27 February 2019
During a routine inspection
At the last inspection in December 2017 we found the service to be in breach of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Issues found included inconsistent staffing levels at night, risks associated with people’s health and care needs had not been adequately assessed, people at risk of poor nutrition and hydration intake were not appropriately monitored and ineffective management oversight which did not identify the issues we found.
At this inspection, although we found that the service had made some improvements to staffing levels and risk assessments, we found some issues similar to those identified at the last inspection and other areas of concern that required further attention and improvement.
People’s experience of using this service: People told us that they were happy living at Baxendale Care Home. Their relatives agreed with this and told us that they believed their relatives received safe and good care.
People told us that they enjoyed the food provided at the home and were always offered snacks and drinks throughout the day.
People and their relatives found care staff to be kind and caring and attentive to their needs. We observed interaction between people and staff was positive. Care staff understood people’s needs well.
There were sufficient numbers of staff available throughout the day and night to safely and appropriately meet people’s needs.
Risks associated with people’s health and care needs had been identified. However, not all individual risks had been assessed to ensure staff were given the guidance and information on how to safely support the person with the risk.
The service was not working in line with the principles of the Mental Capacity Act 2005 (MCA). Where people had Deprivation of Liberty Safeguard (DoLS) authorisations in place and these had expired, there was no evidence that re-authorisation requests had been submitted prior to the current authorisation expiring.
At the time of this inspection the service was transitioning from a paper care plan to an electronic care plan system. Although care plans contained some person-centred information about people, care plans were not fully complete and were not consistent in the information recorded.
A variety of monitoring charts were in place for people which included charts for food intake and activities participation. However, these were not always appropriately and fully completed.
People living in the ‘West Wing’ with advanced dementia, had little access to appropriate activities or stimulation for positive well-being.
Checks and audits were in place to oversee medicines management and administration and health and safety. We were told that care plans were checked to see if they were current and reflective of people’s needs but these checks were not recorded. The service had not identified any of the issues we found as part of this inspection process.
Medicines management and administration was generally safe. People were seen to receive their medicines on time and as prescribed.
Recruitment processes followed by the service ensured that only those staff assessed as safe to work with vulnerable adults were recruited.
People and their relatives knew who to speak with if they had any complaints or concerns to raise and were generally confident that their concerns would be appropriately addressed.
More information is in the detailed findings below.
We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around the absence of current DoLS authorisations and the governance of the service. We have also made a recommendation for the service to consider activities for people living with dementia and ensuring care plans are person-centred. Details of action we have asked the provider to take can be found at the end of this report.
Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published March 2018). This service has been rated as Requires Improvement for the second time.
Why we inspected: This was a planned inspection based on the rating at the last inspection.
Follow up: We will ask the provider to submit an action plan detailing the steps they intend to take to ensure the required improvements are implemented. We will also continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk