We undertook this inspection on 25 May 2016. At the previous inspection, which took place on 25 September 2014, the provider met all of the regulations that we assessed.
Borrage House provides accommodation and care for up to 40 people, with the user bands of 'older people' and 'dementia'. Nursing care is not provided. At the time of this inspection the service was providing care for 36 people. Borrage House is close to the centre of Ripon and is owned by Anchor Trust.
There was a new manager who had been in post for two months. They were not yet registered with the Commission, but had submitted an application to register and were going through the registration process. 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 service had experienced a period of time when it lacked consistent leadership and management. However, during this inspection people were positive about the new manager and their impact so far.
Governance systems were in place to monitor service safety and quality. However, some areas needing improvement had not effectively been recognised or addressed. The new manager showed us that an action plan was now in place, with evidence that the they had identified the home's priorities and was making progress.
The service had not effectively implemented the Deprivation of Liberty Safeguards (DoLS). This meant that some people had been deprived of their liberty without the required authorisations being in place. The new manager had recognised this and was in the process of taking action to put things right.
Although most people spoke well of individual staff and told us that staff usually treated people well, we observed two occasions when people’s privacy and dignity was not maintained during manual handling procedures.
Processes were in place to assess the staffing levels that were needed, based on people’s dependency and the lay out of the building. However, people told us that there had been occasions when they had to wait for staff assistance and our observations showed that the deployment of staff was not always effective.
The service recruited staff in a safe way making sure all necessary background checks had been carried out. Records showed staff received the training they needed to keep people safe and the new manager had taken action to ensure that any additional training and support staff needed had been planned.
The service was generally well maintained, clean and comfortable. However, there were some on-going issues with the fire alarm panel and door closures that the provider was working to rectify. Temporary safety measures had been put in place while this was done.
People told us they felt safe. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They received appropriate safeguarding training and there were policies and procedures to support them in their role. Risk assessments were in place to identify risks due to people’s health or mobility and to make sure these were minimised.
Medicines of people living at the service were managed safely. Staff had received the appropriate training and checks took place to make sure medicines were given safely. However, more written guidance information about medicines prescribed 'as required' would help to ensure that these were managed consistently.
People had their care needs assessed and planned, and reviews took place to make sure people received the right care and support. However, the information in people’s care plans was not as person centred and detailed as it should be.
We received positive feedback from healthcare professionals who worked with people who lived at the home.
People told us the food was good, but could vary sometimes depending on which cook was on duty. We saw people had access to regular drinks, snacks and a varied and nutritious diet. If people were at risk of losing weight we saw plans in place to manage this. People had good access to health care services and the service was committed to working in partnership with both healthcare and social care professionals.
Activities took place regularly and people were supported to attend the activities they wanted to be involved in. Visitors could come and go as they wished.
A complaints procedure was in place and records were available to show how complaints and concerns had been responded to. People who used the service and their supporters were encouraged to give feedback, through surveys, meetings, reviews and comment books. There was evidence that feedback had been listened to, with improvements made or planned as a result.
We identified breaches of regulation and you can see the action we took in the full version of this inspection report.