Bedwardine House Residential Care Home

Bedwardine House is a care home providing accommodation and personal care for up to 25 older people. The care home is an adapted building over two floors. At the time of the inspection 13 people were living at the home.

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

Risks to people were not always identified effectively to ensure people were not at risk. Staff were not always consistent in their description of people’s needs to demonstrate safe care was always provided.

People’s medicines were not always fully managed safely to ensure they were administered or applied correctly.

Areas of improvement had taken place regarding infection control and compliance with COVID-19 requirements. However, further improvement was needed to ensure staff worn a face mask at all times.

The provider continued to have a lack of effective systems to monitor the quality of the service provided by staff to ensure people were safe. As a result, previously identified shortfalls had not always received the improvement necessary to ensure safe care and support was provided.

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 14 April 2021). The provider was in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

At this inspection enough improvement had not been made in all areas and the provider remains in breach of regulations.

Why we inspected

We received concerns in relation to aspects of the care provided and the management of the service. As a result, 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.

This inspection was carried out to follow up on a Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities).

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.

The overall rating for the service has remained as Requires Improvement. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicine management, care planning and management oversight and governance.

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 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.

Bedwardine House is a care home providing accommodation and personal care for up to 25 older people. The care home is an adapted building over two floors. At the time of the inspection 14 people were living at the home.

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

Systems, processes and reviews to assess the quality and safety of the service provided to people continued to be either not in place or ineffective in recognising shortfalls identified during the inspection.

Improvements in the storage of certain medicines had taken place since our previous inspection. Further medicines management shortfalls were identified as requiring improvement.

Improvements had taken place regarding the safe recruitment of staff since the previous inspection.

Government guidelines regarding infection control were not always followed and recorded as required. Staff were seen to be wearing Personal Protective Equipment (PPE) and relatives spoke highly of how the COVID-19 pandemic had been managed including enabling people to maintain contact with their family.

The information within care plans and risk assessments had improved since our previous inspection to ensure staff were able to provide consistent care and support.

Management and staff were aware of their responsibility to report all allegations or suspicions of abusive practice within the home as a means of keeping people safe from harm.

The provider, business manager and deputy manager acknowledged our feedback and gave further reassurances of their plans to make the necessary improvements.

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 04 February 2020). 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 they would improve. At this inspection we found improvement had been made and the provider was no longer in breach of three regulations. Enough improvement had not been made and the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

This inspection was prompted in part due to concerns regarding the management of the home during the COVID-19 pandemic and the deployment of staff. This followed notification from the provider of the outbreak.

In addition, the inspection was prompted following notification of a specific incident resulting in the death of a person following a fall from a height. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

As a result, 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.

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.

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

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance regarding the management of the home.

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 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.

Bedwardine House Residential Care Home is a residential care home providing personal care to 22 people aged 65 and over at the time of the inspection. The service can support up to 25 people in one adapted building.

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

Safe and effective recruitment procedures and systems were not always in place to ensure staff were of good character and suitable to work with people living at the home. The storage and recording of medicines was not always in line with requirements and systems were not sufficiently robust to identify shortfalls.

Systems to identify risks to people were not always sufficiently robust and care records and risk assessments were not always either in place or updated to reflect people’s needs. Management systems were not always identifying shortfalls in these and other areas such as some staff training and the analysing of accidents within the home.

The provider had failed to notify the CQC of accidents whereby people had received or sustained an injury.

There were sufficient staff members on duty to care for people. People told us they liked the staff and found them to be kind, caring and considerate. People felt safe living at the home and told us they had their right to privacy and dignity respected by staff members and were able to make choices about how they spent their day.

People had a range of fun and interesting things to do during the day and told us they enjoyed taking part in these.

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.

Most people liked the food provided and told us they had a choice of food. People had access to a range of healthcare professionals to uphold their wellbeing.

People and staff told us they liked the management of the home. Staff members felt supported by the provider and enjoyed their work.

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 Good (published 08 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the safe management of medicines, staff recruitment, good governance and notifying the Care Quality Commission of accidents within the home.

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 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.

The inspection took place on the 10 and 11 January 2017 and was unannounced.

There was no registered manager at this home because the provider was both the registered provider and the manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to them. People told us they were supported in a safe way and had their medicines as prescribed. The registered provider had systems in place to monitor how medicines were administered to ensure people were not at risk of poor practice.

