Bedewell Grange

Bedewell Grange is a residential care home providing nursing and personal care to up to 52 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 46 people using the service.

People’s experience of using this service and what we found

People, as well as relatives and staff, gave positive feedback about the care provided at Bedewell Grange. Staff knew how to raise concerns and felt confident to do so.

The provider carried out checks and risk assessments to help maintain a safe environment. Staff followed IPC practices to help prevent the spread of infections. Medicines were managed safely. There were sufficient staff to meet people’s needs and new staff were recruited safely. People confirmed staff responded quickly when they needed help.

Staff supported people to have enough to eat and drink. People were happy with the meals they were offered. People's needs were assessed and the information gathered used to develop care plans. Staff received good support and accessed the training they needed. People were also helped to access healthcare services when required.

The provider had a structured approach to quality assurance. Regular audits and checks were done. These were used to identify relevant action and lessons learnt. People, relatives, staff and professionals were offered opportunities to provide feedback about the care provided at the home.

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

Rating at last inspection

The last rating for this service was good (published 27 November 2019).

Why we inspected

The inspection was prompted in part due to concerns received about managing medicines and access to external healthcare services. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

The provider had good infection prevention and control (IPC) practices in the home. Staff used personal protective equipment appropriately and followed good hand hygiene practices. The service was clean and tidy throughout. Staff supported people to maintain contact with relatives. There were enough staff deployed to meet people’s needs in a timely way.

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

Rating at last inspection

The last rating for this service was good (published 27 November 2019).

Why we inspected

We undertook this targeted inspection following an outbreak of coronavirus to check on IPC practices and previous anonymous concerns about staffing levels. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bedewell Grange is a service providing accommodation and personal care to up to 50 older people, including people who may live with dementia in one purpose-built building. On the day of inspection there were 41 people using the service.

People’s experience of using this service and what we found

A new registered manager was in place who was introducing some changes and improvements to the home.

Improvements had been made since the last inspection and these included improvements to staffing levels, safe care and treatment and person-centred care. People, relatives and staff were positive about the changes.

People told us they felt safe with staff support and staff were approachable. One person said, “If I want anything staff come straight away” and "Staff are very friendly and that makes for a caring service, they are very patient.”

We have made a recommendation that staffing deployment should be kept under review, so people receive more person-centred care.

Appropriate checks were carried out before staff began work with people. People received suitable support to take their prescribed medicines. Staff said they were aware of their responsibility to share any concerns about safeguarding and the care provided.

The home was comfortable, well-decorated and clean. The environment was designed to meet the needs of people who may live with dementia.

We have made a recommendation about improvements to people's dining experience.

People were provided with good standards of care by staff who were trained and supported in their roles. A staff member commented, “It is a privilege to work with these people living here.”

There was a good standard of record keeping to ensure people received care that met their needs. People's privacy and dignity were respected.

Risk assessments were in place which identified current risks to people as well as ways to reduce those risks.

Communication was effective, staff and people were listened to. One person commented, “Staff are very patient and attentive.” Staff worked well with other agencies to ensure people received appropriate care.

People were cared for by staff who were kind and compassionate. The atmosphere within the home was friendly and welcoming. One relative commented, "This place is even better than crusty bread, it’s marvellous.”

Activities and entertainment were available to keep people engaged and stimulated during some parts of the day. We advised of further improvements that could be made to occupy people, when staff were busy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this.

There was a stronger and more effective governance system in place. The management and compliance team carried out a regular programme of audits to assess the safety and quality of the home. There were opportunities for people, relatives and staff to give their views about the service.

Processes were in place to manage and respond to complaints and concerns.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 30 October 2018) and there were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part by some concerns relating to people’s care.

We found during this inspection that people were not at risk of harm and the provider was taking action to mitigate risks as a result of concerns that had been raised.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We inspected the service to follow up on the breaches and to carry out a comprehensive inspection.

At the last inspection in July 2017 the service was not meeting all of the legal requirements with regard to regulations 9, person-centred care and regulation 17, governance.

At this inspection we found improvements had been made but further improvements were required with regard to aspects of people’s care. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment, regulation 12, staffing levels, regulation18 and person centred-care, regulation 9.

