Bassett House

Bassett House is a care home providing personal and nursing care for up to 63 older people. At the time of our inspection 61 people were living in the service. The service spans across three floors, with a variety of communal spaces on each floor and an enclosed garden.

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

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. However, some assessments were very generic and monitoring documentation was not completed correctly to evidence appropriate care had been given.

On the day of this inspection we observed staffing levels to be sufficient to safely support people. Staff were visible and call bells were responded to quickly. We saw that recruitment checks had not always been fully undertaken to ensure new employees were of suitable character.

The service was clean, tidy and free from any bad odours. The registered manager had good knowledge of current infection control guidance including guidance regarding the COVID 19 pandemic. People were able to receive visitors and safe measures were in place to enable this. The majority of staff wore PPE appropriately; however, we did observe one member of staff going from room to room without changing their PPE. This was addressed.

People's medicines were managed and administered safely. People we spoke with told us they felt safe living at Bassett House and staff were always available to help them.

The service promoted a positive culture. People told us they were happy living at Bassett and praised the management and staff team. Staff were positive about their roles and felt well supported.

Quality assurance systems were in place to monitor the quality of service being delivered and the running of the home. People’s relatives felt communication from the service during the pandemic had been good and enabled them to keep in touch with family members. Health and social care professionals gave us very positive feedback about their experiences of working with the service.

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 16 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about two people’s medicine management on discharge and a safeguarding concern raised by paramedics. A decision was made for us to inspect and examine those risks. At this inspection we did not find any concerns related to these incidents.

We undertook a focused inspection to review the key questions of safe and well-led only. 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.

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.

We have found evidence that the provider needs to make some improvements. Please see the Well-led key question of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified a breach in relation to Regulation 17 Good governance at this inspection. This is in respect to the assessment and recording of risks to people. 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 for 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.

Bassett House provides accommodation with nursing and personal care for up to 63 people, some of whom have dementia. Accommodation is provided in one adapted building. The building has three floors accessed by a lift or stairs. There are communal lounges, dining areas and small satellite kitchens. At the time of the inspection, 54 people were living at the service. Five of the rooms were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery.

At our last inspection in June 2017 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. We issued the service with five requirement notices.

At this inspection the service had made all of the required improvements and we rated the service Good.

The home had a registered manager. 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. Statutory notifications had been submitted to us to inform us of incidents as required.

The registered manager was supported by a deputy manager and both were visible. People, their relatives, healthcare professionals and staff all told us they thought the registered manager was open and approachable.

People’s medicines were managed safely. Registered nurses administered medicines as prescribed and we observed their practice to be safe. Staff had additional guidance (protocols) for medicines prescribed to be taken ‘as required’ (PRN) and they explained when medicines could be given.

Care plans were detailed and contained guidance for staff to make sure people were supported safely. Risks had been identified and there were risk management plans in place. These had been reviewed regularly. End of life care had been provided with support from the relevant healthcare professionals. People had been given the opportunity to record their end of life wishes.

We have made a recommendation about the provision of care plans for people who required 1-1 support.

There were quality monitoring systems in place for all areas. Where actions and improvement was required this was completed and ‘signed off’ by the registered manager. All quality monitoring was shared with the provider so they could also have oversight of the service.

People were protected from potential abuse by staff that were trained and understood how to safeguard them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Recruitment practices were safe. Pre-employment checks had been completed to make sure suitable staff were employed. There were sufficient numbers of staff deployed to make sure people’s needs were met. The registered manager monitored people’s dependency levels with a tool so that additional staff could be deployed if needed.

Staff were trained and supported. Without exception people and their relatives told us staff were kind and caring. People appreciated the staff approach to their care which they all found to be positive. People had access to health professionals and other specialists if they needed them in a timely way.

There were opportunities for people to follow their interests. Activities were planned with the involvement of people and discussed at ‘resident meetings’ to make sure they were appropriate. The service employed three activity workers who worked together to offer activities according to people’s likes, wishes and needs.

People were supported to have enough to eat and drink. People were supported to make choices about their meals options and where they would like to eat their meals. Staff were available to support people to eat, however the registered manager recognised additional staff at mealtimes would be beneficial. The service was going to recruit more staff into the hostess role which supported mealtimes.

People understood how to complain and complaints were well managed. There were comprehensive complaints records, which documented the outcome and the complainant’s response.

