Badby Park

Badby Park is a nursing home service that is registered to provide care for up to 88 people. There are four units providing care for people with high dependency support needs, complex care and rehabilitation. At the time of the inspection there were 81 people living in the home.

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

The provider had not taken timely action to improve the lives of people living in one area of the building. The environment was not suitable and people did not have free access to other parts of the building and outdoor spaces.

There were missed opportunities to promote people’s wellbeing to have a welcoming space outside. Garden areas were not well maintained and in some areas were a hazard.

We identified concerns relating to the culture of the staff at the service. Not all teams worked well together to ensure people receive a seamless service.

The provider had made improvements to the clinical systems. These had been embedded and the provider had clear oversight of the safety of this part of the service.

Systems, processes and practices safeguarded people from risk of abuse. Risks to people were assessed, monitored and managed. There were enough staff working at the service to meet people's needs. Recruitment processes were robust. Medicines were managed in a safe way. Effective infection prevention control measures were in place. Lessons were learned when things went wrong as incidents were recorded and actions completed to keep people safe.

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.

People thought staff were caring. People were supported to express their views. People's privacy and dignity were respected, and their independence promoted. Care plans were person-centred and guided staff to meet people's needs. People's communication needs were met. People were able to take part in activities provided by the service. People were provided with information about how to complain and when they did, complaints were responded to appropriately.

Quality assurance systems monitored care so there was the potential for it to be improved. The service worked with other agencies to the benefit of people using 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 requires improvement (published 13 May 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the culture of the service. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified a breach in relation to oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Badby Park on our website at www.cqc.org.uk

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Badby Park is a care home service that is registered to provide care for up to 68 people. There are three units providing care for people with high dependency support needs, complex care and rehabilitation. At the time of the inspection there were 62 people living in the home.

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

The provider had taken action to improve the systems and processes in place to monitor and assess the safety and quality of the service. These changes required embedding to ensure they were effective and consistently applied.

People and their relatives told us the service was safe, people were protected against the risk of harm and abuse as staff had received safeguarding training and knew the provider's safeguarding procedure.

There were sufficient numbers of suitable staff employed to keep people safe. People were supported by trained staff who followed the government COVID-19 guidance. The registered manager took action to learn lessons when things went wrong.

Staff received ongoing training to enhance their skills and knowledge. Staff were supported to reflect on their working practices through regular supervision. People were provided with sufficient food and drink that met their dietary needs and preferences. People's health and wellbeing were regularly monitored.

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.

People received care and support from staff that demonstrated compassion and kindness. People were encouraged to make decisions about their care. Where possible, people were supported to maintain their independence. People were treated equally and had their diverse needs respected and facilitated.

People's care was tailored to their individual needs. People were aware of how to raise their concerns and most people were confident these would be managed well. Activities provided ensured people were not socially isolated. People's end of life wishes were documented.

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 5 July 2021) and there were multiple breaches of regulation. 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, however further improvements were still needed to ensure they can be sustained.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 Badby Park on our website at www.cqc.org.uk.

Follow up

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

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

The provider failed to have sufficient systems and processes to assess, monitor and improve the safety and quality of the service. Audits failed to identify areas that required improvement such as infection prevention and record keeping.

People were at risk of abuse due to the lack of robust systems of recording, reporting and investigating incidents and unexplained injuries.

People were at risk of not receiving all their planned care, or person-centred care due to the lack of effective communication between managers and staff in all areas.

The provider had not responded to verbal complaints or negative feedback from surveys in a timely way. People were not always provided with equipment they required to communicate effectively. People did not have free access to an advocacy service.

There were enough staff deployed to provide people with their care. Regular agency staff were used to ensure continuity of care until permanent staff could be recruited. There were not enough allied health professionals or clinical psychologists employed to meet people’s needs. Recruitment for these posts was on-going. Staff were recruited using safe recruitment practices.

Staff training was ongoing. The registered manager ensured staff with specific skills to meet people’s needs were deployed on every shift. New staff received an induction and all staff received supervision.

Staff ensured people received their food and drink safely. Staff used evidence-based tools to assess people’s risks and needs.

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.

We made two recommendations, one to keep the rotas under review to ensure an appropriate skill mix and the other to ensure enough resources are allocated to facilitate people’s moves to their new homes.

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 requires improvement (published 6 January 2021) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management and safety of the service. As a result, we undertook a focussed inspection. This report only covers our findings in relation to Safe, Effective and Well-led.

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.

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 have identified continued breaches in relation to safe care and treatment, and lack of governance and oversight of the service. We also identified a breach in relation to safeguarding service users from abuse or improper treatment.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

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

Badby Park is a care home providing personal and nursing care for up to 68 people with high dependency support needs, complex care and rehabilitation. At the time of the inspection 64 people were being supported.

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

Medicines required improvement. We found issues with the administration, documentation and storage of prescribed medicines.

We found concerns with the oversight of the service. We saw limited evidence of audits being completed.

Records were not consistently completed, we had concerns that care was not being delivered within the prescribed timeframes. For example, repositioning charts, fluid charts and safety checks all had gaps in recording.

People had risk assessments completed and staff knew people well. However, not all information within the risk assessments was consistent with care plans.

People were protected against abuse. Staff understood and were trained in understanding and identifying signs of abuse. Staff knew how to raise any concerns.

