Archived: Baugh House

Updated 7 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was brought forward in response to information of concern we received which indicated potential concerns about the management of risk at the service.

This inspection took place on 05 and 06 April 2017 and was unannounced. The inspection team consisted of two inspectors on the first day and one inspector, an inspection manager and a specialist advisor completing the inspection on the second day.

Prior to the inspection we reviewed the information we held about the service and the provider. This included notifications from the provider about deaths, accidents and safeguarding. A notification is information about important events that the provider is required to send us by law. We also contacted a local authority responsible for commissioning services at this location to seek their feedback. We used this information to help inform our inspection planning.

During the inspection we spent time observing the care and support being delivered by staff. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with seven people, ten relatives, and two healthcare professionals to gain their views on the service. We also spoke with twelve staff, including the current manager, two maintenance staff, the chef and three nursing staff. We looked at records, including 12 people’s care plans and risk assessments, 14 staff recruitment files, staff training records and other records relating to the management of the service.

Updated 7 June 2017

This inspection took place on 05 and 06 April 2017 and was unannounced. At our last comprehensive inspection of the service in May 2015 the service was rated ‘good’. Baugh House is a home providing nursing and residential support for up to 60 people. At the time of our inspection there were 46 people living at the home.

Since the last inspection there had been a series of changes within the management team at the service. At the time of our inspection there was no registered manager in post. 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. The current manager explained they had been in place as an interim measure since March 2017, following the recent departure of the previous manager. They told us the provider was in the process of recruiting for the registered manager post.

At this inspection we found significant concerns amounting to a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to people had not always been adequately assessed, and where areas of risk had been identified, action had not always been taken to manage them safely. Medicines were not safely managed because we found issues in the way medicines were recorded, stored and disposed of. Staff responsible for medicines administration had not always been assessed to ensure they were competent to do so, and were not always up to date with training relating to the safe management of medicines.

People were not always protected from the risk of abuse, because potential abuse concerns had not consistently been reported to the local authority safeguarding team, in line with local protocols and the provider’s safeguarding procedure. Sufficient staff were not always appropriately deployed within the service to safely meet people’s needs. There was also a high level of agency staff usage which meant staff did not always have detailed knowledge or experience in supporting the individual needs of the people living in the home.

Staff were not always up to date with training considered mandatory by the provider. People told us staff did not always seek their consent when providing them with support and we found there was a risk that care and treatment may be given to people against their wishes. The provider had not always complied with the Mental Capacity Act 2005 (MCA) in making decisions on people’s behalf where they had been assessed as lacking to do so themselves. People were not always lawfully deprived of their liberty under the Deprivation of Liberty Safeguards.

People had care plans in place, but these were not always up to date and accurate. People’s preferences in the way they received care were not always met. The provider’s systems for monitoring and improving the quality and safety of the service were not always effective and had not addressed the issues we found at this inspection. Audits undertaken by senior staff did not consistently identify or address areas of concern. The provider’s systems for seeking and acting on people’s feedback were not effective in driving improvements.

You can see the action we have asked the provider to take in respect of these breaches at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also identified areas that required improvement. Complaints were not consistently managed and responded to in line with the provider’s complaints procedure. Whist we observed a number of caring interactions between staff and people, we also noted interactions which were not caring or staff failing to interact with people when they were in distress. People were not always involved in day to day decisions about their care and treatment. A range of activities were on offer to people at the service but improvement was required to ensure appropriate social stimulation was offered to all of the people living at the home.

The overall rating for this service is ‘Inadequate’. Immediately following the inspection the provider GCH ( Kent ) Ltd applied to cancel its registration. This application has been granted and a new provider, GCH (South) Ltd has been registered to provide the regulated activities ‘Accommodation for persons who require nursing or personal care’ and ‘Treatment of disease, disorder or injury’ at this location. CQC decided that we could only permit GCH (South) Ltd to operate this service subject to a number of conditions to address the concerns found at this inspection and to ensure the continued monitoring of the safety of the service. GCH (South) Ltd agreed to accept those conditions on its registration.

There were also some areas of good practice at the service. Appropriate recruitment checks were made on new staff before they started work. People were supported to access a range of healthcare professionals when required and we received positive feedback from visiting healthcare professionals about the support people received during our inspection. People told us their nutritional needs were met and that staff respected their privacy.