People told us staff knew how to support them. Relatives said staff were well trained. Staff had up to date knowledge and training to support people. Staff respected people's rights to make their own decisions and choices about their support. People's permission was sought by staff before they helped them with anything. Staff spent time ensuring people understood what was being said to them, and used a range of communication methods. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well and were authorised to do so.

People had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. People said they had access to health professionals when they needed to. Relatives were confident their family member was supported to maintain their well-being and staff were responsive to changes with their family members health. Two members of the district nurse team confirmed staff made appropriate referrals to them and followed their advice.

People said they enjoyed living at the home and supported by kind and caring staff. Relatives told us they were reassured staff listened to their family members wishes and knew them well. People living at the home saw their friends and relatives as they wanted. People and their relatives explained how staff treated them as individuals and respected their choices. Staff told us they knew people well, and took their preferences into account and respected them.

People and their relatives were included in decisions about how care was provided. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. People had access to interesting things to do and staff spent time with people to meet their needs. We saw staff knew people and their histories well.

The registered provider sought people’s views through meetings and questionnaires. The management team had responded to suggestions made by people, their families and staff where possible, and took an inclusive approach to improvements to the service.

The registered provider had systems in place to monitor the quality of care and treatment people living at the home received. They told us they had recently replaced key staff who were undertaking training to complete their new responsibilities, therefore some systems were in the process of being updated at the time of our inspection.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. This meant that people would be safeguarded as required.

We found that sometimes the risk to the person safety was not always assessed properly. This meant that people were at risk as the provider had not appropriately risk assessed people.

Is the service effective?

People were provided with a choice of suitable and nutritious food and drink. Specialist dietary needs had been assessed and included when the menus were planned.

People told us that their visitors were able to see them in private and that visiting times were flexible. They also told us the home were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

We found that the care plans did not always match what care was being delivered. For example, in one care record, we saw someone's care plan said they were to be assisted out of bed for a wash in the morning. We found that the person was being nursed in bed.

Staff told us they received effective support from the provider and said they had good regular communication.

Is the service caring?

We spoke with eight people who used the service and one relative. We asked them for their opinions about the staff that supported them. What people told us was positive, one person said; 'It's nice here'. Another person said; "Very good staff".

People were supported by staff who demonstrated a clear understanding of their needs. When we spoke with staff it was clear that they genuinely cared for the people they supported.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. We saw that one person was supported to paint crockery, which we saw displayed around the home.

People were treated with respect and dignity by the staff on duty. For example we saw one staff member discreetly wipe a person's face after they had finished their lunch.

Is the service responsive?

The provider was responsive to people's needs. We saw examples where people were supported to attend hospital appointments when they were required.

People completed a range of activities within the service regularly. People told us they were supported by staff to play games and activities that they enjoyed.

The provider told us that they regularly held residents meetings to gather the views of the people who lived there. This meant that the provider had considered the views of people in running the home.

Is the service well-led?

Staff were clear about their roles and responsibilities. They told us the management team always welcomed their suggestions for improvement. They considered the service was well-led. They said they received regular opportunities to meet on an individual and felt supported in their work.

The provider had some quality assurance systems in place. We saw records that showed areas of the quality of the environment had been reviewed. For example, the maintenance audits and fridge temperature audits were completed. However, we found that risks to the health and welfare of people that lived at the home were not always assessed. This meant that the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We looked at care records for two people and looked at other supporting documents for the service. We spent some time with the registered manager and the deputy manager of the service.

Consent had been obtained from people before care and treatment had been provided. Alternative arrangements had been made to support people who were unable to consent to their treatment or support. Staff told us they: 'Always ask people if it's ok or if they are happy with me providing care'. One staff member said: 'You have to approach people in the right manner'.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff told us they were aware of each person's needs and how to give care and support to meet those needs.

Recruitment procedures were in place to make sure that suitable staff were provided to care for people.

People who used the service were supported by staff who were suitably trained and qualified to meet people's needs. The provider made sure they carried out an annual appraisal of the staff and held quarterly meetings with senior staff so they were able to raise any concerns or issues they had.

The provider did not have an effective process in place that monitored the quality of its service.