Buckingham Lodge

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.

Recommendations

We have made recommendations under safe and well led to further improve practice and sustain improvements.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Buckingham Lodge is a residential care home providing personal care to 37 people aged 65 and over at the time of the inspection. The service can support up to 64 people.

The service is purpose built and accommodates people over three floors. Each unit has its own lounge, kitchenette, dining areas and bathroom. 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 provides residential care. The second floor supports people with residential and dementia care needs.

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

We received mixed feedback on the care provided. People were generally happy with their care and felt safe. However, some of their feedback on staff practice, staffing levels and activities indicated safe care was not consistently provided.

Risks to people, including infection control risks were not always identified and mitigated. Systems were in place to safeguard people. However, staff practice and reduced staffing levels had the potential to put people at risk.

People were not supported by sufficient numbers of suitably trained staff. Staff described working under pressure and unsupported on shift which impacted on the quality and timings of people’s care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice

The service was not consistently managed, and auditing was ineffective in bringing about improvements to the service. Records were not accurate, accessible and suitably maintained.

Systems were in place to ensure staff were suitably recruited. We have made a recommendation to improve recruitment process to include photographs of staff and show evidence that they have explored gaps in employment.

The provider had a duty of candour policy in place, although records were not available to evidence the service worked to the policy and the regulation. The interim manager confirmed this would be addressed for future incidents and provided us with an action sheet to show how that would be monitored.

Medicines were safely managed, and systems were in place to monitor accident and incidents.

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 requires improvement (published 19 July 2019) and the provider was in breach of two regulations of the Health and Social Care Act 2008. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about people’s care and staffing levels. A decision was made for us to inspect and examine those risks. As a result, 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 COVID-19 and other infection outbreaks effectively

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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 Buckingham Lodge 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 and will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, staffing, safeguarding, good governance and the application of the Mental Capacity Act 2005.

We served warning notices in respect of breaches of Regulation 12, 17 and 18 of the Health and Social Care Act 2008 with a timescale for compliance. The progress with meeting these regulations will be reviewed at the next inspection.

Please see a summary of the actions we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Buckingham Lodge is a residential care home providing personal care to 36 people aged 65 and over at the time of the inspection. The service can support up to 64 people.

The care home is purpose built and accommodates people over three floors. Each unit has its own lounge, kitchenette, dining areas and bathroom. Alongside this the care home has a cinema room, hairdressers and family room. The ground floor unit provides care to people with dementia, whilst the first floor provides residential care. The second floor had a mix of people with residential and dementia care needs.

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

People and their relatives were generally happy with the care provided and described staff as kind and caring. They felt their family members health needs were met and told us how their family members overall health had improved. However. they told us there was a lack of continuity in care due to the high use of agency staff and there were limited activities provided.

We found risks to people were not mitigated which had the potential to put people and staff at risk. The service had a high number of staff vacancies. This led to inconsistent care for people and a lack of suitably skilled staff on shift to promote safe care. We have made a recommendation to address this. Systems were in place to safeguard people and their medicine was appropriately managed. The home was clean, and systems were in place to mitigate infection control risks. The provider monitored accident and incidents and picked up trends in accidents/ incidents to prevent reoccurrence.

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; however, the policies and systems in the service did not support this practice. We have made a recommendation to address this. Staff inductions and training took place. However, the provider had identified gaps in training and the completion of inductions and formal supervisions of staff which they were addressing. People were assessed prior to admission to the home. Their medical and nutritional needs were identified and met.

Person centred care was not consistently provided. People had care plans in place which were under review and development. They did not have access to regular in house or community activities. Their end of life preferences were not identified. Recommendations have been made for the provider to work in line with best practice to promote person centred care. Systems were in place to deal with concerns and complaints which enabled people to raise concerns about their care if they needed to.

People and their relatives confirmed staff were kind and caring. Their privacy and independence were promoted. We observed positive and negative interactions between staff and the people they supported. We have made a recommendation for staff practice to be monitored.

The service did not have a registered manager and there had been three registered managers since the service was registered with the Commission in 2015. This had led to inconsistences in the management of the service. A new manager had been appointed and was due to start the week after the inspection. The provider had systems in place to audit the service. They had identified shortfalls within the service and had an action plan in place to bring about improvements. However, the findings of this inspection demonstrated good governance was not established.

Rating at last inspection: The last rating for this service was good (published 18 January 2018). At this inspection the rating had changed to requires improvement.

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.

Why we inspected

The inspection was prompted in part by the increase in notifications of incidents between people and concerns we received about staffing levels, people’s care and the management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see safe, effective, responsive, caring and well led sections of this full report.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Enforcement

We have identified a breach in relation to the management of risks and good governance at this inspection.

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.

We asked the provider to complete an action plan to show what they would do to improve the key questions in safe, effective, caring, responsive and well led.

The previous registered manager had implemented actions from the action plan which had shown improvements in all areas had been made and the provider was no longer in breach of the regulations. The inspection took place on 12 and 15 December 2017 and was unannounced. At the time of the inspection the previous registered manager had left the service. There was a person managing the service who had submitted an application to become the new 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. The person managing the service had been in post since November 2017.