Infection control was managed appropriately. We saw appropriate personal protective equipment [PPE] being used. The environment appeared clean and tidy. Cleaning schedules were in place.

Staff felt supported within their roles. Staff, people and relatives were encouraged to give feedback on the service. New surveys had been implemented to gain everyone’s feedback and suggestions for improvement.

Complaints had been well managed. Relatives and staff all knew how to complain.

Referrals were made to professionals as required. We saw evidence of speech and language therapists, dietitians and occupational therapists being involved in people’s care and support needs.

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

Rating at last inspection

The last rating for this service was good (published 29 December 2018).

Why we inspected

We inspected due to concerns relating to the number of safeguarding alerts received. 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.

The overall rating for the service has changed from good 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Badby Park 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 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 medicines and oversight of the service 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.

On the day of our inspection 65 people were living in the home.

At our last inspection on 11 April 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks in relation to people’s daily life had been identified and planned for. There were enough staff, who were safely recruited to ensure people received care when they needed it. People received their medicines as prescribed from staff who were trained to manage medicines in a safe way. There were systems in place to minimise the risk of infections.

People continued to receive an effective service. Staff were trained and supported to understand and provide care that met people’s individual needs. People were supported with their health and nutritional needs and had access to appropriate healthcare services when required. The policies and practices within the home supported people to exercise choice and control in their lives and care was provided in the least restrictive way.

People continued to receive care that promoted their dignity and privacy and respected their individuality. Staff understood what was important to people and provided care in a kind and supportive manner.

People continued to receive a responsive service. Their needs were assessed and planned for and regularly reviewed to ensure they continued to receive the care they required. Staff knew and understood people’s needs well and people and their relatives were consulted about the care they received.

There was a complaints procedure in place and action had been taken to address any complaints that had been raised.

The service strived to remain up to date with legislation and best practice and worked with outside agencies to continuously look at ways to improve people's experiences.

The home was well led and the manager encouraged an open and inclusive culture where people could speak out about their views and any concerns they had. Systems were in place to regularly check the quality of the services provided and the provider and registered manager took timely action to address any identified issues.

There was a registered manager in post at the time of 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.

At the last inspection in January 2015, we asked the provider to take action to make improvements to ensure that people’s human rights were protected; people experienced restrictions in their movement and people who lacked capacity to make decision for themselves had not had the required assessments completed nor had there been any best interests decisions or authorisations sought for the restrictions in place. We asked the provider to send us an action plan setting out the action they would take to protect people’s rights and strengthen systems to support the Mental Capacity Act 2005 (MCA), and associated Deprivation of Liberty Safeguards (DoLS) within an appropriate time frame and this action has been completed.

At the last inspection in January 2015 we asked the provider to take action to make improvements to the way that medicines were managed because people had not received their prescribed medication and because staff had not ensured that prescriptions had been dispensed in a timely way. We also asked the provider to send us an action plan setting out the action they would take to improve the way that medicines were managed and ensure that people received their medicines as they were prescribed and this action has been completed.

At the last inspection in January 2015 we asked the provider to take action to make improvements to the management of records because there were numerous examples where people’s records were not maintained in good order or fit for purpose. We asked the provider to send us an action plan setting out the action that they would take to improve the standard of record keeping in the home and this action has been completed.

Systems were in place to ensure people were protected from harm; staff had received training and were aware of their responsibilities in raising any concerns about people’s welfare. The provider had robust recruitment systems in place; which included appropriate checks on the suitability of new staff to work in the home. Staff received a thorough induction and training to ensure they had the skills to fulfil their roles and responsibilities. Staff training was regularly refreshed to ensure staff were following current guidance and good practice. There were enough suitably skilled staff deployed to meet people’s needs.

People’s care was planned to ensure they received the individual support that they required to maintain their health, safety, nutrition, mobility and to maximise their independence. People received support that maintained their privacy and dignity and whenever possible had opportunities to be involved in making decisions about their care and their participation in the organised activities that were taking place in the home.

People were assessed prior to admission to ensure the service was able to meet their needs and these assessments formed the basis of the individual plans of care. The individual plans of care contained all of the required information, were well maintained and regularly reviewed. Staff were knowledgeable about the individual care needs of the people they supported.

People had information about how to complain about the service and complaints were investigated, complainants received a timely response. The provider fostered a positive culture where the management and staff learnt from complaints and other information.

The management team had been strengthened and managers were accessible to the people who lived there, their relatives and the staff. The management understood their roles and responsibilities in notifying the Commission about the incidents that occur in the home, such as notifications of injury or events that affect the running of the service. Quality assurance systems were in place to assess and improve the quality of service provided.

One person told us 'the staff asked me about lots of things, about my preferences, what I like doing, do I go to church and stuff' another person told us 'the staff are lovely, you can tell them if you need something'.

Only one person was able to comment on the food that was provided, they said 'the food is nice, you can choose'. A relative told us 'My husband has a restricted diet but the dietician has been to see him and the chef's been up to see if there is anything different he would like, it's his choice'.

One person told us 'I feel safe here', however another person told us 'I was upset because another person living here wasn't very nice to me, but the staff sorted things out and it's all right now'. However the provider may wish to note that one person when asked what they would do if something was wrong or something had happened that they did not like told us 'I don't know; I'm not sure what I could do'.