The service was clean throughout with no unpleasant odours. Equipment and the premises were regularly maintained.

The service also provided five intermediate care beds. This service provides support to older people to help them avoid going into hospital unnecessarily and to help them to be as independent as possible after discharge from hospital before returning home.

We undertook a full comprehensive inspection on the 21 and 22 June 2017. The first day of the inspection was unannounced. During our last inspection at Bassett House in July 2016 we found the provider did not meet some of the legal requirements in the areas we looked at. After the previous inspection the provider wrote to us with an action plan of improvements that would be made to meet the legal requirements in relation to the law. We found on this inspection the provider had taken some steps to make the necessary improvements.

A registered manager was employed by the service and was present throughout our inspection. 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 were arrangements in place for the safe storage and administering of medicines as prescribed. However, where people were administered medicines covertly appropriate processes had not been followed and there was no evidence that decisions were undertaken in the person’s best interest. Protocols for “as required” medicines were not of a consistent good quality.

The service did not always act in line with current legislation and guidance where people lacked the mental capacity to make certain decisions about their support needs. Mental capacity assessments had not been undertaken and there was no evidence that discussions had taken place to make decisions in the person’s best interest. We saw that people were supported with making decisions around their care. Staff sought people’s consent before providing them with care and support.

During our last inspection some care plans did not contain up to date assessments. Whilst improvements had been made some sections of care plans still lacked person centred information and guidance for staff.

Staff were aware of their responsibilities to keep people safe. They had the knowledge and confidence to identify safeguarding concerns and knew what actions to take should they suspect abuse was taking place. Whilst risks to people’s personal safety had been assessed and plans were in place to minimise these risks they did not always provide enough guidance for staff on how to reduce the risks.

Whilst the provider had systems in place to monitor the quality of service to ensure improvements were identified these had not picked up the areas needing improvement we had noted.

Staff spoke passionately about wanting to provide people with a high standard of care. People were supported by staff that had gotten to know them well. People were treated with kindness and compassion in their day-to-day care. People and their relatives spoke highly of the staff and the care and support they provided.

There were sufficient numbers of suitably trained staff to keep people safe and meet their individual care and support needs. People were supported by staff who received on-going training and support to enable them to deliver effective care and support. Safe recruitment practices were followed before new staff were employed to work with people. Checks were undertaken to ensure staff were of good character and suitable for their role.

Arrangements were in place for keeping the home clean and hygienic and to ensure people were protected from the risk of infections. During our visit we observed that bedrooms, bathrooms and communal areas were clean and tidy and free from odours. Regular maintenance of the home was undertaken to ensure the safety and suitability of the premises. A call bell alarm system was in place to ensure people who use the service could call for help when required.

People, relatives and staff spoke positively about the management of the service. People, those important to them and staff had opportunities to feedback their views about the service and the care and support people received. Processes were in place to ensure complaints were dealt with in a timely manner.

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

We carried out this inspection over two days on the 13 and 14 July 2016. The first day of the inspection was unannounced. Two inspectors and a pharmacist inspector attended the inspection on the 13 July 2016. The same two inspectors and an expert by experience attended the inspection on the 14 July 2016. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. During our last inspection in May 2015 we found the provider did not meet some of the legal requirements in the areas that we looked at.

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.

Medicines were not always managed safely. Records pertaining to the safe administration of medicines were not always completed correctly. Medicine administration records did not always contain all relevant protocols and advice for administration, including detailed ‘as necessary’ (PRN) protocols.

Staffing rotas reflected the staffing levels identified by the dependency tool. However, some staff members, people and relatives said there were on occasions not enough staff present and this concerned them.

Whilst people were supported to eat and drink food and fluid charts were not always completed which meant it was not always possible to determine whether people had received sufficient fluids and food.

Staff showed concern for people’s wellbeing in a caring and meaningful way and they responded to people’s needs when required. People were treated with kindness and compassion in the day to day care. People and their relatives were mostly positive regarding the care and support provided by staff.

People and their relatives were involved in developing their care, support and treatment plans. Care plans were personalised and detailed daily routines specific to each person. However some care plans did not contain up to date assessments. This meant people’s care plans were not always in line with their needs.

The staff had received appropriate training and supervision to develop the skills and knowledge needed to provide people with the necessary care and support. Staff received regular refresher training and attended a range of training which included training specific to the needs of people using the service, for example dementia awareness. Safe recruitment practices were followed before new staff were employed to with people.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Senior management and staff had a good understanding of supporting people to make decisions and choices.

