18 October 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
One inspector and an Expert by Experience carried out this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Butterfly House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced on both days of the inspection.
What we did before the inspection
We reviewed information we had received about the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with seven people who used the service and 11 relatives about their experience of the care provided. We spoke with seven members of staff including the compliance officer, registered manager, senior care staff, care staff, the chef and the laundry assistant. We reviewed a range of records. This included four people's care records and a range of medication records. We looked at records in relation to recruitment and a variety of records relating to the management of the service.
18 October 2022
About the service
Butterfly House is a residential care home providing personal and nursing care up to a maximum of 36 people. The service provides support to people with dementia. At the time of our inspection there were 29 people using the service.
The service was located in a residential area of Weston-Super-Mare and was undergoing renovation to create an additional two rooms and an office for staff. Refurbishment of the home had been undertaken recently and provided a dementia friendly environment for people. The home had three floors with communal and dining areas on the ground and first floor.
People’s experience of using this service and what we found
Risks to people were assessed and action taken to reduce or mitigate these. This included risks associated with COVID-19. People were protected from abuse. There were enough staff in number and experience to meet people's needs. People's medicines were managed safely. People's care was delivered in a personalised way, recognising and respecting people's individual choices, preferences and protected characteristics. Staff were trained and supported to deliver care in line with best practice guidance and the law.
The provider had infection control procedures in place to protect people and prevent the spread of infection. Staff accessed personal protective equipment (PPE) and acted in accordance with government guidance.
Robust quality assurance systems and a strong learning culture across the organisation contributed to continual development and improvement of the home.
There were arrangements in place to support people's end of life care and wishes. Staff were kind and patient towards the people they looked after. Staff understood how to support people with the challenges that living with dementia could bring. A relative said, "Butterfly House is more the small, family friendly and relaxed culture than big institutional care homes, and all the staff and the managers are very friendly and respectful to residents and visitors.”
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.
Rating at last inspection and update
The last rating for this service was requires improvement (published 1 May 2020) and there was a breach of Regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
At our last inspection we recommended that the provider referred to current guidance on ‘as required’ and topical medicines and updated their systems and practice accordingly. At this inspection we found that the provider had made this improvement.
Why we inspected
The inspection was prompted in part due to concerns received about the management and leadership within the home and concerns around providing 1:1 care. 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, responsive and well-led only.
We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, responsive and well led sections of this full report.
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 requires improvement to good based on the findings of 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 COVID-19 and other infection outbreaks effectively.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk