Bablake House

We found examples of good practice.

Detailed and up to date policies and risk assessments were in place to reduce the risk of infection to people living at the home.

Staff and people living in the home accessed testing in line with Government guidance.

Systems were in place to record individual’s COVID-19 vaccination status, isolation periods and COVID-19 test results.

Staff were observed wearing personal protective equipment (PPE) appropriately.

The manager monitored staff compliance by observing practice, to ensure that it was in line with their training.

Bablake House is a care home providing personal care to a maximum of 45 older people, younger people and people living with dementia within a large adapted building. At the time of our visit, 38 people lived at the home. This included six people in short term discharge to assessment beds (D2A) which are used to support timely discharges from hospital.

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

People felt safe and safeguarding procedures were in place to protect people. Staff knew how to manage risks, but guidance was not always in place to help them provide safe care.

People received their medicines when they needed them. However, we recommended the provider reviews their medicines policy to ensure it reflects best practice guidance and current legislation.

The management team had developed good working relationships with health and social care professionals and shared information when required to ensure people received the care and treatment, they needed to remain healthy and well.

Enough staff were on duty to meet people's needs and staff received an induction when they had started work to help them provide the care people needed. People and relatives had confidence in the ability of staff to provide effective care. Staff spoke positively about their training, but they had not received training to help them support people to manage some health conditions.

People spoke positively about the food and drinks provided and risks associated with eating and drinking were well managed.

The environment was clean and continued to meet people's needs. Areas in need of updating had been identified and plans were in place to make improvements. Staff practiced good infection control.

People liked the managers and had opportunities to feedback their views on the service they received. Staff enjoyed their jobs and understood what the provider expected of them.

The management team demonstrated commitment to their roles. Some action had been taken to strengthen quality monitoring processes to improve outcomes for people. However, some audits and checks required further improvement.

The management team understood their responsibility to be open and honest and lessons had been learnt when things had gone wrong.

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 13 June).

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of the service people received including the management of some risks. As a result, a decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

Bablake House is a care home registered to provide personal care and accommodation for a maximum of 45 people, including people living with dementia. The home is located on the outskirts of Coventry and the accommodation is set out over two floors. There were 37 people living at the home at the time of our visit. This included eight people, on a short term basis who had been discharged from hospital for a period of assessment and re-enablement known as ‘discharge to assess’.

The principle behind ‘discharge to assess’ is that people who no longer require care in hospital but are not yet able to return home, can be supported in a more appropriate setting such as a care home for a period of assessment and re-enablement before returning home.

People in care homes receive accommodation and 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.

At our last comprehensive inspection in April 2017 we rated the service as ‘Requires Improvement’. This was because the service was not as responsive to people’s needs as it should have been and was not consistently well led. For example, people did not always receive personalised care, staff were not always responsive to people’s needs in a timely way and there was not enough for people to do during the day. Quality monitoring systems were not consistently robust and we had not been notified of all incidents we should have been told about. At this inspection we found improvements had been made and have rated the service as ‘good’.

The service had a registered manager. This is a requirement of the provider's registration. 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 home provided safe care for people who lived at Bablake House. Staff understood what might constitute abuse and the action to take if they had any concerns. There were enough staff available to meet people’s needs and staff were deployed effectively within the home. Staff understood risks related with people’s care and knew how to manage risks to minimise harm. The suitability of staff was checked during recruitment procedures to make sure they were safe to work at the home. People’s medicines were managed, stored and administered safely.

Staff had completed training in infection control and wore gloves and aprons when supporting people and carrying out their work to help prevent the spread of infection. The home was clean and tidy, there was building work taking place but this did not impact on people’s communal space.

People had an assessment completed before moving to the home to make sure staff could meet their care and support needs. Staff received training and had the knowledge and skills they needed to meet people’s needs effectively. The registered manager and care staff understood the principles of the Mental Capacity Act (MCA) and how to put these into practice. Capacity assessments were completed and where required Deprivation of Liberties authorisations to keep people safe were in place. People’s nutritional and healthcare needs were assessed and kept under review.