Buckingham Lodge 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 service is registered to accommodate 64 people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of our inspection there were 37 people using the service.

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Medicines were managed safely; we examined the handling of people’s medicines during our inspection. Medication Administration Records (MAR) charts were correctly completed and people received their medicines as prescribed by the GP.

People were safeguarded from abuse. There were systems in place to ensure people were safe. Staff were knowledgeable about abuse and what to do if they had any concerns. People told us they felt safe living at Buckingham Lodge.

Staff were available to support people. Our observations showed that staff were able to spend quality time with people and care was not rushed. People told us staff were kind and caring.

Risk assessments were in place and were regularly reviewed. People with a specific risk such as malnutrition had a care plan in place to support this.

Staff were knowledgeable and received effective training and support to enable them to carry out their role.

The service complied with the Mental Capacity Act 2005 (MCA). Staff understood the mental capacity, best interest decision making and deprivation of liberty. We saw evidence of best interest meetings and decisions made. 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.

People had a choice of menu and could have additional snacks throughout the day. We saw people were offered fluids throughout the day to ensure they did not become dehydrated.

The service provided responsive care, people’s wishes, preferences and dislikes were taken into consideration. Complaints were responded to and used as a way of improving the service.

Staff told us the culture of the service had improved and they felt supported by the management. One member of staff told us, “Definitely a big turnaround.” Audits were used to monitor the quality of care.

At the time of our inspection, there was 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.

On the first day of our inspection, the registered manager and the deputy manager were not at the service. Staff told us they did not know of their whereabouts or why they were not available. There was not a designated member of staff in charge of the home. This left the building unsafe in the event of an incident. The regional manager was contacted and arrived at the service later that day.

Medicines were not always ordered administered or recorded appropriately. This meant that people were at risk of not receiving their medicines safely. We advised the provider to seek guidance to ensure medicines were managed safely. For example, following the National Institute for Health and Care Excellence (NICE) guidelines on managing medicines in care homes.

People told us staff were caring; although, we did not always observe this during our inspection. We observed that some staff were focused on tasks and did not engage with the people they were caring for. People’s privacy was protected, but their dignity was not always supported. However, some staff demonstrated kindness and compassion when assisting people. There were enough staff to meet people’s needs at the time of our visit.

People were protected against abuse and neglect. Staff we spoke with were knowledgeable of the process to follow if they suspected abuse had occurred. People told us they felt safe living at Buckingham Lodge.

Staff received training support and appraisal. However, staff supervisions were not always carried out on a regular basis. The service complied with the Mental Capacity Act 2005. Staff understood mental capacity, best interest decision making and deprivation of liberty. People had the ability to voice their concerns and had regular ‘residents and relatives’ meetings where they could discuss any concerns they had. However, we saw some complaints had not been responded to with outcomes. We did not always see evidence that complainants were kept informed of the status of their complaint.

Risk assessments were in place for most people’s needs. However, some people who had been identified at risk of weight loss did not have a plan of care to address this. There was a risk that people were not always provided with adequate nutrition and hydration. We discussed this with the regional manager who immediately put food and fluid charts in place for people who were assessed as being at risk of malnutrition.

Staff told us the workplace culture could improve and they said if they voiced an opinion or idea, they were not always listened to.

We found several breaches 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 the report.

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

The service was registered on 5 April 2015 and provides accommodation and personal care for up to 64 people who require residential and dementia care. At the time of our inspection there were 21 people using the service. The service had a registered manager supported by a deputy 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.

We saw people were well cared for and comfortable in the home. Everyone we spoke with complimented the staff who supported them. People’s comments included. “They are very patient and treat me well”.

People were cared for by motivated and well-trained staff that had completed a programme of essential training to enable them to carry out their roles and responsibilities. New staff had completed an induction training programme and there was a programme of refresher training for the rest of the staff.

People were supported to make their own choices and decisions where possible. Staff understood the principles of the Mental Capacity Act (2005). Where identified as a care need, people were provided with the assistance they needed to eat and drink. Staff liaised with the district nurses and the person’s GP when needed.

Managers and senior staff provided effective leadership to the service and regular residents’ meetings ensured people were involved in the running or the home. The atmosphere of the home was warm, friendly and supportive.

People were supported to engage with a variety of activities and entertainments available within the home.

The home employed two activity coordinators; activities were available to all people living in the home. The home is a member of the National Activity Providers Association (NAPA) and had participated in the Dignity in Care campaign and received recognition for this. People were actively involved in activities and entertainments within the home, one person told us they enjoyed different people visiting the home and the opportunity to go out.

Care plans were not always personalised and did not always make reference to people’s emotional, psychological and spiritual needs. However, new documentation in relation to this was in progress at the time of our inspection.

We have made recommendations in relation to pre admission information and ensuring internal audits are more robust and effective.

We identified concerns in relation to medicine practices. This constituted to a breach of the regulation 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 the report.