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Inspection carried out on 11 October 2019

During a routine inspection

About the service

Buckingham House is a care home with Nursing. It can accommodate up to 53 people. At the time of the inspection 45 older people some of whom were living with dementia lived at the home. Accommodation was over three floors. The second floor had been opened in the summer to offer more independent living accommodation for people. People had access to a range of seating areas and well-maintained small garden area on the ground floor.

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

People and their relatives told us Buckingham House was “Homely,” " Welcoming, friendly and had kind staff.” Relatives told us the environment was “A breath of fresh air” and “The level of cleanliness is high.”

People were supported by staff who had been recruited to ensure they had the right skills and attributes to work at the home. The home had occasional support from external temporary workers. We found the service did not have a system in place to ensure temporary staff had the required skills. For instance, a nurse needed to have a current registration with their professional body. We have made a recommendation about this in the report.

People who required support with the administration of their prescribed medicines, had this provided by staff who had been deemed competent. We found records relating to people’s medicines were not always accurate. We found some stock levels were incorrect. Audits carried out by the service did not always reflect the amount of medicine held at the home. We found staff were not always provided with adequate information on medicines which were prescribed for occasional use. We have made a recommendation about these issues in the report.

People had care plans in place which reflected their likes and dislikes. However, care plans did not routinely hold information about people’s life histories and were not always updated in a timely manner when needs changed. We have made a recommendation about this in the report.

The service supported people with end of life care. However, we found mixed evidence about how the service recorded people’s wishes. We have made a recommendation about ensuring people’s end of life wishes are recorded.

People were cared for by staff who demonstrated kindness, compassion and respected individual's dignity. Comments from people and their relatives included “All staff behave in a professional manner,” “His care has been exemplary” and “I am impressed by the cheerfulness of the staff who do a difficult job with patience.”

People had access to a wide range of activities within the home and the local community. The home had regular visits from school children and people were supported to practice their chosen faith or religion.

People were routinely consulted about changes to the home environment, future activities and decisions about their care.

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 provider and management team had systems in place to monitor the quality of the service provided and used feedback to drive improvement.

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 9 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 9 February 2017

During a routine inspection

This comprehensive inspection was undertaken on 9 and 10 February 2017. It was an unannounced visit to the service.

Buckingham House is a care home which provides personal care and nursing care to people. It is registered to provide care up to 53 people, some of whom are living with a dementia illness. At the time of our inspection there were 25 people living at the home.

On 3, 4 and 5 August 2016 we conducted a comprehensive inspection of Buckingham House and found a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Records relating to people’s care and treatment were not always accurate and gave the reader conflicting information. This meant there was a potential for people to receive inappropriate care. We served a warning notice to the provider following the inspection. A warning notice gives a date the service must be compliant by. The date the service needed to be compliant was 26 October 2016. We also found people were not supported in line with the Mental Capacity Act 2005. We asked the provider to send us an action plan detailing how they intended to improve. In addition we made five of recommendations to ensure people received safe, effective and responsive care. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Buckingham House' on our website at www.cqc.org.uk.

The service had a registered manager in post. 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.

At this inspection we found improvements had been made and previous breaches of the regulation had been met. We found the home to be calm and relaxed, we saw people interacting with staff, with smiles and laughter.

People gave us positive feedback about their experience of living at Buckingham House. Comments included, “I think the staff are very good and friendly,” “The staff are fantastic I have no complaints” and “I think the staff are first class.” This was supported by what a visitor told us, “Yes the staff are fantastic, really are. Really kind and never seem to rush the residents.”

We found risk assessments were completed correctly and evaluated on a regular basis. The registered manager and deputy manager had put systems in place to regularly monitor the content of records relating to people’s care and treatment. This was to ensure people received the care they required.

People were protected from the risk of abuse. The service had a safeguarding procedure in place. Staff received training on safeguarding people. Staff had knowledge on recognising abuse and how to respond to safeguarding concerns.

People’s human rights were protected. We found the service correctly identified when a capacity assessment was required. When completed these were for a specific decisions and completed in line with the code of practice for the Mental Capacity Act 2005. The service recorded decisions that had been made in people’s best interests.

People told us they received a personalised and responsive service. We found care plans were of a good quality; they gave detailed information about how to care for a person and contained people’s likes and dislikes.

People gave us positive feedback about the food. Comments included “Food is good, and I get a good choice” and “Food is very nice, I get a good choice. If it wasn’t nice I would complain.” The chef was involved in meetings with the nursing staff to ensure they provided appropriate food to people who had been identified at high risk of malnutrition.

People told us they received the care they required and felt included in discussion about their care. One person told us “I have been here for four years; it’s the best

Inspection carried out on 3 August 2016

During a routine inspection

Buckingham House is a care home which provides personal care and nursing care to people. It is registered to provide care up to 53 people, some of whom are living with a dementia illness. At the time of our inspection there were 25 people living at the home.

On 8 and 9 February 2016 we conducted a comprehensive inspection of Buckingham House and found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. The service was rated ‘inadequate’ and placed into ‘special measures’. We took enforcement action to ensure people’s safety and ensure improvement occurred at the service. We made an urgent decision to place a condition on the provider’s registration to restrict admissions to the service. We also served two warning notices to the provider following the inspection. A warning notice gives a date the service must be compliant by. The date the service needed to be complaint was 7 May 2016. We asked the provider to send us an action plan detailing how they intended to improve. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Buckingham House’ on our website at www.cqc.org.uk.

