Background to this inspection
Updated
7 April 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team included two inspectors, a specialist advisor who was a trained registered nurse, a medicines inspector who works on behalf of CQC and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Buckingham Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Before the inspection we reviewed information we already held about the service including previous inspection reports, notifications which are important events the service are required to tell us about. We also reviewed complaints, safeguarding records and share your experience feedback. We spoke with the local authority quality monitoring team and the clinical commissioning team about their recent involvement with the service and their ongoing monitoring. We reviewed the service’s own action plan. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.
During the inspection-
We visited each unit and carried out observations of the care, activities provided and the meal time experience. We reviewed six care plans. We spoke with maintenance staff, the housekeeper, activity staff, two-unit managers, a registered nurse, two care staff, the registered manager, the service manager and quality manager. We spoke with seven people using the service, three relatives, and two health care professionals. We reviewed medicines and medicine practices on each floor and reviewed records in relation to staffing, recruitment and other records relating to the management of the business.
After the inspection –
We continued to seek clarification from the provider to validate evidence found. We gave written feedback and asked for additional evidence.
Updated
7 April 2020
About the service
Buckingham Lodge is a residential care home providing personal and nursing care to up to 73 people aged 65 and over. At the time of the inspection there were 58 people using the service. The service is provided in a purpose-built home over three floors, ground, middle and top floor providing residential care, dementia care and nursing.
People’s experience of using this service and what we found
The service had a poor regulatory history which could have affected people’s experiences over time and damaged the service’s reputation. The service had at this inspection made some notable progress and had a better organisational structure with a registered manager, deputy manager and unit lead on each floor. It had fully recruited to its nursing posts but still had some agency usage. Some staff were new and still settling into their role. Training across all staff was improving and people mainly received consistent standards of care.
The service had continued to strengthen its governance and oversight to help ensure risks were quickly identified and managed effectively. Daily walk around, safety debriefings and daily management meetings had been implemented to help focus staff on where the risks were and deploy staff where necessary. Record keeping could be improved to clearly show how incidents were effectively managed and reduced as far as possible, with clear lines of accountability across the whole staff team.
Staffing levels were reviewed in line with the numbers of people who used the service and their needs, but some felt staffing levels were not always appropriate and they had to wait for their care which was not provided in line with their preferences.
Staff understood how to safeguard people and how to raise concerns. The audit trail had improved but there were still a number of risks associated with people’s needs and behaviours which at times affected others. Care plans did not always detail enough information about how staff could reduce and help people manage their anxiety which could affect their behaviour.
Medicines were well managed, and we did not identify any concerns in this area. The service was meeting people’s health care needs and working hard to improve joint working with other health care professionals. A number of whom told us there had been issues with communication, record keeping and uptake of training.
Staff recruitment was sufficiently managed which meant staff employed were suitable but there were concerns about employment of temporary staff who did not necessarily have the right skills. The service tried to mitigate this risk by asking the agency for information and by completing an in-house induction.
People were supported to eat and drink and risks of not eating enough or drinking enough mitigated as far as possible. The dining room experience could be enhanced further if people were encouraged to socialise together and staff joined in.
Staff were caring and considerate of people’s needs. Although the service took into account people’s preferences this was not always fully recorded. Records generally had significantly improved but were still not sufficiently person centred but were regularly reviewed and updated.
People were asked their views and staff promoted choice and sought people’s consent. Records relating to capacity were sometimes contradictory.
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.
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 requires improvement (published 14 February 2019) and there were multiple breaches of regulation.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, sufficient improvement had been made and the provider was no longer in breach of regulations but still rated requires improvement throughout.
Why we inspected
This was a planned inspection based on the previous rating.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.