Archived: Bodmeyrick Residential Home

Bodmeyrick Residential Home is a residential care home providing personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 28 people.

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

We had received information of concern regards to how people’s risks were being managed, in particular falls, moving and handling and in relation to hydration, nutrition and swallowing. These concerns were not substantiated. People’s individual risks were identified, and extensive risk assessment reviews had been carried out to identify ways to keep people safe. Risk management considered people’s physical and mental health needs and showed measures to manage risk were as least restrictive as possible.

Where people’s needs changed there was timely contact and involvement of relevant health and social care professionals. One professional commented: “Staff contact the surgery by a variety of methods depending on the urgency of the problem…. I have always found the staff to be knowledgeable regarding the residents…. This has a positive effect on the holistic response to residents changing needs.”

We had received information regarding the heating and hot water systems not working properly. We asked the registered manager to look into these concerns. They carried out temperature checks over a period of time. It was found that room temperatures were fine and would continue to be monitored. There had been a problem with the hot water which was remedied by the maintenance team and electrician on 20 January 2021 with the thermostat being replaced.

We had also received information about a fire at the service. We established that staff followed the correct evacuation procedures to keep people safe. We contacted the fire service, who confirmed that the premises were safe, stating, “From the information held on our system, it seems that these premises are well managed.”

People had personal emergency evacuation plans (PEEPs), which are individual plans, detailing how people will be alerted to danger in an emergency, and how they will then be supported to reach safety. Staff had received health and safety and fire safety training to ensure they knew their roles and responsibilities when protecting people in their care.

We had received information of concern about people’s needs not being met and staffing numbers being low. Also, that some staff have not had the required training to do their role safely and competently. These concerns were not substantiated. We raised these with the registered manager. The registered manager provided us with evidence that people’s needs were being met in a timely way according to their assessed care and support needs. People we spoke to in general felt their needs were being met and had no concerns about staffing levels and staff competence to support them appropriately. We observed people’s needs being met during our visit in an unhurried manner. For example, call bells were responded to in a timely manner and staff were seen spending time with people engaging in meaningful conversations.

We were assured that the infection control measures, Personal Protective Equipment (PPE) and guidance on working in a pandemic were being followed to keep people safe.

We had received information of concern stating that staff did not feel able to raise concerns with the management team, felt unsupported, undervalued and felt focus was on negatives leading to staff feeling bullied. However, during this inspection staff we met and spoke with gave a different view. Staff commented: “Morale is good. The managers are very supportive. I can always speak to them, doors always open and you can talk about anything. We are always thanked at the end of our shifts” and “I love it here. I have been supported from the start. I have never felt bullied and everyone seems to enjoy working at Bodmeyrick.”

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 (report published in December 2019).

Why we inspected

We undertook the targeted inspection to check on specific concerns we had which related to the safe care and treatment of people, specifically the number of staff on duty and how risks were managed and how the management team supported their staff.

CQC have introduced targeted inspections to follow up on a Warning Notice or other 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.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bodmeyrick Residential Home on our website at www.cqc.org.uk.

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 found the following examples of good practice.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

Clear signage was displayed around the service on what PPE was required to protect people and if any person living in the service was at higher risk.

The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of procedures and precautions being taken, and how to keep people safe. The registered manager worked with the care staff team to ensure infection prevention and control measures were followed.

Cleaning and infection control procedures had been updated in line with Covid-19 guidance to help protect people, visitors and staff from the risk of infection. The registered manager arranged up to date training to ensure staff knew how to keep people safe during the COVID-19 pandemic and any potential outbreak in the service.

The registered manager ensured people living in the service, and staff, had access to additional support, including one-to-one meetings and contact by phone, to offer any emotional support needed.

During the summer months some families had met with their relatives in the garden and new arrangements were in place for families to meet in a safe area of the home during the winter months. Staff helped people to stay in touch with family and friends through phone and video calls.

The staff were following up to date infection prevention and control guidance to help people to stay safe. The registered manager ensured staff and people who used the service understood why every measure was in place.

People at high risk and those wishing to remain in their own rooms were supported by staff to occupy themselves. Staff provided activities whilst maintaining people’s safety. Some people living with dementia found it difficult to understand the safe distancing rule. However, staff were quick to intervene if people got to close and diverted them elsewhere, without causing distress to either party.

Further information is in the detailed findings below.

Bodmeyrick is a residential care home which provides accommodation and personal care for up to 28 older people. At the time of our inspection there were 27 people living at the service.

