The Boynes Care Centre

The Boynes Care Centre is a nursing home providing nursing and personal care for up to 40 people living with dementia. At the time of the inspection 18 people were residing at the service.

The Boynes Care Centre consists of a two-storey building with two wings, Malvern and Cedars. The home consists of both a period and more modern purpose-built accommodation.

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

Risks to people were not always identified effectively to ensure people were not at risk of harm.

Medicines were not always managed safely to ensure people always received their medicines as prescribed. Audits in place were not effective in ensuring management practices were identifying shortfalls.

Omissions regarding fire safety monitoring and checks to protect people against the risk of fire were insufficient and had not fully identified and rectified concerns identified as part of the inspection.

Environmental checks to ensure the safety of people were not always undertaken in line with guidance and the provider’s own procedures or sufficient action was not always taken when risks were identified.

Care plans were in place and reviewed however these did not always fully identify people’s care needs and how these were to be met.

Improvement was needed in the recording of valuables when handed in for safekeeping.

Procedures were in place to prevent the spread of COVID-19. Staff were however at times seen not to wear a facemask to assist in reducing the risk of potential infection. Testing of people and staff members took place regarding the pandemic. Systems were in place for relatives and friend to visit and infection control measure where in place regarding these people.

Systems to monitor the quality of the service provided were not always effective in identifying risks to people. As a result, action had not always been taken in a timely way to reduce risks.

The provider had systems in place for the safe recruitment of staff. Staff were seen to engage with people in meaningful pastimes.

Staff were aware of their responsibilities regarding the reporting of abuse. People felt safe living at the home and liked the staff who provided their care and support.

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 August 2019).

At this inspection not enough improvement had been made in the safe domain previously rated as requires improvement.

Why we inspected

We received concerns in relation to staffing and communication. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Boynes Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to medicine management, monitoring the safety of the environment, care documentation and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The Boynes Care Centre 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.

The Boynes Care Centre accommodates up 40 people in a large adapted property with more modern extensions. The home is split into two unit. Malvern unit supports people older people and people living with Multiple Sclerosis. A service is provided for people on short stay as well as permanent. Cedar unit supports people living with a dementia. There were 16 people living at the home at the time of the inspection.

At our previous inspection on 27 and 28 September 2017 we rated the service as ‘Requires Improvement’ in each of the five key questions as well as overall. We identified three breaches in regulation. These included the provider had failed to ensure people received safe care and treatment. The provider had not ensured people were safeguarded against abuse. The provider did not have effective arrangements in place to monitor and improve the quality and safety and welfare of people using the service.

As a result, we had asked for the provider to send us a report explaining the actions they were going to take to improve the service. Shortly before our inspection the registered manager had sent us an update on the actions they had taken since the previous inspection. We undertook this inspection to see whether the provider had made the necessary improvements.

At this inspection we found the provider was no longer in breach. Although improvements had taken place we identified some areas where further improvement is necessary. We brought these to the attention of the registered manager as well as other senior managers working for the provider. Some of these shortfalls were acted upon immediately such as checking whether nurse with their registration to practice renewed. Other shortfalls were investigated and we were sent action plans in relation to these.

The provider had a registered manager in place. 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.

Since our previous inspection improvements have taken place in areas such as staffing, staff knowledge on protecting people from abuse and governance. A registered manager was in place and showed a passion to make further improvements at the home.

People who lived at the home as well as relatives and staff were complimentary about the care provided and were confident in the registered manager and the improvements made.

We identified shortfalls in how medicines were managed. These were discussed at the time of the inspection and action taken to reduce the risk of reoccurrences.

People were cared for by the staff who had knowledge of how to keep people safe and what to do if they believed people to be at risk. People’s wishes were taken into account to ensure people’s preferred life styles were met.

People had a range of fun and interesting things to do and were involved in deciding in these. People were able to take advantage of a mini bus to go on outings to interesting places as well as shopping and meals out.

People were supported to have maximum choice about their lives and were supported in the least restrictive way possible. Staff spent time with people talking about important things in their life and had developed a caring relationship. People were encouraged to make decisions about their day to day life. People’s privacy and dignity was respected.

People’s needs were assessed before they moved into the home and these were reviewed as to ensure they could be met. Staff ensured people had enough to eat and encouraged people to drink. People were complimentary about the food provided.

Staff received the training they needed to provide the care and support people required to keep them safe and maintain their wellbeing.

There were enough staff to meet people’s needs and staff worked as a team to support each other to ensure people’s needs were met. Healthcare professionals were consulted and involved in people’s care as needed to maintain their wellbeing.

Accidents and incidents were recorded and the registered manager analysed these to consider any trends and to look at any lessons learnt because of these.

The home was clean and tidy and staff had an awareness of infection control.

We undertook a comprehensive inspection of this service on September 2016. At that inspection the service was rated as requires improvement overall and we identified short falls in two regulations. We asked the provider to complete an action plan highlighting what they would do to improve the quality of care. We found some improvements, however not all of the action points on the providers plan had been completed.

After this inspection we received concerns in relation to how people were safely cared for and how their care was managed. As a result we undertook an unannounced comprehensive inspection to look into those concerns on the 27 and 28 September 2017. The inspection was carried out by two inspectors, a specialist advisor and an expert by experience.