Bedewell Grange 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.

Bedewell Grange accommodates a maximum of 50 older people, including people who live with dementia or a dementia related condition, in one adapted building. At the time of inspection 44 people were using the service.

A new manager was in place who was introducing some changes and improvements to the home. They had started work in September 2018 and were in the process of applying for registration with the Care Quality Commission.

People said they felt safe and they could speak to staff as they were approachable. However, we had concerns staffing levels were not sufficient or staff appropriately deployed to ensure people received safe and person-centred care.

People were not always supported to have maximum choice and control of their lives with staff supporting them in the least restrictive way possible, the policies and systems in the service did not always support this practice.

Records reflected the care provided by staff and they were regularly evaluated but we considered further improvements were required to ensure people received person-centred care when they were unable to tell staff how they wanted their care to be provided.

People were supported with eating and drinking as needed and systems were in place to ensure they received a varied diet.

Risk assessments were in place and they identified current risks to the person. Staff knew the people they were supporting well.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Appropriate training was provided and staff were supervised and supported. Staff had an understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves.

Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. Communication was effective to ensure staff and relatives were kept up-to-date about any changes in people’s care and support needs and the running of the service.

A complaints procedure was available. Staff and relatives said the management team were approachable. People had the opportunity to give their views about the service. There was consultation with people and family members and their views were used to improve the service. People had access to an advocate if required.

The home was clean and well-maintained for the comfort of people who used the service. The home was designed to promote the orientation and independence of people who lived with dementia.

This inspection took place on 4 July 2017 and was unannounced. This meant the provider did not know we would be visiting. A second day of the inspection took place on 6 July 2017 and was announced.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At the last inspection on 10 and 11 March 2015, the service was rated Good. At this inspection we have made recommendations about the deployment of staff and the review of the Mental Capacity Act 2005 Code of Practice regarding the role of Lasting Power of attorney (LPA). During this inspection we identified two breaches of regulation. Care records did not always reflect the appropriate treatment and care needs of people who used the service and the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure that people received appropriate care and support.

Staff had completed training to ensure they were able to recognise the types of abuse and take appropriate action. The registered manager had dealt with safeguarding concerns immediately.

Where risks were identified they were assessed and managed to minimise the risk to people who used the service and others.

Medicines records we viewed were complete and up to date. This included records for the receipt, return and administration of medicines.

Staff had completed mandatory training required to perform their role. We noted all training was up to date as were supervisions and appraisals.

The provider carried out monthly health and safety checks including fire safety to ensure people lived in in a safe environment. A business continuity plan was in place to ensure people would continue to receive care following an emergency.

A robust recruitment process was in place ensuring staff had the appropriate skills, experience and knowledge to care and support people.

People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible and the policies and systems in the service support this practice.

Kitchen staff had an understanding of people’s dietary needs. People were promoted and supported in maintaining a healthy diet.

We observed staff were kind, caring and compassionate towards the people they supported. Relatives we spoke with told us staff were always respectful.

People and relatives knew how to make a complaint. Relatives told us both the registered manager and deputy manager were approachable.

Whilst care plans were comprehensive and contained detailed information this was not consistent and people’s needs were not always accurately reflected through relevant care plans.

The service had developed good working relationships with external health care professionals visiting the service. We saw evidence in care plans of cooperation between care staff and healthcare professionals including, occupational therapists, nurses and GPs.

The service was proactive in seeking feedback from people, relatives and staff in order to monitor and improve standards.

The registered manager ensured statutory notifications had been completed and sent to the CQC in accordance with legal requirements.

The service had a range of activities. People were supported to maintain links to their local community.

The provider had recognised some of the areas for improvement we had identified during our inspection however they had not acted upon them.

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

Comments from relatives included "I am happy with Bedewell. The staff are great with my x. They are always letting me know what is going on". "The manager is at hand if I have any questions in relation to my x".

Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people with their care needs.

We looked at how the service recruited staff by checking six staff files. These showed that the appropriate checks and procedures were being followed.

We found people who used the service understood the care and treatment choices available to them. People's needs were assessed, and the planning and delivery of care and treatment met their needs and protected their rights.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.

We found people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.