The Care Quality Commission (CQC) has rated Buckingham House in Birmingham, inadequate, and placed it in special measures following an inspection in September.
Buckingham House, run by Moundsley Hall Limited, is a care home providing personal and nursing care for up to 60 people. At the time of this inspection there were 46 people using the service.
The inspection was prompted in part due to concerns received about how people's needs were being managed.
Following this inspection, the service’s overall rating has dropped from good to inadequate, as have the ratings for being safe, effective and well-led. Being responsive has declined from good to requires improvement, and caring has again been rated as requires improvement.
The service is now in special measures, which means it will be kept under close review by CQC to keep people safe and it will be monitored to check sufficient improvements have been made.
Restrictions have also been placed on the provider’s registration, which means the service must receive written permission from CQC before accepting people into the home in order keep people safe.
Craig Howarth, CQC deputy director of operations in the midlands, said:
“When we visited Buckingham House, it was disappointing to see such a significant shortfall of strong leadership. We found leaders and the culture they created didn’t assure the delivery of high-quality care for people living at the home.
“For example, an ambulance crew raised safeguarding concerns, as staff were disinterested when they arrived, and were on their phones with no knowledge of the person's history or when they became unwell. They showed no urgency for the person's care even though the ambulance crew had arrived.
“One person told us how they had called for assistance with personal care, and it took 30 minutes for a staff member to attend. They were then told that it would require an additional member of staff to help them to the toilet. The person was then left for another 30 minutes, which made the person embarrassed and upset.
“There was a lack of management and oversight of medicine stock levels. This had resulted in someone missing seven doses of medicine to treat an identified heart condition. Another person with an eye condition, hadn’t had 17 doses of their prescribed eye drops, which is totally unacceptable and could risk people becoming more unwell.
“This poor care is unacceptable, and following the inspection we informed the provider that they needed to make significant improvements. We will continue to monitor the service closely, including through future inspections, to determine whether the issues we identified are addressed so people using the service receive the care they have a right to expect.”
Inspectors found:
- People did not receive safe care and treatment. Risks and care needs were not always identified and actions to lessen risks not taken
- People did not always have their clinical needs met effectively. Instruction from health professionals was not always followed leaving people at risk of further health complications
- The environment was not always safely maintained and risks to people's safety not always identified or rectified
- People did not always receive care that was personalised to their individual needs
- Infection control was not effectively managed
- Staff, including the manager, could not tell inspectors what to look out for or what response was needed to keep the person safe in the event of a seizure
- Key information about people's needs were missing from their care records. For example, two people who had been assessed as being at risk of self-harm and had no care plans or risk assessments to inform staff about how best to support them.
The report will be published on CQC’s website in the next few days.