At the time of our inspection there was no registered manager in place. The previous registered manager had left in August 2017. There was a new manager in post who was completing the registration process, they had been in post two and a half weeks at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

We saw there was not always sufficient staff effectively deployed to ensure people remained safe. People had not always had their risks identified, and these risks assessed and mitigated. Staff were not always aware of the safe way to support people. Accidents and incidents were not consistently investigated and actioned. Incidents of potential abuse were not always reported to ensure the manager took appropriate action. The management team had started to take action with some of the areas that needed improving. People told us they had their medicines as prescribed.

People were not always assessed when needed to ensure they were able to consent to their care. People may have been deprived of their liberty without a best interests assessment being completed. Staff told us they were not confident to complete assessments despite the training they had received. Staff respected people's rights to make their own decisions and choices about their support. People had food and drink they enjoyed to maintain a healthy diet. People said they had access to health professionals when they needed to. Relatives were confident their family member was supported to maintain their well-being.

People said they were supported by kind staff. Relatives told us they were happy with the care their family member received. However we saw staff were not always able to spend the time they needed to meet people’s needs. Staff were not consistently focussed on people, we saw there was a culture of task focussed care. Staff did not show a consistent dignified approach to supporting people living at the home. People living at the home were able to see their friends and relatives as they wanted. Staff knew people well, and worked with people to maintain their independence.

People told us they did not always have interesting things to do. The management team had identified people needed more interesting things to do. They were looking at increasing staff support in this area. People and their relatives had had access to regular meetings and further meetings had been arranged to keep them updated with changes in the management team. They knew how to raise complaints and were confident to raise them. There was had a complaints process in place to ensure people were listened to and action taken if required, however we found learning from one complaint had not been fully actioned.

The provider had not taken action to ensure systems in place were robust and effective to provide quality safe care. Staff were demoralised with the constant changes in management and lack of staff support to manage complex people’s needs. The provider had systems in place to monitor the quality of care and treatment people living at the home received. These were not always effective at responding to changes in people’s care provision. Where improvements had been identified there was a plan in place however actions were not completed or sustained.

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

At this inspection, we could not be assured that the necessary improvements to other areas of people’s care had been made. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 18 and 24 May 2016 and was unannounced.

The home provides accommodation for a maximum of 40 people requiring nursing and personal care. There were 23 people living at the home when we visited. A registered manager was in post when we inspected the service. 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 and associated Regulations about how the service is run.

People’s medicines were not always stored appropriately and concerns about how the medicines were stored were not shared with the registered manager. This meant that people may have taken medicines that were not stored as they should have been and the medicines may have been affected.

People were supported when they needed help in communal areas where there was likely to be a staff member around. Staff offered help and support to be people when they were in the lounge or dining areas.

People were supported by staff that received training and support from their line manager. This gave staff opportunities to discuss issues of importance to them and discuss people’s care if needed.

Staff supporting people did not always know which people were subject to a Deprivation of Liberty and how they were affected. This meant that we could not be assured that people were not unlawfully restricted when they were being cared for.

People were not always offered choices throughout their meal and were allocated a pudding based on their ability to eat. People’s mealtime experiences were affected by staff that did not always engage with them or who spoke about them to other staff in their presence.

People were not always cared for in a manner that demonstrated dignity and respect. Staff were at times task focussed and did not empathise with the person they were supporting. This caused some people unnecessary distress. Staff did not always engage and support people in a manner that showed a caring attitude as people were categorised as either having “Dementia” or “MS”.

People’s care was updated based on people’s changing medical needs. People’s individual interests were being supported although people who had specific needs about their care did not get an opportunity to discuss these.

People understood they how they could complain if they needed. Where people had raised a formal or informal complaint they were satisfied that action had been taken. A process was in place for acknowledging and responding to complaints.

People did not always benefit from care that was high quality because systems in the home for ensuring people received this were ineffective. The registered manager did not have a team that understood or delivered care to people, that was high quality, regardless of where they lived within the home.

Staff supporting people did not ensure issues affecting people’s care were brought to the attention of the registered manager so that action could be taken. The registered manager's system for ensuring staff demonstrated caring with dignity and respect was not effective. Although staff was behaviour was being monitored, staff did not consistently demonstrate a caring attitude throughout the home.

People understood they how they could complain if they needed. Where people had raised a formal or informal complaint they were satisfied that action had been taken. A process was in place for acknowledging and responding to complaints.

People did not always benefit from care that was high quality because systems in the home for ensuring people received this were ineffective. The registered manager did not have a team that understood or delivered care to people, that was high quality, regardless of where they lived within the home.

Staff supporting people did not ensure issues affecting people’s care were brought to the attention of the registered manager so that action could be taken. The registered manager's system for ensuring staff were safe to support people was not robust nor was their system for ensuring staff demonstrated caring with dignity and respect.

We spoke with five people who used the service, a relative, a health care professional, six staff and the registered manager. People we spoke with were complimentary about the care and support that they received. One person said: 'I am happy with my care'. A relative told us the care was: "Top marks, you could not better it".

We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were asked about their preferences about their care so they felt involved in their care and treatment.

Systems were in place for the prevention and control of infection to ensure that people lived in a clean and well maintained environment.

A more thorough system of audit had been put in place to ensure that people were not placed at risk of receiving inappropriate care.