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

People, relatives and professionals gave consistently positive feedback about the care provided at Bodmeyrick Residential Home. Comments included: “The staff look after me very well, they’re very good”; “Staff have a wonderful person-centred approach to dementia care. They are aware of the importance of getting to know the individual and see Bodmeyrick as the residents’ homes” and “The kindness and understanding that was shown to (relative) has exceeded whatever we imagined.”

There was a strong, visible person-centred culture. This was evident from all staff within all roles. From care staff, domestic staff and management. The person-centred culture was embedded at all levels. People were truly respected and valued as individuals, with staff thinking ‘outside of the box.’

Staff were exceptional at anticipating people’s needs. The service recognised that some people living with a dementia were often restless, therefore they introduced a sensory room. The room contained dimmed lighting and many sensory items available on the walls and freely on shelves (such as, fiddle muffs, lavender bags and water balls). Now when people became anxious the room enabled them to be relaxed and less anxious.

The registered manager and provider truly valued the well-being of staff. They saw this as key to running the service as well as possible. Staff had recently attended a resilience training course run by a clinical psychologist. This was about looking after their own well-being and mental health. Following the training, the registered manager introduced a positive feedback folder for each staff member. Staff could then put positive comments for staff to refer to if they are having a bad day. Caring about staff well-being was also seen as very important in order for them to support people in a kind and compassionate way.

Staff were highly motivated to ensure people received care which was compassionate and kind. We saw people had developed strong relationships with staff, and it was evident that this was an important ethos of the service.

Staff ensured people received the best possible care and support. For example, supporting the various activities and events which happened at Bodmeyrick Residential Home. Staff believed in the importance of these events and the coming together as a community.

Staff adopted a strong and visible personalised approach in how they worked with people. For example, staff spoke of the importance of empowering people to be involved in their day to day lives. People felt that their care was focussed on their individual needs.

The staff groups training, knowledge and empathetic nature meant they recognised maintaining people’s dignity was essential to them feeling valued, respected and genuinely cared for.

The service’s visions and values centred around the people they supported. The organisation’s statement of purpose documented a philosophy of maximising people’s life choices, encouraging independence, inclusion and people having a real sense of worth and value. Staff expressed a passion for providing high quality care. This inspection found that the organisation’s philosophy was definitely embedded in Bodmeyrick Residential Home.

Bodmeyrick provided people with safe, effective, compassionate and high-quality care. The management team actively promoted a relaxed and welcoming atmosphere. The service strived to provide people and those that matter to them with rich and fulfilled lives.

The management team were forward thinking. They provided strong leadership; were good role models for all staff and drove up excellent practice to provide people with opportunities. They had established a service where staff were clear about the values and ethos of the service. It had a positive culture that was person-centred, open, inclusive and empowering. Staff were motivated and proud of their service.

Staff were supported to reach their true potential. Staff were encouraged and supported to specialise in certain areas. The home had ‘champions’ which included for incontinence, safeguarding and moving and handling. The champions had been encouraged to undertake specialist training in these areas to ensure information was disseminated to the entire staff team which was current and up to date in order to support people in the best possible way.

Bodmeyrick is a very important part of the community. Community links had been and continued to be developed which reflected the changing needs and preferences of the people living at the service.

A number of extensive methods were used to assess the quality and safety of the service people received and continuous improvements were made in response to the findings.

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 practice.

The service provided safe care to people. One person commented: One person commented: “I feel very safe here. The staff are good.” Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place.

People received effective care and support from staff who were well trained and competent.

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 (report published in April 2017).

Why we inspected: This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bodmeyrick Residential Home on our website at www.cqc.org.uk

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.

At the last inspection, the service was rated Good. However, they had a breach of regulation 13 due to not having Deprivation of Liberty Safeguards in place for people who were not free to leave unsupervised. This inspection found improvements had been made and the service was now meeting all the regulations.

At this inspection we found the service remained Good.

Why the service is rated good:

The service continued to provide safe care to people. One person commented: “The staff keep me safe.” Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet, which they enjoyed.

Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

The service was caring and people had built strong relationships with each other and staff. People engaged in a wide variety of activities and spent time in the local community going to specific places of interest.

Staff spoke positively about communication and how the registered manager worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received and made continuous improvements in response to their findings.

On the day of our visit we were told there were 28 people living at Bodmeyrick Residential Home. We spoke with three people living at the home and observed several others spending time in the sitting and dining rooms. We spoke with the deputy manager who was the person in charge at the time of our visit and six staff. We looked at records relating to staff training and the care records of one person using the service. We also spoke with a visiting health care professional.

