Baugh House Care Centre

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

People told us they felt safe. There were safeguarding policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work and there were enough staff available to meet people’s care and support needs. Risks to people were assessed and staff were aware of the action to take to minimise risks where they had been identified. Staff were following advice and guidelines recommended by health care professionals. Medicines were managed safely. The service had procedures in place to reduce the risk and spread of infections and COVID 19.

People and their relatives had been consulted about their care and support needs. Assessments were carried out before people started using the service. People and their relatives knew how to make a complaint if they were unhappy with the service. There were procedures in place to make sure people had access to end of life care and support if it was required.

The provider took people, their relatives, staff and health care professional views into account through satisfaction surveys and feedback from these was used to improve the service. Relatives told us there had been improvements since the new manager started working at the home. Staff said they received good support from the new manager and staff moral had improved. The manager and staff worked with health and social care professionals to drive improvement and to deliver an effective service.

Rating at last inspection and update: The last rating for this service was requires improvement (published 30 July 2019) 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.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. 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 Baugh House Care Centre on our website at www.cqc.org.uk.

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

Since our last comprehensive inspection of this service the registered manager had left and there had been a number of different managers in succession. An acting manager and deputy were overseeing the service with support from the provider. A new clinical lead had also just started to work there.

Staff told us morale was poor at the service and that they did not feel listened to by the provider. Some staff felt communication was poor. We found there had been limited opportunities for families to express their views about the service. Visiting guidance required some updating to ensure staff and visitors had appropriate guidance so they were managed safely.

The management team were working to address the issues we identified and had planned to carry out surveys and produce a newsletter for relatives. Initiatives aimed to improve staff morale were also being introduced.

There were systems to manage the service. The management team had identified a range of areas which could be improved and had an action plan which they were working through to ensure this occurred. Audits and checks were carried out on the quality and safety of the service and learning was identified.

People received their medicines when they needed to. Medicines were safely administered, stored and managed.

Infection prevention and control procedures were adhered to.

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 30 July 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had received in relation to medicines management and the way the home was managed.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 work alongside the provider and local authority to monitor progress. 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

Since our last inspection of this service the registered manager had left and the deputy and quality assurance manager were overseeing the service with support from the provider. They had identified a range of improvements required and had an action plan which they were working through to ensure this occurred.

Infection prevention and control procedures were adhered to.

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 30 July 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had because the manager had left the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 work alongside the provider and local authority to monitor progress. 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 service had safeguarding and whistleblowing policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks took place before staff started work and there were enough staff available to meet people’s care and support needs. The service had procedures in place to reduce the risk of infections.

People’s care and support needs were assessed before they moved into the home. Staff had the skills, knowledge and experience to support people appropriately. Staff were appropriately supported through induction, training and regular supervision. People were supported to maintain a healthy balanced diet and they had access to health care professionals when they needed them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People and their relatives (where appropriate) had been consulted about their care and support needs. The home had a complaints procedure in place. There were procedures in place to make sure people had access to end of life care and support if it was required.

The registered manager had worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people and their relatives views into account through meetings and satisfaction surveys. Staff enjoyed working at the home and said they received good support from the registered manager and management team.

Rating at last inspection: The last rating for this service was requires improvement (published 07 August 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

At our last inspection we found a breach of regulations because sufficient numbers of staff were not deployed throughout the home to meet the needs of people using the service. At this inspection we found improvements had been made and the provider was no longer in breach of this regulation.

At our last inspection we also found that improvement was required with the provider's quality monitoring processes as we found gaps in people's medicine administration records where prescribed medicines had not been signed by staff as given to people and the reasons for omissions had not been documented. At this inspection we again found gaps in medicine administration records where prescribed medicines had not been signed by staff as given to people. We found breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people’s medicines were not being managed safely and risks relating to people’s care and support were not always managed safely. Staff had not always followed the instructions of health care professionals when supporting people. We also found a breach of Regulation 17 because the home’s systems for monitoring the quality and safety of the service were still not operated effectively.

Improvement was also required because some people told us that some staff did not handle them the way they wished to be handled. Some people told us activities provided at the home did not meet their needs.

Why we inspected: This was a planned inspection based on the previous rating.

At our last inspection on 25 and 27 July 2017 we found breaches of Regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to concerns that medicines were not always managed safely and the provider had not always followed safe recruitment practices when employing new staff.

