The Care Quality Commission
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  • Care home

Archived: Duchess Gardens Care Centre

Overall: Requires improvement read more about inspection ratings

Lady Lane, Bingley, West Yorkshire, BD16 4AP (01274) 551173

Provided and run by:
Elder Homes Bradford Limited

Important: The provider of this service changed. See new profile

All Inspections

16 July 2014

During an inspection looking at part of the service

Summary

The inspection team was made up of three inspectors, one of whom was a pharmacy inspector.

We set out to answer our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found.

If you wish to see the evidence supporting our summary please read the full report.

Safe

At the last inspection we found the service did not have enough suitably qualified, skilled and experienced staff to meet people's needs. During this inspection we found improvements had been made. The nursing staff hours had been increased by six hours a day and at the time of the inspection the provider was recruiting additional care staff. Most of the feedback from people who used the service was positive; however, some people said their experience was that some staff were more attentive than others. Some people also expressed the view that it was not always easy to find staff when they needed them.

We found people were not protected from the risks associated with medicines because the provider did not have effective processes in place to make sure medicines were managed safely.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, they were able to describe the circumstances when an application should be made.

Effective

Overall the people we spoke with were satisfied the service met their needs.

One person said their relative had not been at the home very long but had settled in well. They said they were satisfied their relative was well cared for and said staff kept them informed. They said if they had any questions or concerns they were dealt with immediately.

We saw people had access to a range of health care professionals who visited them at the home.

We found people's care records were up to date and contained information about their individual needs and preferences. We saw people and/or their relatives were involved in reviewing their care plans.

Caring

Several described the staff as 'caring', 'very good', 'skilful' and 'responsive'. One person said 'The staff are lovely, very gentle and kind'.

We observed staff were kind and considerate in their interactions with people. We saw staff sitting chatting with people and observed they were attentive to people's needs. For example, we saw one person rubbing their stomach and staff responded quickly asking the person if they were unwell.

Responsive

Two people who used the service said staff listened to them and took notice of what they said. The home had a day centre and also employed separate staff to provide social activities and stimulation for people who used the service. When the Healthwatch team visited the home, on 7 July 2014, they observed there was a lack of meaningful activities for people living with dementia. They also observed the environment on the dementia care unit was not designed to support and/or promote people's sense of wellbeing.

The relative of one person who used the service said the day centre was very good but was concerned staff were not always available to help their relative to get to and from the day centre. They said they had raised this on numerous occasions but it didn't change.

One person who used the service told us they had been out on two trips recently which they had really enjoyed. However, a visitor told us their relative had only been supported by the home to go out on two occasions in two and a half years since they moved in.

Well- led

At the last inspection in April 2014 we found that improvements had been made but we still had concerns about the effectiveness of the systems the provider had in place to monitor and assess the quality of the service and to identify, assess and manage risk.

During this inspection we found the provider was continuing to make improvements to this aspect of the service. For example, at the meeting for people who used the service in June 2014 some people had mentioned that the food was cold when it was served. We saw action had been taken to address this, for example by providing new hot food trolleys. We also saw the service was giving people information about the actions they had taken in response to their feedback. This took the form of a colourful notice with the headings 'What you told us' and 'We did'. The 'We did' section told people about a new seating area in the garden and changes to the menu. In the course of the inspection we were able to confirm these changes had been implemented.

We found improvements had been made to the way accidents and incidents were dealt with and there was evidence of learning and actions to reduce the risk of similar accidents/incidents happening again.

However, we felt further improvements were needed to demonstrate the processes were working effectively. We were particularly concerned that the provider's processes had not identified the on-going risks in relation to the safe management of medicines.

29 September 2015

During a routine inspection

The inspection took place on 29 September 2015 and was unannounced. At the time of the inspection there were 54 people who used the service.

Duchess Gardens Care Centre is a converted four floor building and is registered to provide personal care and nursing to a maximum of 131 people. The home provides care for older people, people living with dementia and people with long term mental health needs.

Since the last inspection a manager has been registered. 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 has a history of failing to meet the regulations and at the last inspection which was carried out on 27 January and 02 February 2015 we judged the service to be inadequate. The provider was in breach of a number of regulations. These included the regulations relating to respecting and involving people who used the service, care and welfare, meeting people’s nutritional needs, managing medicines, staffing and staff training and development, record keeping and quality assurance. We told the provider they had to make improvements. The regulations have changed since then; new regulations came into use on 01 April 2015. However, during this inspection we followed up the areas of concern from the last inspection to check if the provider had taken action to improve the service and make sure people were safe and receiving appropriate care. Overall, we found improvements had been made across all aspects of the service but there was still work to be done to make sure the changes were sustained.

