed to manage the service locally. 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.
We last inspected Bickleigh Down Care Home on 4, 5 and 6 March 2015. We asked the provider to take action to ensure the safe management of medicines and accurate records were kept. The provider sent us an action plan detailing the improvements they would make by the end July 2016. At this inspection we found improvements were still required.
Aspects of people’s medicine management were not always safe. We found documentation and care plans did not always reflect what action was taken if people did not wish to take their medicines. We had concerns the procedures in line with the Mental Capacity Act (2005) were not always followed when people required their medicine covertly. Agency nurses did not always know the systems in place for medicine audits, ordering and emergency medicine which some people might require. This had meant some people had been without their medicine for a short period and there might have been a delay in receiving emergency medicine.
There were sufficient staff on duty to meet people’s needs safely however, there was a high level of agency staff which particularly affected the dementia nursing units. This affected the leadership and continuity of care in these units. Agency staff were unfamiliar with the systems and processes on these units and did not know people well.
Essential work was reported promptly to the provider, but not completed in a timely way. This impacted on people’s safety. For example there were problems with the call bell system and with one of the fire doors.
People’s environment was clean and staff followed safe infection control procedures. However, there was a strong smell of urine in the two dementia nursing units. This affected the carpets in the communal areas and some bedrooms. This had been reported to the provider and action had not been taken.
People had risk assessments in place to mitigate risks associated with living at the service however we found particularly on the nursing dementia units some of these had not been reviewed to reflect people’s current care needs.
People’s mental capacity had not always been assessed in line with the Mental Capacity Act (2005) as required. Applications to deprive people of their liberty had been submitted where required. However, some staff did not have a good understanding of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Further training was being arranged for staff following the inspection.
People were asked for their consent prior to being assisted; however some staff were unsure how to manage people who might decline personal care. This had led to the distress of one person. Staff told us they were keen to learn alternative ways to manage this and be creative in how personal care could be provided to meet people’s individual needs.
People’s nutritional and hydration needs were met, but the systems in place did not ensure people always had their preferences met. For example the current system used to deliver food to people from the kitchen to the dementia nursing units meant some people’s choices were not always met as the food was plated up in the kitchen. Staff also told us evening tea was often before 5pm which meant there was a long gap between tea and breakfast. Although night snacks were available for those who were able to ask for these, many people on the dementia nursing units were unable to communicate if they might be hungry.
Staff were recruited safely. People were looked after by staff trained in many areas. Additional training needs identified during the inspection were promptly booked. People were protected by staff who could identify abuse and who would act to protect people. People told us they felt safe living at the service.
People told us staff were kind, caring and compassionate. Permanent staff and regular agency staff knew the people they care for. People knew how to raise a complaint if they had one and there were systems in place to investigate complaints.
There were activity coordinators and a range of social events to support people to remain active and stimulated. Arts and crafts, dressing up days and musical events were held at the service. People's faith needs were met.
People had their health needs met and saw their doctors, opticians and attended hospital appointments when required.
People were supported to maintain their independence for as long as possible. People told us personal care was provided in a way that maintained their dignity; staff knocked on doors before entering people’s rooms, closed curtains and spoke to them and addressed them in the way they preferred.
We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.