The inspection took place on 8 and 9 February 2016 and was unannounced. Borovere is registered to provide accommodation and support for up to 30 people. The location has two bedrooms out of commission in a part of the building known as the ‘Coach House’ and is using the two double bedrooms to accommodate people singularly; therefore they can only accommodate 26 people. At the time of the inspection there were 25 people living there. The service had a 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.
People and staff gave mixed views about the adequacy of staffing levels. Assessments of people’s level of care needs were completed and this information was used to determine the level of people’s fees but not the staffing needs of the service. Staffing levels for the service were fixed. There was no budgetary allowance for agency staff and management had to cover shortfalls where possible. There was not always a professionally qualified member of care staff on duty, on-site, to ensure suitable staff were deployed within the service at night. On-call senior care staff were available to be called upon if required. There had not always been a qualified first aider on-site at night as required. The registered manager made arrangements to ensure people’s safety whilst night staff underwent first aid training immediately following the inspection. Although no harm to people resulted from this, there was a risk of harm the longer this situation continued.
There were not robust arrangements in place to ensure staff were qualified and competent to administer people’s medicines. The registered manager took immediate action following the inspection to make sure night staff undertook medicines awareness training to ensure people’s safety. Records in relation to people’s medicines were not always complete. Processes to ensure medicines were stored at the correct temperature were not robust. Staff had failed to ensure people’s liquid medicines were always in date. Processes to monitor the quantity of medicines were not robust. Staff did not always administer people’s medicines safely.
Risks to people from the environment had not been adequately assessed and managed. There was the potential that people could leave the building without staff’s knowledge or be placed at harm through staff not securing unsafe areas of the service, such as the sluice. The garden was not safe and the perimeter was not secure. The registered manager was taking action in relation to the safety of the garden and took action during the inspection to ensure people could not access high risk areas of the service to ensure their safety.
The provider’s quality monitoring systems were not robust or effective. Some issues had not been identified or where issues had been identified they had either not been rectified or had not been addressed promptly. There was the potential that people might experience harm and opportunities to improve the service were not used effectively.
The management of records within the service was not robust. People’s personal care records were not stored totally securely to prevent any potential access by unauthorised people. Other records including people’s daily care records had not been completed at the time the care or support was provided, or there were gaps. People’s medicine records were not always secured when staff administered medicines to people.
People’s records demonstrated that risks to them as individuals in relation to different aspects of their care had been assessed and managed. Staff had access to written guidance about risks to people and had taken appropriate action to mitigate them.
People and relatives told us they felt safe. Staff had undergone relevant safeguarding training and understood their role in relation to safeguarding people and the actions they should take to keep people safe from the risk of abuse. Staff had undergone relevant recruitment checks as part of their application process to ensure their suitability to work with people.
Staff underwent an induction upon the commencement of their role. Unless an issue was identified which needed to be addressed during their induction period new staff did not receive one to one supervision until after their induction. There was a lack of evidence to demonstrate how this policy would adequately support staff to meet the requirements of the ‘Care Certificate’ which is the industry standard induction for new staff. There was the possibility that new staff may not have felt fully supported in their induction to ensure they could provide people’s care effectively.
Where people lacked the mental capacity to make specific decisions, staff were guided by the principles of the Mental Capacity Act 2005. This ensured any decisions made were in the person’s best interests. Not all staff had undergone relevant training but they had access to relevant guidance. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLs applications had been submitted for people where required. People’s liberty was only restricted when this was legally authorised.
People were offered a choice of nutritious meals. People had nutrition care plans that provided staff with guidance about the person’s nutritional needs. People’s weight was monitored regularly.
Staff were observant to changes in people’s presentation and took the required action to ensure they were referred to a healthcare professional if needed. People were supported to access a range of healthcare services to ensure they could maintain good health.
People told us staff were kind and very caring and that they were happy with the staff. People told us they were supported by staff to receive their care when they wanted it and that their wishes were respected. They also told us staff upheld their privacy and dignity when providing their care.
Staff had access to information about people’s life histories and communication needs in their care plans. They used this information to communicate with people in a caring and kindly manner.
People were supported by staff to express their views and to make decisions about their care where possible. For example, they were shown the platter of vegetables at lunchtime so that they could choose what and how much they wanted to be served.
Staff were aware of people’s needs, which were assessed, recorded and reviewed appropriately. Staff supported people to be independent where possible. Staff told us they hoped that one person would shortly be assessed by the GP as able to be supported out of their bed to sit in a chair. However, they were concerned that they would not be able to provide this level of care to the person with the current staffing numbers; this would not promote their independence.
People appeared to enjoy the activities being provided. However people told us that sometimes there was “Nothing to do” when the activities co-ordinator was not available, which was on four days one week and on three days the alternate week.
There was a process for people to make complaints about the service but not everyone spoken with was aware of how to complain. Where complaints had been received appropriate action had been taken to investigate the complaint and make any required changes.
Overall people were happy with the management and one person commented “The manager is lovely.” However, a person’s relative told us the home had changed and that “Management was not as dynamic as it was.” There was a clear management structure in place. Staff told us the management team was supportive and was available to them. The registered manager often worked alongside staff in the provision of people’s care.
We found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.