People told us they felt safe. Staff were able to recognise abuse and told us they were confident the registered manager would take action to address any concerns they reported. Senior staff were aware of how to report abuse and were familiar with the whistle blowing procedures. However, we found junior staff were less clear about how to report concerns outside of the organisation.

Significant improvements had been made to the way people’s medicines were managed and this helped to make sure people were protected.

Staffing had improved since the last inspection. A new deputy manager with qualifications and experience in caring for people with mental health needs had been appointed. The home was continuing to recruit staff and used agency staff to cover shortfalls. We found improvements had been made to the way agency staff were booked and to the induction they were given when they worked at the home for the first time. This helped to reduce the risk that people would not experience continuity of care. There was mixed feedback about whether or not there were enough staff available to meet people’s needs. A system for checking people’s needs had been implemented to help determine the staffing numbers and skill mix. However, there were no guidelines on how often this was to be reviewed. This created a risk that the right numbers of suitably skilled staff would not always be deployed to meet people’s needs. We found this was a breach of regulation because the provider did not have a proper system in place to assess, monitor and mitigate the risk.

The provider had processes in place to make sure all the required checks were completed before new staff started work in the home. However, in two of the four staff files we found the checks had not been completed properly and this could potentially put people who used the service at risk. This had not been identified until the inspectors pointed it out. This was a breach of regulation because it showed the providers systems for assessing, monitoring and mitigating risks were not effective.

At this inspection we found the home was clean and well maintained.

There was training programme and the registered manager was in the process of making sure all staff were up to date with the training they needed to work safely and meet people’s needs. Staff told us they felt supported by the registered manager. However, six of the staff we spoke with told us they had not received any one to one supervision or appraisals and we found some gaps in staff knowledge around subjects such as safeguarding and the Mental Capacity Act 2005. We judged the provider was in breach of the regulation because although improvements had been made they were not enough to ensure staff received appropriate support and training to help them carry out their duties.

Improvements had been made to the way people who were at risk of poor nutrition were supported. However, the food and drink provided to people did not always take account of their preferences and was not always appropriate to their needs, for example in the case of people with diabetes. We found this was a breach of regulation because it demonstrated the provider did not have sufficient regard to people’s well-being in relation to meeting their dietary needs.

The home was working in accordance with the requirements of the Mental Capacity Act 2005 which meant people’s rights were protected.

People told us staff were kind and compassionate and treated them with respect. We observed interactions between staff and people living at the home were pleasant and friendly. Staff knew about people’s previous lives, family, and preferences as well as care needs. However, on occasions we observed staff missed opportunities to engage people in conversation when they were supporting them with personal care.

Some aspects of the way the services were provided helped people to stay independent. For example, we saw some people had adapted cutlery so that they could eat without help from staff. However, in some other ways people were not supported. For example, the menu was a chalk board in the dining room and it would not have been easy for everyone to read. People were given the opportunity to take part in a varied programme of planned activities.

People told us they were satisfied with the care they received. People’s needs are assessed and their individual care plans and risk assessments were up to date and provided an accurate record of their care needs. The involvement of people and/or their representatives was not always evident in their care records.

A relative told us they had made a complaint and were happy with the way the registered manager had dealt with it. We saw complaints and compliments were recorded.

Staff spoke about the registered manager with respect and admiration. They said the registered manager had made changes which had improved life for people living at the home and for staff.

The provider had not sent any quality assurance questionnaires to people who used the service or their representatives since the last inspection. There were meetings for people who lived at the home and the registered manager told us they had an open door policy and encouraged people to come and speak to them if they had any concerns.

We found improvements had been made and the registered manager and staff were clearly committed to continuing to improve the service for the benefit of people who used the service. However, we found the provider was still in breach of some regulations and these issues had not adequately dealt with in their improvement plan.

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

27 January and 02 February 2015

During a routine inspection

The inspection was unannounced and was carried out on 27 January and 2 February 2015. At the time of the inspection there were 54 people receiving care at Duchess Gardens Care Centre.

The last inspection was on 16 July 2014. At that time we found the provider was not meeting a number of the regulations. We told the provider they must take action to make improvements to the way they monitored the quality of the service. We also gave them a warning notice telling them they must take action to make sure medicines were managed safely. We followed up all those areas during this inspection.

Duchess Gardens Care Centre is a converted four floor building in Bingley, West Yorkshire. The centre is registered to provide personal care and nursing to a maximum of 131 people. The centre provides care for older people, people living with dementia and people with long term mental health needs.

The service did not have a registered manager, the previous registered manager left soon after the inspection in July 2014. 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. There was an acting manager in post at the time of the inspection, prior to accepting the manager’s post they had been employed at the home as an administrator.

