Boldmere Court Care Home

Boldmere Court is a care home providing nursing, personal care and accommodation for up to 68 people. The service provides support to older people, people with dementia, people requiring mental health support, people with a physical disability and younger adults. At the time of our inspection there were 63 people using the service.

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

Risk assessments required more information on techniques for staff to support people when displaying distressed behaviour. Risk assessments did not always contain enough or up to date information.

Some people received time critical controlled medicines however they did not always receive their medication at the required prescribed time.

Records in relation to the use of restraint were not clear and transparent to show if the restraint used was the least restrictive technique for the shortest possible time in line with best practice guidance.

Best interest documentation sometimes lacked sufficient information to demonstrate restrictions had been arranged in people’s best interests.

The provider’s handover documentation did not always have sufficient information to ensure staff were up to date with people’s conditions and health needs.

Audits undertaken by the provider were not always effective at monitoring the quality of the service, some risk assessments lacked detail to clearly identify what mitigation was in place. In addition, some care plans did not contain enough detail.

One person’s bedroom was in an unsafe condition. The provider had safeguarding systems and processes in place to keep people safe. People felt safe and were supported by staff who knew how to protect them from avoidable harm.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

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 the service under the previous provider was requires improvement, (published on 03 June 2021) and there were 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 the provider remained in breach of regulations.

Why we inspected

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.

The inspection was prompted in part due to concerns received about care delivery. 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, Effective and Well Led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 safe care and treatment, the need for consent and governance.

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 meet with the provider following this report being published to discuss how changes will be implemented. 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.

Boldmere Court is a care home providing nursing and personal care to older people. The care home is registered to provide support to 68 people. At the time of the inspection 67 people were living at the home. The accommodation is provided over three floors each of which has its own communal areas.

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

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. Staff supported some people that displayed behaviours that may challenge others. We found where restraint was used as a way of managing this behaviour, the records were not clear and transparent if the restraint used was the least restrictive technique for the shortest possible time in line with best practice guidance.

Risk assessments were in place and staff we spoke with were able to tell us about the risks they needed to be aware of when supporting people. However, care plans could be improved to give more guidance to staff on how to respond to some behaviours to ensure a consistent response by staff.

Appropriate Personal Protective Equipment (PPE) was made available to all staff, however we observed some care staff wearing PPE that had not been supplied by the provider, therefore we could not be assured it met the standards required by the Governments COVID-19 guidance.

The provider had quality monitoring systems in place, however, this inspection found they did not always identify issues and therefore were not fully effective. A lack of oversight meant potential risks to people's safety had not been responded to appropriately.

The management team acknowledged where improvements were required, they were open to the inspection and demonstrated a willingness to address any concerns and make the improvements required.

Staff worked in partnership with other professionals in the support of people’s health and wellbeing.

Relatives we spoke with felt engaged with the home and said there had been good communication during the COVID-19 pandemic.

People received their medicines when needed and staff where trained to administer people's medicines safely.

People were supported by staff who were deployed in sufficient numbers to meet their needs.

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 Good (Published on 25 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received by whistleblowing’s on safeguarding and the use of restraint. A decision was made for us to inspect and examine those risks.

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 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. 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 Boldmere Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID19 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 Regulation 13 (Safeguarding service users from abuse and improper treatment) at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

There was a separate visitors room for essential visitors that could be accessed through its own entrance. A call bell had been fitted in the room to allow visitors to call staff and remove the need for visitors to access any other areas of the home.

Relatives had access to their family members digital care records so they could see care plans and daily records. Families could make notes on peoples care and send messages to both people and staff.

The home had two lifts which they used as a one way system. All ‘clean items’ including food and clean linen moved in the right lift and all ‘dirty items’ linen for wash and food waste moved in the left lift to minimise the spread of infection.

A digital memory box feature for each person was introduced where peoples relatives could upload photos and stories to share which positively supported peoples wellbeing.

The home was divided into five areas and movement between these areas was restricted to minimise the spread of infection. Staff were then allocated to a particular area for the duration of their shift.

Further information is in the detailed findings below.

The home is registered to provide accommodation and personal care, for a maximum of 68 people and there were 68 people living at the home on the days of the inspection.

A registered manager was in place. A 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 last inspected Boldmere Court on 16 February 2017, when we rated it as ‘good’ overall, however we rated the key question, ‘Is the service well-led’ as requires improvement because we found we saw that there were systems in place to monitor and improve the service but they did not always identify shortfalls that needed to be addressed. At this inspection we found improvements had been made.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People felt safe living at the home. Staff were available to people and demonstrated good knowledge about people living at the home. People were supported by staff to have their medicines and records were maintained of medicines administered.

People and relatives complimented the cleanliness of the home. Staff maintained good hygiene and used protective clothing when appropriate.

