Bletchley House Residential Care and Nursing Home

Bletchley House residential care and nursing home, is a care home providing personal and nursing care to up to 44 people. The service provides support to people over and under 65. At the time of our inspection there were 28 people using the service.

Bletchley House accommodates up to 44 people across 2 floors, each of which has separate adapted facilities. One of the floors specialises in providing nursing care.

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

Medicines were not always stored safely.

Care plans contained comprehensive information however, risks associated with anticoagulants were not always documented in the care plans.

The provider did not always ensure people were provided with opportunities to do the things they wanted.

People told us staff were attentive to their needs. Staff were recruited safely and received appropriate training for their role.

Staff followed all necessary infection prevention measures. Staff wore appropriate Personal Protective Equipment (PPE) and received training in infection prevention and control.

The provider had systems in place to share any learning within the service. Improvements had been made following our previous inspection.

The provider and manager actively sought feedback from everyone involved with the service and had developed action plans to address any shortfalls and make improvements.

People were supported to have maximum choice and control of their lives, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 13 May 2022) 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 improvements had been made and the provider was no longer in breach of regulations.

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.

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 remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bletchley House on our website at www.cqc.org.uk.

Follow up

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

Bletchley House Residential Care and Nursing Home is a care home providing personal and nursing care for up to 44 people. At the time of the inspection 36 people were receiving support.

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

Systems in place to ensure the proper and safe management of medicines were not robust and did not ensure people received their medicines as prescribed.

Staff were using both paper records and electronic records which made finding relevant information difficult. Some care records and risk assessments contained conflicting and out of date information.

Management of the service had been unstable and numerous managers had been recruited and then left the service. There had not been a manager registered with the Care Quality Commission since 21 December 2020. There had been a reliance on a high use of agency staff, which did not ensure consistency for people receiving care and support. The interim manager had recognised this as an area for improvement and had successfully recruited 11 new staff. Further recruitment was ongoing.

Provider level quality assurance audits to ensure effective oversight and safe care in the absence of a registered manager had not been effective in identifying areas for improvement and ensuring required improvements.

People felt safe living at Bletchley House. Staff were trained in safeguarding and understood their responsibilities to protect people from harm. Staff followed all necessary infection prevention measures. Staff wore appropriate Personal Protective Equipment (PPE) and received training in infection prevention and control.

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.

Staff continued to work in partnership with health professionals involved in monitoring and providing care and treatment for 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 and update

The last rating for this service was Good (published 18 March 2021)

Why we inspected

We received concerns in relation to the management of medicines, staffing and management instability and a lack of provider oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 Good to Requires Improvement based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bletchley House on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 take further action if needed.

We have identified breaches in relation to people receiving safe care and treatment, the safe management of medicine and a lack of provider oversight.

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

Bletchley House Residential Care and Nursing Home is a care home providing personal and nursing care for up to 44 people. At the time of the inspection 31 people were receiving support.

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

People and relatives told us the service was safe, and staffing levels were sufficient.

Risk assessments were in place and covered the risk present in people’s lives. Regular reviews and updates took place to ensure assessments were relevant.

Medicines were stored and administered safely, and staff were trained to support people effectively. Staff were supervised well and felt confident in their roles.

The service was clean, and staff understood infection control procedures and followed them. Staff wore appropriate personal protective equipment. People and staff we spoke with were satisfied the service was kept clean to a high standard.

Audits of the service were undertaken and any issues found were addressed promptly. Staff felt well supported by the interim manager and were motivated to provide good care to people.

Staff referred to external professionals as required and followed advice to ensure people’s needs were met.

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.

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 the service was Requires Improvement published on 25 September 2020.

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.

Why we inspected

The inspection was prompted in part due to a complaint about staffing levels and responding to people promptly. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 coronavirus and other infection outbreaks effectively.

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.

Bletchley House Residential Care and Nursing Home is a residential care home providing personal and nursing care for up to 44 older people including people living with dementia. At the time of inspection, 29 people were living in the service.

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

Improvements had been made to record keeping of people's daily care needs. Charts and logs were consistently completed and there was evidence of regular management oversight of these.

Improvements had been made to governance arrangements. A range of quality assurance checks and audits were carried out. Follow up actions were taken when needed. The registered manager was committed to making continued improvements and was passionate about people receiving high quality care. Feedback from relatives and staff confirmed the registered manager was available and approachable.

Staff views were mixed about morale within the team, and some were concerned about staffing levels as more people came to live in the service. A dependency tracker was used to calculate how many staff were needed according to people's individual care needs. Improvements had been made to the dependency tool since the last inspection which should ensure sufficient staff once occupancy increases.

The management team were honest about the areas which still required improving and had a plan in place to keep this moving forwards. Better monitoring of staff training had been implemented. There was a clear process in place to ensure staff remained up to date with refresher and specialist courses.

Relatives wanted more communication and updates from the service, particularly in light of visiting restrictions due to the pandemic. The majority were satisfied with the level of care their family members received.

Staff and resident meetings took place regularly and safely. Identified actions were followed up promptly.

The service worked in partnership with health professionals and other agencies to ensure people's needs were met.

A comprehensive Safe Operating Procedure during Covid-19 which set out good infection prevention and control practices. Staff and people who lived in the service participated in a programme of regular Covid-19 testing. Enhanced cleaning schedules were in place and as far as possible staff worked on the same floor. This reduced the risk of infection spread in the event of anyone testing positive for the virus. A specific risk assessment for use of agency staff was going to be put in place. There had been no use of agency staff for some months prior to the inspection.