The continuity of care was compromised because the service did not have enough nurses and the arrangements for providing cover with agency nurses were ad hoc. People’s care and welfare was further compromised because the nurses that were employed did not have the right qualifications, knowledge or experience to meet their needs. Medicines were not managed safely and this put people at risk.

People’s needs were not always properly assessed and care was not always planned and delivered to meet their individual needs. People did not always get the right support to enable them to eat and drink sufficient amounts to maintain their health. The home had a day centre where people were supported to take part in social activities and there were planned outings to local places of interest. However, there were inconsistencies in the way this aspect of the service was delivered and for many people the opportunities to take part in any meaningful social activities were limited.

We saw positive interactions when staff showed kindness and compassion to the people in their care. However, we also observed people were not always treated with respect and dignity and staff were not always attentive to people’s needs.

We saw staff had received training on safe working practices. Staff told us they were receiving more training and this was helping to improve the service. However, there was a lack of training linked to the needs of people using the service which meant staff did not always have the skills and knowledge needed to understand and meet people’s needs.

There was a lack of strong and consistent leadership; the service has had a high turnover of managers and senior staff. Lines of communication were not always clear and managers, nurses and senior staff were not aware of what was happening in the home.

The provider had systems in place to monitor and assess the quality of the services provided and to identify, assess and manage risk. However, these systems were not working because they had not identified the serious concerns we found during the inspection.

We found the provider was in breach of a number of regulations. CQC is considering the appropriate regulatory response to resolve the problems we found.

9, 10 April 2014

During an inspection looking at part of the service

The inspection team was made up of four inspectors and a specialist advisor. One of the inspectors was a pharmacy inspector. We set out to answer our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found.

If you wish to see the evidence supporting our summary please read the full report.

On 13 December 2013, we served a fixed penalty notice to Elder Homes Bradford Limited for failing to have a registered manager in place at Duchess Gardens Care Centre. A fine of '4,000 has been paid. In April 2014 the manager submitted an application for registration to the Commission.

Safe

The people we spoke with, people who used the service and their relatives, told us they felt safe in the home. However, we found the service did not always have enough suitably qualified and experienced staff on duty and this meant there was a risk to people's safety and welfare. This was compounded by the layout of the building which provided accommodation in two adjoining buildings over three and four floors respectively. We have asked the provider to tell us what action they are going to take to make sure staffing levels and skill mix are appropriate to the needs of people who use the service.

We found the provider did not have an effective system in place to make sure they learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This increased the risk of harm to people and failed to ensure that lessons were learned from mistakes. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety.

We found people were not protected from the risks associated with medicines because the provider did not have effective processes in place to make sure medicines were managed safely.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, they were able to describe the circumstances when an application should be made.

Effective

Overall the people we spoke with were satisfied the service met their needs. Relatives also told us they were generally satisfied with the service. One relative told us 'I would recommend this place, it is mostly good, and if I mention any issues they sort it out for me'.

We saw people had access to a range of health care professionals who visited them at the home.

We found people's care records were up to date and contained information about their individual needs and preferences. We saw people and/or their relatives were involved in reviewing their care plans.

Caring

For the most part we observed staff were kind and considerate in their interactions with people. One person said the 'Staff are always nice and friendly' and another said 'Lovely staff, but they are a bit short staffed'.

We observed staff dealing compassionately and calmly with one person who became upset during the morning.

When we spent time observing care practices in the unit for people living with dementia we found there was a lack of meaningful interactions and the interactions that took place were for the most part task focussed.

In another part of the service we observed a member of staff leading a person by the hand into a lounge. The member of staff was walking an arm's length in front of the person and did not speak to them other than to direct them to a chair.

Responsive

The service provided a range of activities for people and had a day centre which people could attend. However, on the day of the inspection there no activities taking place on the dementia unit. A relative of person who used this part of the service told us 'I would like more activities as there is not a lot to do. They have activities upstairs but only occasionally downstairs'.

Well- led

The staff we spoke with spoke highly of the manager and felt that since their appointment morale had improved.

However, we found the provider did not have effective systems in place to assess and monitor the quality of the service. We also found an absence of systematic processes for learning from complaints, service user satisfaction surveys and concerns raised by staff. This meant the provider did not have enough information about their core business and could not show evidence of learning from incidents and accidents.

10 February 2014

During an inspection looking at part of the service

During the inspection we spoke with the manager, the clinical manager, the unit manager and a nurse. They told us about the systems in place for managing medicines. They told us that improvements had been made in medicines management since our last visit

We did not speak to people about their medicines during this visit.