Services which have been placed in ‘special measures’ have to be inspected within six months of the last report being published. This comprehensive inspection was undertaken on 3, 4 and 5 August 2016. It was an unannounced visit to the service. At this inspection we found significant improvements had been made in many of the areas where previously they had not meet standards expected from health and social care providers.

At the time of our inspection there was no registered manager in post. 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. We had previously been advised that the registered manager had not worked in the service for some time. We had previously asked both the registered manager and the provider to ensure that an application to de-register was made. The application was successfully made after our last inspection in February 2016. The service had not had stable and consistent management since October 2014. The service had successfully appointed new managers, however, none had continued in their position. The service had again appointed a new manager and at the time of our inspection they had been in post for one month.

Risks posed to people were assessed, however we found practices around the management of risk did not always reflect the care and support required. For instance some of the assessments and care plans for risks associated with falls, nutrition and manual handling were not assessed consistently which meant the true level of risk was not highlighted.

Staff had received training on the Mental Capacity Act 2005. Where people lacked capacity to make specific decisions, assessment was made. However there was a lack of evidence that decisions made by third parties where people had lacked capacity had been made in people’s best interest.

Care plans which detailed what support people required, did not always evidence that people had been consulted about the way they wished to be supported. We have made a recommendation about this in the report.

People were supported to have enough to eat and drink, and had choice over meals provided. However we saw that meal times were close to snack times, which meant some people, did not eat a main meal. We have made a recommendation about this in the report.

We heard mixed responses about the staffing levels. Relatives were concerned about when the service will start to admit new people. They told us they did not want this to affect the staffin

Inspection carried out on 8 February 2016

During a routine inspection

This inspection took place on 08 and 09 February 2016. It was carried out following on-going concerns since our last inspection around people’s safety. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Buckingham House’ on our website at www.cqc.org.uk. It was an unannounced visit to the service.

We previously inspected the service on 28 September and 02 October 2015; the service was not meeting the requirements of the regulations at that time. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We asked the provider to send us an action plan detailing how they intended to improve. The provider told us the actions would be completed by 30 January 2016. At this inspection we checked if appropriate improvements had been made. we found continued breaches in the Health and Social Care Act 2008.

Buckingham House is a care home which provides nursing care for older adults some of whom are living with dementia. It is registered to provide accommodation for 58 people. At the time of our inspection 36 people lived at Buckingham House.

The service had a registered manager in post. 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. However the registered manager had not worked in the service for some time. We had previously asked both the registered manager and the provider to ensure that an application to de-register was made. To date this application had not been made successfully.

People were not protected from avoidable harm, as systems were not in place to ensure people’s safety. The local authority was investigating a number of safeguarding alerts concerning people who live at the home.

Medicines were not managed and stored in a safe way, which led to people not being given medicine prescribed and their health and welfare being affected adversely.

People were not always supported with the care they required as care plans did not always reflect their current needs.

The service was not well-led; it had not had a stable management structure in place, although recent changes to management had had a positive impact. However, the provider told us that they would complete a number of actions by the 30 January 2016 to improve people’s care. We found that these actions had not been completed in full.

Staff were knowledgeable about people living at Buckingham House, and we noted some good interaction between people and staff.

Following this inspection we issued an Urgent Notice of Decision to restrict new admissions to Buckingham House whilst the provider makes improvements to the service.

We have made recommendations about the management of complaints, infection control, gaining consent, training on dignity and fire risk management.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found a Breach of The Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that

Inspection carried out on 28 September & 02 October 2015

During a routine inspection

Buckingham House is a home that provides nursing and residential care to people. It has been registered with the commission since August 2014.

We carried out an unannounced inspection on 28 September and 2 October 2015. At this time 35 people were living in the home, although the home is registered for 53 people. Accommodation was spread over three floors.

Buckingham House 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. The registered manager had not worked in the service since November 2014. The service had appointed a new manager; they had not yet submitted an application.

Staff were knowledgeable regarding how to recognise abuse and what actions they would take if had concerns highlighted. People were not always protected from avoidable harm as risk assessments for residents were not always completed or reviewed regularly. Incidents that had occurred were not always reported by the completion of an incident form. The service relies heavily on agency staff who appear to be very knowledgeable in how to support residents.

All pre-employment checks required were not always completed; Gaps in employment were not always explained and some health checks on staff were not completed. Agency staff had an induction prior to working within the service.

Medicine were not always managed in line with best practice, no clear audit trail of actions taken regarding medicine was recorded, especially in relation to where changes in medication had occurred. This meant that people did not always have medication when needed.

The service regularly maintained equipment used, and undertook regular fire tests.

Staff did not always feel supported, regular meetings between management and staff did not take place.

The service worked in line with the Mental Capacity Act 2005 and where required made appropriate referrals to the local authority for a Deprivation of Liberty Safeguard (DoLS), however they did not always ensure that they had satisfied themselves of the relative’s legal authority to act on behalf of people.

People were supported with access to food and fluids, however the service did not actively record what people had eaten, even when concerns were identified.

Staff were knowledgeable of people’s needs and spoke with them in a respectful and dignified manner. People had some access to activities; however the activities co-ordinator had recently left the service, and therefore opportunities to engage in activities were limited.

The service gathered information about residents preferences, and strived to complete a ‘Me and my life’ document. This detailed people’s life history their significant relatives and friends.

Some of the relatives we spoke with did not have confidence in the management to deal with issues or complaints.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.