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 8 May 2020). At the last inspection we found there was a continued breach of regulation due to poor record keeping and a lack of effective management oversight of record keeping. CQC issued a warning notice to advise of areas which needed improvement.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore inspected the key question of well-led. We also looked at infection prevention and control under the key question of safe. Ratings from previous comprehensive inspections for other key questions were used in calculating the overall rating at this inspection.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection following a warning notice being issued.

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.

Bletchley House Residential Care and Nursing Home is residential care home that provides residential and nursing care for up to 44 older people including people living with dementia. At the time of inspection, 32 people were living at the service.

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

Audits and checks were not always effective in picking up omissions in the recording of people’s care. Systems to monitor staff training were not always clear or being used effectively. It was not always clear that people received the support they were assessed as requiring.

Staffing levels kept people safe, but some people felt there were not enough staff to engage with or complete certain tasks for them.

Care plans were in place but contained varying levels of detail, and were not always easy to follow for staff who wished to understand what people’s needs and preferences were, in a prompt manner.

Medicines were stored and administered safely, but records for topical medicines were not always accurate. Staff were trained to support people effectively. Staff were supervised well and felt confident in their roles. Staff felt able to contact management and senior staff for support at any time.

People were supported to have a varied diet, their food and fluid intake was monitored as required. We received mixed responses about the quality and consistency of the food served to people.

Healthcare needs were met, and people had access to health professionals as required.

People felt safe within the service. Staff we spoke with understood safeguarding procedures and felt confident their concerns would be listened to and followed up. Risk assessments were in place to manage risks within people’s lives. Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

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.

Staff treated people with kindness, dignity and respect.; We observed positive interactions between people and staff, and feedback from people about staff was good.

A complaints system was in place and was used effectively. The manager was open and honest, and worked in partnership with outside agencies to improve people’s support when required. Staff felt well supported by the manager, and were motivated to provide good care to people.

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 01 March 2019).

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 in all areas, and the provider was still in breach of a regulation.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bletchley House Residential Care and Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breaches in relation to good governance. Not enough improvement was made since our last inspection. Record keeping and oversight on records was not always efficient.

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 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 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.

Bletchley House is residential care home that was providing residential and nursing care for 37 older people including people living with dementia.

People’s experience of using this service:

The manager had completed audits to support quality checks, however for some areas, these had not identified where improvements needed to be made. This was linked to inconsistent recording in many areas of care planning.

People told us they felt cared for.

Staff morale had improved and everyone was committed to ensuring people received good care and support.

Medicines were managed safely and people were encouraged to be as independent with medication as possible.

There was sufficient staff to support people.

People had health care support from professionals. When people were identified as unwell, staff had raised the concern and taken action with health professionals to address their health care needs, however, the action required was not always documented.

The manager worked in partnership with health and care professionals.

They had displayed the latest rating at the service and on the website.

When required notifications had been completed to inform CQC of events and incidents, this helped us to monitor the action the provider had taken.

The manager was open and committed to making improvements.

More information is in the detailed findings below.

Rating at last inspection:

GOOD (report published 01 September 2017)

Why we inspected:

This was a planned inspection based on our last rating and aimed to follow up on information of concern we received prior to the inspection. We explored the areas of concern as part of our inspection.

Enforcement:

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated requires improvement.

Bletchley House Residential Care and Nursing home provides accommodation, nursing and personal care to older people.

At the time of our inspection the provider confirmed they were providing care to 25 people.

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.

The service was not always safe. People were not always able to alert staff when they required assistance as they could not always access the call bell system. People who did use the call bell system told us that staff did not always come quickly enough to meet their needs.

Some people in the service received support with pressure wounds and were using pressure mattresses. We found one person had a deflated mattress and staff were not aware of this. Checking systems were in place for mattresses, but these were not effective enough to make sure every person was supported safely and to have the right inflated mattress.

People told us they generally felt safe within the service. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to enable them to be as independent as possible .

Effective recruitment processes were in place and followed by the service. This meant that only people that were suitable to be working with vulnerable adults were employed. During our inspection we saw that there were sufficient numbers of staff on shift that day to meet people's care and support needs. Rotas showed that staffing was consistent.

Medicines were stored and administered safely. The people we spoke with told us that they were happy with the support they received to take their medicines.

All staff went through an induction process before working within the service. Staff told us that the process was thorough, and that along with the ongoing training they received, they felt well trained and confident within their roles.

Staff received supervision from management. All the staff we spoke with said that they received supervision and felt that it was a valuable process. We saw that supervisions had been recorded, and that on-going supervisions had been booked in for the coming months.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People had a choice of freshly prepared food and drink. People told us they were happy with what was on offer. We saw that food and fluid intake was being accurately monitored and recorded for people when required.

Staff supported people in a caring manner. They knew the people they were supporting well and understood their requirements for care. We observed positive interactions between staff and people.

People's privacy and dignity was maintained. People told us they felt their privacy was respected, and staff we spoke with explained the importance of maintaining people’s privacy and dignity.

The service had a complaints procedure in place and people knew how to use it. We saw that any complaints made had been responded to promptly.

Quality monitoring systems and processes were used to drive future improvement and identify where action was needed.