We found that people were not protected against the risks associated with the unsafe management of medicines because the provider did not have effective systems in place.

3, 4 December 2013

During an inspection looking at part of the service

We overheard one person who used the service telling their relative 'I can have a cooked breakfast everyday if I want'. We observed people were offered a choice at breakfast which included a cooked breakfast.

Another person who used the service told us it was a 'Very presentable home' They said the 'Food is eatable and we are given a choice.' They said they staff were 'always nice' but said sometimes there were not enough of them. Another person said they it was a 'Very nice home with nice staff'.

We found people were offered adequate nutrition and hydration. We found staff were aware of people's individual dietary needs and preferences.

We found care was not always planned and delivered in such a way as to ensure people's safety and welfare.

We found the provider did not have effective systems in place to assess and monitor the quality of the service and identify and manage risks to people's safety and welfare.

We found people were not protected from the risks of receiving unsafe or inappropriate care because accurate records were not maintained.

28 August 2013

During an inspection looking at part of the service

We spoke with three people who used the service and the relatives and/or friends of three people who used the service.

Two people who used the service told us they had no concerns. They said the staff were 'nice' and food was good. One person told us they could see their GP quickly whenever they needed to and said they had a dental appointment soon. Another person said they were generally satisfied with the care provided. However, they said they would prefer to have a male carer to support them with their personal care and they would like to have a shower more than once a week.

Two people's relatives/friends told us they were happy with the service, one person described it as 'excellent'. Both said they were kept informed and involved in making decisions. They said the staff responded quickly to requests for support and any medical needs were dealt with quickly. Another person said the care was 'so, so' and said they were not sure if staff kept up to date with people's care plans.

Our findings during the inspection reflected the mixed views we received from people. We found there were inconsistencies in the way people's care and welfare needs were identified and in the way care was planned and delivered.

We found improvements were needed to the way people's medicines were managed.

We found the provider had systems in place to make sure appropriate records were maintained.

9 April 2013

During a routine inspection

One visitor told us they were 'delighted' with the care their relative received at Duchess Gardens. They said they were kept fully informed and had 'peace of mind' knowing their relative was safe and well cared for. Many of the people who used the service were not able to tell us directly about their experiences. However, people who were able told us they enjoyed living at Duchess Gardens and said the staff looked after them well.

One visitor said there were occasions when there did not seem to be enough staff on duty. However, they said the staff were always kind and caring no matter how rushed they were.

The people we spoke with and their visitors raised no concerns about their safety and said if they had concerns they would discuss them with the manager.

We saw people were offered choices, for example one person liked to sit looking out of the window in the sun and staff moved the persons chair so they could have the view they liked. We observed the meal service at lunch time. We saw people were offered 'cover ups' for their clothes. Most people had their lunch time meal at the table; however we saw people were able to have their meals in their rooms if that was their preference. We saw people were offered a choice of food and hot or cold drinks. People told us they enjoyed the food.

We found improvements were needed to way the provider checks and monitors the quality of the services provided and to the way people's care records were maintained.

20 September 2012

During an inspection in response to concerns

We haven't been able to speak to most people using the service because they had complex needs and were unable to tell us their experiences. However we used the Short Observational Framework for Inspection (SOFI) to assess the care delivered. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. However one person told us "They look after me here."

We observed care in the lounges of two of the four floors for three hours each and saw people were cared for and the activities coordinator encouraged people to take part in activities. However we saw the care records were confusing due to a change in the documentation and people were not assessed appropriately for risks to their safety and welfare. These observations showed us the registered care provider was not managing the care and treatment of people effectively.

We also saw that people who use the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

29 March 2011

During a routine inspection

During the visit we saw that people looked well cared for and they told us they are. They said the staff are kind, caring and friendly. One person said "everyone treats me with respect and kindness".

People told us they have seen improvements since the new manager started. They said the home seems more organised and communication between staff about people's needs has improved so that people get the right care whatever staff are on duty.

People told us that staff listen to them and take notice of what they say. They said they feel safe in the home. During the visit we saw that staff interacted with people in a kind and respectful way.

The people we spoke to when we visited did not raise any concerns about the availability of staff. One person who contacted us after the visit said they were concerned that there were not always enough staff to take account of the fact that people are accommodated on four floors. They were concerned that people were sometimes left unattended in the lounges for long periods of time and said it was sometimes difficult to find staff.

People told us they have seen an improvement in the standards of cleanliness in recent months. When we looked around the home was clean.

During the visit we observed the meal service at lunchtime. It was well organised and staff were available to help and/or encourage people where necessary. We saw that people were offered a choice of meals at lunch time. People told us they enjoy their meals and confirmed that they are always offered a choice of food.