We carried out this unannounced inspection on 1 October 2018. Bernadette House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The service is registered to provide accommodation and residential care for up to 35 people, including older people and people living with dementia. There were 31 people living in the home at the time of our inspection.
The service can also provide personal support and care for people in their own homes. The registered manager confirmed the service covered the Lincoln city area and surrounding villages. At the time of this inspection there were no people using this part of service.
The service was run by a company who was the registered provider. The service had a registered manager in post who was available at the time of this 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. Like registered providers (‘the provider’) 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘The registered persons’.
At our last inspection on 3 March 2017 we found that improvements needed to be made to ensure that the service was consistently safe and well-led. We rated each of these parts of the service as ‘requires improvement’. Overall, our assessment of the service was ‘requires improvement’.
At this inspection we found that the improvements we had identified were needed at our last inspection had been made and that suitable arrangements had been introduced to ensure that the service was safe and being well-led. Given the progress made we revised our assessment of each of these aspects of the service to ‘good’ and also changed the overall assessment of the service to ‘good’.
However, at this inspection we found some peoples care records were not consistently effective in fully confirming all of their individual wishes and how decisions about the way their care was delivered had been agreed. The registered persons have told us about the actions they are taking in relation to this.
There were sufficient staff available and deployed in ways which helped to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way and communicated effectively, internally and externally.
People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.
People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm. There was evidence of organisational learning from significant incidents and events. Any concerns or complaints were handled effectively.
People were supported to make choices and have control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
The registered persons had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people's best interests.
CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Through our discussions with staff it was clear they understood the principles of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection, five people who lived at the home were subject to a DoLS authorisation and the registered persons informed us they were awaiting the outcome of a further seven applications which had been submitted to the local authority.
Training and support systems were in place to provide staff with the knowledge and skills required to meet people’s needs effectively. Staff worked well together and were kind and attentive in their approach.
The overall physical environment and facilities in the home generally reflected people’s requirements and people were provided with a range of food and drink which met their individual needs and preferences.
People were involved in giving their views on how the service was run and there was a range of audit and review systems in place to help monitor and keep improving the quality of the services provided.