There were systems in place to monitor the quality and safety of the service provided. Where required actions to improve the service had been identified and acted upon. People, relatives and staff were encouraged to share their views on the quality of the service they received.

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

This inspection was carried out by a pharmacist inspector to assess what the provider had done in response to the action we had told them to take with regards to the safe management of medicines.

Is the service safe?

We found the service was safe because people were protected against the risks associated with medicines.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. Additionally we used the Short Observational Framework for Inspection (SOFI) tool for a forty minute period.

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

Is the service safe?

Care plans instructed staff how to meet people's needs in a way which minimised risk for the individual. People's diversity, values and human rights were respected. People were treated with respect and dignity by the staff.

Mental Capacity Act 2005 assessments were included, as appropriate in all plans of care. Staff understood mental capacity, consent, choice and deprivation of liberties safeguards (DoLS).

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home liaised effectively with the local authority DoLS team and had made applications as appropriate. The home had not made any DoLS referrals in 2013 or 2014.

We found that medication was not administered and recorded in a way which kept people as safe as possible. We have asked the home to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the unsafe use and management of medicines.

The home had robust recruitment procedures and checked, as far as possible, that candidates were safe and suitable to work with vulnerable people. People told us they had never experienced any poor treatment and felt very safe in the home.

Systems were in place to make sure that the manager and staff continually monitored the quality of care offered to people. We received no negative comments about the care the home offered to the people who lived there.

Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People told us they were: 'treated very well'. One person told us that they were: 'very glad' they had chosen the home. They said: 'I really couldn't have done better'.

People's health and care needs were assessed with them, and/or their relatives, as appropriate. Care plans were detailed and clearly identified people's needs and how they should be met. They were reviewed regularly and changes were made to meet people's changing needs.

Is the service caring?

People were supported by kind, caring and patient staff. We saw that care staff responded quickly and sensitively if people asked for or indicated that they needed help. People told us that they were treated with respect and dignity at all times and said: 'staff always make me feel comfortable and never cause any embarrassment'. They described staff as: 'excellent, caring and patient'.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People told us that their relatives and friends were always made welcome in the home and as a result liked to visit. This resulted in people visiting them more often.

Is the service responsive?

The home had made changes and improvements as a result of ideas and discussions with people who live in the home and their relatives.

People knew how to make a complaint if they were unhappy. The home had received a number of complaints in 2013 and 2014. These were dealt with appropriately and actions taken, as necessary. People told us: 'we are very confident that staff would listen to us and do what they needed to'. Staff told us they were 'absolutely confident that the manager listens to complaints and takes the proper steps'. Relatives described minor issues that were 'put right immediately'.

Is the service well-led?

Staff members told us that they were supported to do their job well and it was a very positive place to work. They said that they felt valued and their views were listened to. People who lived in the home and their relatives told us that staff and the manager were very approachable, as was the provider who visited regularly.

The service had a comprehensive quality assurance system. We saw records which showed that identified shortfalls and ideas people put forward were addressed. As a result the quality of the service was being maintained or improved.

We spoke with relatives of people who lived in the home. They told us the manager and staff communicated professionally with them and responded promptly to any issues they raised.

We found that staff were supported to undertake regular training.

We found that the home provided enough staff to meet peoples needs.

We found that the home had an effective complaints procedure in place. People living in the home and their relatives felt able to raise concerns or make a formal complaint if the need arose.

We undertook this subsequent inspection visit in response to concerns that had been raised and brought to our attention. These related primarily to the care and welfare of the people living in the home and the staffing levels that were provided. We found that the home was compliant in the areas inspected and was taking steps to improve the quality of service and address the concerns that had been raised.

People living in the home we spoke with told us they were satisfied with the care and support provided. People said they were treated well by the staff and generally had their needs attended to promptly.

We spoke to three relatives who were visiting the home. We were told that staff were always available when they visited and they were made to feel welcome in the home. We were told the staff communicated well with them and kept them informed of concerns or issues.

We observed that people appeared well cared for and interacted positively with the staff. The nursing staff organised and prioritised the care and support that was delivered. We saw that the staff worked well as team.

Changes and improvements were being made to the management structure of the home. An additional deputy manager had been recruited and one deputy now had the designated task of overseeing all clinical matters within the home.