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Inspection Summary


Overall summary & rating

Good

Updated 27 June 2017

We inspected Borrage House on 18 and 26 May 2017. The first day was unannounced and we told the provider we would be visiting on the second day.

At the last inspection in May 2016 we found the provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to ineffective staff deployment, deprivation of liberty applications had not been managed well and evidence that people were not treated with dignity. We asked for and received an action plan telling us what the provider was going to do to ensure they were meeting regulations. At this inspection we found improvements had been made in all areas and the provider was no longer in breach of regulations.

Borrage House is a large property which consists of a Victorian main building with modern extensions. The service provides care and support for up to 40 older people, some of who may be living with dementia.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

Systems in place for the management of medicines had been developed. Staff who used them had been supported to understand how to better manage the system to enable safety.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and regularly reviewed to ensure they contained the most up to date information. Care plans contained information about how people preferred to be supported. This enabled staff to have the guidance they needed to help people to remain safe and receive the care they chose. People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw there was a plentiful supply of activities and outings.

We saw staff had received training and supervision to enable them to perform their role. Some staff had received an appraisal to review their overall performance. A plan was in place to ensure each staff member received this.

People told us there were enough staff on duty to meet their needs. We found safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff were attentive and observation of the staff showed they knew people very well and could anticipate their needs. People told us they were happy and felt well cared for.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services.

The provider had a system in place for responding to people’s concerns and complaints. People were regularly asked for their views. There were effective systems in place to monitor and improve the quality of the service provided.

Inspection areas

Safe

Requires improvement

Updated 27 June 2017

The service was not consistently safe.

Changes to medicines management had been implemented to keep people safe. Staff were being supported to use them.

There was enough staff on duty to ensure people’s needs were met. Risks to people safety were well managed to prevent avoidable harm.

Staff we spoke with could explain indicators of abuse and the action they would take to ensure people’s safety was maintained. Recruitment checks were carried out effectively.

Effective

Good

Updated 27 June 2017

The service was effective.

Staff received training and supervision to enable them to fulfil their role. Appraisals were in the process of being carried out.

People were supported to make choices in relation to their food and drink and to maintain good health.

The staff and registered manager understood the principles of the Mental Capacity Act 2005 and acted in people’s best interests where required. Appropriate applications to deprive people of their liberty had been made.

Caring

Good

Updated 27 June 2017

The service was caring.

People were supported by caring staff who respected their privacy and dignity.

Staff were able to describe the likes, dislikes and preferences of people who used the service. Care and support was individualised to meet people’s needs.

Where people’s needs changed staff worked with professionals to ensure people were pain free and comfortable. They took into consideration the person’s own view. This demonstrated compassionate care.

Responsive

Good

Updated 27 June 2017

The service was responsive.

People who used the service and relatives were involved in decisions about their care and support needs.

People had opportunities to take part in activities of their choice inside and outside the service. They were supported and encouraged with their hobbies and interests.

People told us they felt confident to tell the registered manager and staff. If they were unhappy Appropriate forums to raise concerns were available.

Well-led

Good

Updated 27 June 2017

The service was well led.

The service had a registered manager who understood the responsibilities of their role.

People and staff we spoke with told us the registered manager was approachable and they felt supported in their role.

People were regularly asked for their views and their suggestions were acted upon. Quality assurance systems were in place to ensure the quality of care was maintained.