25 May 2022
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 Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out by two inspectors on both days and an Expert by Experience on day two. 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 and/or personal care as a single package under one contractual agreement dependent on their registration with us. Buckingham Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection a manager had been appointed and had applied to CQC to be registered.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with eight people who used the service about their experience of the care provided. We spoke with five staff which included the manager, acting regional manager, deputy manager, a team leader, the wellness coordinator and had informal conversations with two carers.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us and we carried out some other general observations at lunchtimes on both days.
We reviewed the environment and a range of records. This included eight people's care records and multiple medication records. We looked at four staff files in relation to recruitment and four other staff files in relation to training and supervision. We reviewed a sample of health and safety records.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data, rotas, allocation records, audits, meeting minutes, fire records, policies and procedures.
We spoke with six relatives and seven staff, which included the manager. We received written feedback from one relative. We requested feedback from health professionals involved with the service. None was received.
25 May 2022
About the service
Buckingham Lodge is a residential care home providing the regulated activity accommodation for persons who require nursing or personal care to up to 64 people. The service provides support to older people and people with dementia. At the time of our inspection there were 30 people using the service.
Buckingham Lodge is purpose built and accommodates people over three floors. Each unit has its own lounge, kitchenette, dining areas and bathrooms. Alongside this the service has a cinema room, hairdressers and family room. The ground floor unit provides care to people living with dementia, whilst the first floor supports people with residential and dementia care needs. At the time of the inspection two units were in use.
People’s experience of using this service and what we found
People and their relatives were generally happy with the care. They told us staffing levels and communication with them had improved, although there was still some inconsistencies in staff due to agency use and access to activities for people. People and relatives commented “I am happy living here, the carers are all very nice and always very helpful," and “I am really pleased with Buckingham Lodge and can’t speak highly enough of mum’s care, it is second to none and the carers are all good.”
Risk to people were identified and mitigated, with staff aware of people’s risks and how to support them. Systems were in place to safeguard people. However, infection control practices observed did not always mitigate the risks of cross infection. A recommendation has been made to improve practices.
Staff were suitably recruited with training and supervision of staff improved. The provider had been proactive in recruiting staff to provide consistent care to people. Staffing levels had improved with an isolated occasion where the staffing deemed required was not provided due to short notice sickness.
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. Improvements have been made with decision specific mental capacity assessments and best interest decisions in place. However, we have made a recommendation for the provider to work to best practice in their application of the Mental Capacity Act 2005 and ensure mental capacity assessments and best interest decisions are referred to in relation to the delivery of care.
Staff meeting minutes and email communication with relatives indicated that the service did not encourage negative feedback. This did not promote an open and honest culture to promote positive outcomes for people. We have made a recommendation to address this.
Auditing and monitoring of the service was taking place which enabled the provider to identify shortfalls in the service provided. Improvements have been made to records, however we have recommended further improvements to ensure records are suitably maintained.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 15 September 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We carried out an unannounced focused inspection of this service on 15 and 16 June 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding, staffing, good governance and need for consent.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements and warning notices.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings 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 COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Buckingham Lodge on our website at www.cqc.org.uk.
We have made recommendations under safe and well led to further improve practice and sustain improvements.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.