Archived: Bispham Gardens

Bispham gardens is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bispham Gardens Nursing Home is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 28 people. Accommodation is on the ground floor. There are several communal areas including a quiet lounge, conservatory and dining area. At the time of our inspection visit there were 23 people who lived at the home.

There was a registered manager in place. 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 December 2017, we found four breaches of regulation. We found breaches in the regulations related to Safe care and treatment, good governance, safeguarding and person-centred care. We issued requirement notices for these breaches in regulation. In addition to the requirement notices we made recommendations related to dignity, consent, decision making, staff deployment, management of complaints and supervision

Following the inspection in December 2017 we asked the registered provider to act to make improvements in the areas we had noted. The registered provider was required to send the CQC an action plan, outlining how they intended to make improvements. We used this inspection process carried out in September 2018 to check the action plan had been followed and improvements made.

At this inspection, we looked at the storage, administration and documentation around medicines and found these followed best practice guidance. However, we noted best practice was not consistently followed around medicine administration. The registered manager told us this would be addressed using supervision and retraining.

The service had systems to record safeguarding concerns, accidents and incidents and acted as required to make improvements and minimise future risks. The service monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents to the Care Quality Commission when required.

The registered manager had robust systems to ensure people’s care, treatment and support was delivered in accordance with best practice guidance and current legislation. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

Care plans held information that guided staff on people’s likes dislikes and health conditions. People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care.

Staff deployment was organised with staff being allocated daily tasks. However, there was mixed feedback on staffing levels.

We observed positive interactions between staff and people at Bispham Gardens. Staff used humour and appropriate touch and treated people with respect and patience.

Staff we spoke with told us they felt supported by the management team and were encouraged with their personal development.

Staff we spoke with confirmed they did not commence in post until the registered manager completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles.

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us any concerns raised had been addressed by the registered manager.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff meetings and daily discussions with people who lived at the home to seek their views about the service provided. People told us the management team were approachable and the registered manager took regular walks around the home to assess the environment.

We looked around the building and it was clean and safe place for people to live. We found equipment and the environment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required.

Staff delivered end of life support that promoted people’s preferred priorities of care.

We observed interactions over lunch time and noted people had their meal in the dining room or in their bedroom. We received mixed feedback on the food available.

People told us there were a range of activities provided to take part in if they wished to do so. There was a comprehensive daily and weekly activities schedule at the home. We observed activities taking place and saw these were enjoyed by people who participated.

At the time of inspection there was no manager who was registered with the Care Quality Commission. There had been no registered manager since November 2017. The registered provider had appointed a new manager who was due to start their employment in January 2018.

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 had not previously inspected Bispham Gardens Nursing Home. This was their first inspection since they had registered with the Commission in May 2017.

The inspection of Bispham Gardens occurred in part due to the clinical concerns and safeguarding notifications received. The information we received indicated potential concerns about the management of risk at the home. Before our inspection we had been made aware the registered provider did not meet all the standards set out in the regulations. They did not deliver care and support that was consistently safe, effective, caring responsive and well led.

Whilst the registered provider and local authority had both identified areas of concern, they were working together to address these issue related to the care being delivered. Through their own self-assessment process, the registered provider had identified areas for improvement. They were working to address these through an improvement and sustainability plan. They had worked together with the local authority to create an action plan to identify and manage risk and protect people from future avoidable harm.

At this inspection visit breaches of legal requirements were identified in relation to person centred care, safe care and treatment, safeguarding and governance. You can see what action we told the provider to take at the back of the full version of the report.

We looked at how medicines were managed at Bispham Gardens. We found the administration and management of medicines was not consistently managed safely.

Care records we looked at did not consistently identify risk and ways to reduce risk.

Documentation we saw showed the registered provider was not consistently working in accordance of the Mental Capacity Act 2005.

We looked at how the service provided personalised care that was responsive to people’s needs. Care plans lacked information in relation to people’s needs. For example, we found specific information related to one person’s wound care and frequency of dressing changes was not recorded in their plan of care.

The registered provider had begun to implement a series of audits within the home. However, we found these were not always effective in identifying concerns. It was noted at the time of our inspection the provider did not have a robust quality auditing system in relation to medicines, managing risk, consent and care planning related to personalised care.

We received mixed feedback on staffing levels at busy times of the day and staff deployment. We have made a recommendation about this.

Consent and timely best interest decisions had not taken place when supporting people who lacked capacity. We have made a recommendation about this.

Not all care staff had received regular supervision from their manager. We have made a recommendation about this.

Three separate staff at different times used language that did not promote people’s personal dignity. We have made a recommendation about this.

We looked at how people’s concerns and complaints are gathered and responded to and used to improve the quality of the care provided. We looked at how the registered provider recorded and responded to complaints received. The complaints we saw contained limited information and no outcomes. We have made a recommendation about this.

We saw evidence of partnership working with multi-disciplinary professionals to improve health outcomes for people who lived at the home.

We observed staff spent time with people who lived at the home. We observed staff were patient with people and offered reassurance when required. People who lived at the home told us staff were kind and caring.

Arrangements were in place to protect people from the risk of abuse. Staff had knowledge of safeguarding procedures and were aware of their responsibilities in reporting any concerns. We saw evidence of information of concern being passed onto the appropriate parties when required. This was to promote the safety of people who could be vulnerable.

People told us they felt safe at the home. People were encouraged to personalise their rooms to make it feel homely.

Recruitment procedures ensured the suitability of staff before they were employed. Staff told us they were unable to start their employment without all the necessary checks being in place.

People were happy with the variety, quality and choice of meals available to them.

People told us activities took place and said they had the option as to whether or not to join in. We saw people doing jigsaws, arts and crafts and visiting hairdressers and activity co-ordinators during our inspection visit.

We walked around the home and found premises and equipment were maintained appropriately and adapted to meet the needs of people with reduced mobility and or living with dementia.

The registered provider had a structured induction training program for new staff. They had introduced incentives for staff to maintain their knowledge through ongoing training.

Staff praised the improvements made at the home since the change in the management team and the introduction of the acting manager. They described the acting manager as approachable and willing to listen.