People were positive about the food provided and received diets to support their health conditions. People had sufficient to eat and drink during the day.

Some people at Bablake House were living with dementia, during our inspection visit we saw they looked contented and settled. People said staff were helpful and understanding, and we saw friendly and caring interactions between staff and the people they cared for. Staff maintained people’s privacy, and treated people with dignity and respect.

The managers and staff had a good understanding of people’s individual needs and preferences. People had a personalised care plans for staff to follow and staff were kept up to date about any changes in people’s care.

The atmosphere in the home was friendly and homely, and care and support was provided in a person centred way. There were things for people to do during the day to keep them stimulated and occupied and visitors were welcome at the home. People knew how to complain if they needed to and complaints received had been responded to in a timely manner.

Since out last inspection the provider had increased the management of the home and employed a deputy manager. The registered manager told us this had improved the service people received as the responsibility of running the home was now shared. Care staff who worked permanently in the home told us there had been improvements since the changes in the management team. For example, they had more time to spend with people as staff were less focused on completing tasks. Staff felt supported by the registered manager and deputy manager, and were happy working at the home. The provider and management team checked the quality of the service people received and implemented improvements.

At the last inspection of the service in January 2016 we rated the service as Good. Since the last inspection the provider had changed their provider name to Bablake House Limited. This meant the service was required to be re-inspected and rated. We inspected Bablake House on 6 April 2017. The inspection was unannounced.

There was a registered manager in post at the service. 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 systems and processes to protect people from risk of harm. Staff understood their responsibilities for keeping people safe and for reporting concerns about abuse or poor practice within the home. Risks to people’s individual health and wellbeing were identified and care was planned to minimise the risks. Staff’s suitability for their role was checked before they started working at the home. There was a safe procedure for managing people’s medicines.

The registered manager made sure there were enough staff to keep people safe. However, people and staff told us there were not always enough staff to respond quickly to people’s requests for support because they were so busy. During our visit we saw there were periods of time where no staff were available in the lounge areas where most people spent their day.

Staff received the training and support they needed to meet people’s needs effectively. All staff, whatever their position, had been trained to understand dementia so they could interact effectively with people living in the home.

People told us staff were friendly and caring. During our visit people were treated as individuals and were encouraged to make choices about their care. Staff protected people’s privacy and dignity when providing personal care. However, how staff referred to people who required assistance to eat, did not uphold their dignity.

The registered manager understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people had their liberty restricted in their best interests, applications had been submitted to, or authorised by the Supervisory Body. Staff understood how to support people to make decisions about their daily lives.

There were processes to ensure people’s nutritional needs were met and people had enough to eat and drink during the day. People’s health needs were monitored and people were referred to healthcare services when a need was identified.

The provider used a computerised care planning system that provided up to date information about people’s care needs to staff. Staff had a handover about any changes in people’s care when they came on shift and received a written handover about each person on their handsets. People’s care records contained individualised information about how people liked to receive their care. Most staff had a good understanding of people’s needs and preferences. However, not all staff had read the handover or care plans on their handsets so were unable to tell us about people’s current needs.

People told us they were satisfied with the care they received. People told us there was occasional entertainment and activities but most people said there was not much to do during the day to keep them occupied or stimulated.

Visitors were welcomed and relatives and friends could visit at any time. People and relatives told us they could express their views and opinions about the home and knew how to raise any concerns with the management team.

People who lived at the home, relatives and staff said the home was well managed. There were systems in place to monitor the quality of the service through feedback from people and a programme of checks and audits.

The registered manager and senior staff regularly checked the environment to ensure it remained safe, but they had not identified some areas of concern we found when we walked around the home. Not all notifications required to be sent to us had not been completed. It is important for providers to tell us about certain incidents in the home so we can monitor these to make sure people remain safe and well.