Below is a summary of what we found. The summary describes what we observed, were told and the records we looked at.

Is the service safe?

Safety had been increased because all staff were receiving the training and support they required to work to an appropriate standard. This included protection from abuse and how to move people safely.

Is the service effective?

The service was effective because people received care based on best practice. This was because staff had the knowledge and skills to provide effective care. A health care professional said they had no concerns about the care provided at the home and staff always followed the advice provided.

Is the service caring?

We observed people receiving respectful care and support. People were offered choice and their needs and wishes responded to. For example, one person wanted a specific seat cushion for comfort. People told us, "The girls look after me so much" and "Quite a decent lot. We have a laugh and a joke."

Is the service responsive?

The care records we examined provided detail about the person as an individual and the care they required. This information helped staff respond to them as an individual. Staff were able to describe the specific needs of that person and how they were able to respond to those needs.

Is the service well-led?

The provider had ensured improvement in staff training and systems were in place so this would continue. Staff told us they could take issues about training to senior staff and management and support would be provided. This indicated a positive culture at the home.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes, we judged the service was safe.

People told us they felt safe and secure. The people we spoke with were very positive about the staff who worked with them. People told us staff were caring and supportive. For example, one person said 'The staff are excellent, they make me feel very cared for.' Similarly visitors and staff we spoke with, were all very positive about care practice in the home.

We saw that the home was well designed and maintained. Decorations and furnishings were well maintained and comfortable. Records showed equipment was regularly serviced.

On the day of the inspection the home was clean and on the whole there were no unpleasant odours. The people who used the service all said they were happy with the standard of cleanliness. People said the laundry service was run to a good standard.

We inspected the staff rotas, which showed that there were sufficient staff on duty to meet people's needs throughout the day and night. The majority of people said call bells were always answered promptly. People said staff were unrushed and patient with them.

Records were generally to a satisfactory standard. For example everyone had a care plan and there was evidence these were regularly reviewed. We have suggested records of visits from some medical professionals could be improved. Health and safety records were comprehensive and showed appropriate checks are always completed to ensure the building and equipment were safe.

Is the service effective?

Yes, overall we judged the service was effective, although improvement was required regarding training delivery.

People all had an individual care plan, which set out their care needs. Care plans contained satisfactory information and were accessible to staff.

People said staff met their needs and responded promptly when they needed assistance.

People had access to doctors, district nurses, chiropodists and opticians.

People were positive about the meals provided. From our observations we found people received appropriate support at meal times.

We recognised staff had recently undertaken a lot of training over the last few months. However we were concerned that there were shortfalls in training delivery for example first aid, dementia awareness and manual handling. We were told people were happy with care standards and from our observations care standards were good. However, we were concerned about the risk (for example regarding risk prevention if there was limited manual handling training, and also what would happen if a person was injured, if there were limited staff trained in first aid techniques). Although we did not see any signs of poor practice, we were concerned if staff had not received formal training regarding dementia this may limit their understanding of the needs of people with this diagnosis.

Is the service caring?

Yes we judged the service was caring.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were taken into account and respected. There was a programme of activities available for people. The home had an activities co-ordinator who worked at the home three days a week.

People who used the service said they were supported by caring and professional staff. We were positive about the care practices we observed. Comments from people who lived at the home included 'the staff are very polite and respectful' and 'the care is very good, staff are helpful and will always take enough time.' A relative told us 'I am very happy with the care here. My mother is very happy,' and 'I have no concerns'the staff will always communicate with me if they have any concerns.'

At the inspection we used our 'Short Observational tool For Inspection' (SOFI) tool to observe care during lunchtime. From the exercise we judged the care given during the observation period to be to a good standard: for example staff were attentive to people's needs, they provided appropriate support and they were professional in their conduct.

Is the service responsive?

Yes we judged the service was responsive.

The people we spoke with all said the staff treated them with respect and dignity. The care practice we observed was professional and supportive. For example a person who lived in the home told us 'I have no bad reports, the staff are very good.'

The home had good links with local health services. For example a general practitioner told us staff would appropriately contact the surgery and district nurses when it was necessary.

Is the service well-led?

Yes we judged the service was well led.

Staff, people who used the service and their relatives were all positive about the management of the home. People told us the staff and management were approachable, and would resolve any problems if they voiced any concerns. One person told us 'the manager is open and friendly' she is efficient and things run smoothly. If there are problems she nips them in the bud.'

The home had a satisfactory quality assurance system to monitor the quality of the service and ensure suitable improvements took place where this was necessary.