At this inspection we found that improvements had been made in the management of medicines however, further improvement was required with the provider’s quality monitoring processes as we found gaps in six people’s medicine administration records where prescribed medicines had not been signed by staff as given to people and the reasons for omissions had not been documented. We saw that improvement had been made in that robust recruitment checks were being carried out before staff were employed to work at the home.

At this inspection we also found a breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that sufficient numbers of staff were not deployed throughout the home in order to meet the care and support needs of people using the service. You can see what action we told the provider to take at the back of the full version of the report.

All of the staff we spoke with said they enjoyed working at the home. However, there were mixed views about the support they received from managers. Some staff felt that managers had not always listened to what they had to say and some told us they did not feel they were respected. We have made a recommendation about motivating staff and team building.

The home had 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. They were also aware of the legal requirement to display their current CQC rating which we saw was displayed at the home.

People told us they felt safe living at the home. Training records confirmed that staff had received training on safeguarding and there was a whistle-blowing procedure available and staff said they would use it if they needed to. Staff were attentive to people’s needs. Action was taken to assess any risks to people and risk assessments and care plans included information for staff about action to be taken to minimise the chance of accidents occurring. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals. We found that the home was warm, clean and tidy and free from any unpleasant odours. People were protected from the risk of infections. People told us the home was comfortable and met their needs.

Staff had the knowledge and skills required to meet people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People told us they enjoyed the meals provided to them and they could choose what they wanted to eat. People were supported to maintain good health and they had access to healthcare professionals when they needed them.

People had been consulted about their care and support needs. These needs were assessed before they moved into the home. Care plans and risk assessments included detailed information and guidance for staff about how people’s needs should be met. People’s privacy and dignity was respected. People received appropriate end of life care and support when required. There was a range of activities for people to partake in if they wished to do so. The home had a complaints procedure in place and people and their relatives said they were confident their complaints would be listened to and acted on.

The provider sought the views of people using the service and their relatives through residents and relative’s meetings and satisfaction surveys. The registered manager worked with other care provider’s and professional bodies to make improvements at the home.

This was the first comprehensive inspection of the service since it was registered under the provider, GCH (South) Ltd in May 2017. Prior to this the service had been inspected in April 2017 under the previous provider, GCH (Kent) Ltd, at which time it was rated ‘Inadequate’. CQC decided that we could only permit GCH (South) Ltd to operate this service subject to a number of conditions to address the concerns found during that inspection. GCH (South) Ltd agreed to accept those conditions on its registration and has complied with their requirements since that time.

There was no registered manager in post at the time of our inspection. The current manager was in the process of applying to become registered manager. 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.

We identified breaches of regulations because records relating to people's medicines were not always properly completed to demonstrate they had received their medicines as prescribed, and because the provider had not always followed safe recruitment practices when employing new staff. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people had been assessed and action taken to manage identified risks safely. However, improvement was required to ensure records relating to the management of any wounds people had were kept up to date and accurate. Improvement was also required to ensure sufficient staff were consistently deployed on each unit at night time to meet people’s needs, and to ensure quality assurance systems consistently identified issues and drove improvements.

People were protected from the risk of abuse because staff were aware of the action to take if they suspected abuse had occurred. Staff were supported in their roles through training and supervision and told us they were well supported by the management team. People were able to access a range of healthcare services when needed and were supported to maintain a balanced diet.

Staff sought consent from people when offering them support and the provider worked within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People told us their privacy was respected and that they were treated in a caring and dignified manner. Staff involved people in day to day decisions about the support they received.

People told us their care and support needs were met. They had care plans in place which had been developed based on an assessment of their needs and preferences, which were reviewed on a regular basis to ensure they remained up to date. The service offered a range of activities for people to take part in and plans were in place to increase the level of activities offered.

The provider had a complaints policy and procedure in place, and people told us they were aware of how to raise any issues they had. Most staff spoke positively about the management of the service, although one staff member highlighted that there had been a series of changes in the manager role and it was too early to have formed a proper view on the management arrangements.

The service had systems in place to seek feedback from people using the service and senior staff confirmed that any feedback they received would be acted on to drive improvements. We also saw action had been taken to address issues identified during checks and audits conducted by staff.