Staff told us training helped them meet the specific needs of the people living at the home and they attended regular training to ensure they kept their knowledge updated.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and had submitted the appropriate applications where they had assessed that people were potentially receiving care that restricted their liberty.

People enjoyed a choice of meals and were supported to access professional healthcare outside of the home, for example, they had regular visits with their GP and any changes to their care needs were recognised and supported by staff.

People said staff were caring and treated them with respect. We saw people were relaxed around the staff supporting them and saw some positive communication with staff. Staff showed us that they knew the interests, likes and dislikes of people and people were supported to enjoy various activities. We saw that staff ensured that they were respectful of people’s choices and decisions.

People were involved in planning their care. Relatives also said they were involved in reviews of people’s care and said staff listened to them. People and staff told us that the management team were approachable and if they had any concerns they would be listened to.

The management team ensured regular checks were completed to monitor the quality of the care that people received, and action had been taken where areas were identified for improvement.

People, relatives and staff were positive about the overall service. Relatives and staff complimented the improvements made under the new management. Staff felt supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes.

Boldmere Court Care Centre provides accommodation and support for up to 68 people with nursing and personal care needs. Some people were living with dementia. There were 65 people living in the home when we inspected.

There was a registered manager in post. 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 in place to monitor and improve the quality of the service, but these had not always been sufficient to ensure that shortfalls in the service had been identified so that they could be addressed in a timely manner.

People and their relatives were happy that their views about the service were listened to and responded to and actions taken where needed to improve the service. People, their relatives and staff were extremely positive about the registered manager and his interactions with them.

People received a safe and effective service because staff received the appropriate training and support to provide safe care. Staff were knowledgeable about people’s needs and people received an individualised service. People received support from staff that were caring and considerate.

People were supported to have their health needs met through support to take their medicines and to attend and receive medical attention when needed.

People were supported to eat and drink food that met their needs and that they enjoyed.

People’s human rights were protected because consent was received from people or their relatives for the care provided. Staff worked according to the principles of the Mental Capacity Act to achieve this. This meant people were given choices and opportunities to be involved in making decisions about the care they received.

At this inspection we found that improvements had been made and the requirements of the warning notices had been met although some aspects of the governance of the service needed further improvements.

Boldmere Court Care Centre provides accommodation and support for up to 68 people with nursing and personal care needs some of whom were living with dementia. There were 67 people living at the home when we inspected.

People were protected from harm because staff understood their responsibility to take action to protect people from the risk of abuse and harm and the provider had systems in place to minimise the risk of abuse.

People were involved in planning their care and management of any risks identified in relation to the care they received. People received care and support from staff that were trained and supported to carry out their roles. The social needs of people living with dementia were not always met in an appropriate way.

There were sufficient staff available to meet people’s needs and recruitment process ensured that suitable staff were employed.

People were supported to receive their medicines as prescribed.

People were supported to make choices about their care and staff worked in line with the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure their human rights were protected.

People enjoyed their meals but actions were not always taken to ensure any weight loss or gain was investigated in a timely manner.

People received support from healthcare needs to monitor their ongoing health conditions and emergency treatment as needed.

People were treated with kindness and care and their privacy and dignity was maintained.

People received responsive care and their views were gathered through surveys, meetings and complaints.

The management and leadership in the home had improved and the morale within the staff group was good and people were happy with the service they received.

Systems were in place to monitor the quality of the service but further improvements were needed.

We saw good interactions between people who lived there and staff. We observed that people were at ease in the company of staff. One person told us, "I'm very pleased with the care and staff."

We found that people were asked to give their consent before support was given. This meant that staff acted in accordance with people's wishes and ensured that people received care and support in the way they liked.

We saw that people's care needs were assessed and identified so that their health and wellbeing was promoted and met. Systems were in place to support staff to provide care and support that met people's needs and kept them safe. One person said, "Staff look after us very well."

We found that there were enough staff to meet people's needs and ensure their safety.

We found that people were asked for their views about the home and people were listened to. The provider had a robust system in place to ensure the quality of service provision was monitored so that any necessary improvements could be made.

During our previous inspection we raised some concerns about the home. We were told by the operations director that there had been changes in management as well as the care staff. One relative we spoke with said, 'There has been changes in staff, things have steadily gotten better'.

We saw that people were involved in making choices about what they wanted to do and what they ate and drank.

We found that people's needs were assessed and planned to ensure that the care people received was safe and appropriate. All of the people we spoke with told us they were happy with the care they received. One person told us, "It's nice here'. A relative we spoke with said, 'They are brilliant with my mum, she absolutely adores it here'.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people.

People received their medicines as prescribed by their doctor to ensure their health needs were met.

People's health and welfare needs were not met by sufficient numbers of staff.

There home was recording accidents and incidents and taking feedback. However, they were not being analysed to implement the learning.