Archived: Butterhill Care Centre

Butterhill Care Centre is a residential care home providing personal and nursing care to 13 people aged 65 and over at the time of the inspection some of whom were living with dementia. The service can support up to 28 people in one adapted building.

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

Systems in place to learn and improve care were not always effective. Although there was no risk of harm, the systems had had not identified the missed recordings we found. Following the inspection, the registered manager took action to address the errors.

People were supported by staff trained to recognise and report on potential harm or abuse. Staff were safely recruited and responded to people’s needs timely and effectively. We found people’s medicines were managed effectively. The registered manager had an environmental action plan to help effectively prevent and control infection. Lessons were learnt when things went wrong.

Managers and staff shared a positive culture which was person-centred, and they were open and honest when things went wrong. Staff and managers were clear about their roles and responsibilities. The provider encouraged people to share their views on the service and worked in partnership with other health and social care professionals to meet people’s needs.

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 12 October 2019).

Why we inspected

We received concerns in relation to staffing levels, staff practice in relation to personal protective equipment (PPE) and the environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe section of this full report.

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.

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.

The overall rating for the service has remained the same. 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 Butterhill Care Centre on our website at www.cqc.org.uk.

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.

Butterhill Care Centre is a residential care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. The service can support up to 28 people in one adapted building. Butterhill Care Centre specialises in providing care to people living with dementia.

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

People told us they felt safe. Systems were in place to keep people safe and staff understood how to protect them from abuse. People’s risks were assessed and staff understood how to manage these risks. People were supported by a sufficient number of safely recruited staff. Medicines were administered safely. People lived in a clean and tidy environment and staff understood how to prevent the spread of infection. When things went wrong, the care manager ensured lessons were learned to reduce the risk of future reoccurrence.

People’s needs and choices were assessed and reviewed when needed. People were supported by staff who were well trained and knowledgeable to meet their needs. People were supported with eating and drinking in line with their care plans. People were supported to access healthcare support when needed and referrals were made in a timely manner. People’s personalised needs were considered in the decoration of the home.

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.

People were supported by kind and caring staff. People were encouraged to express their views and be involved in making their own decisions. People were encouraged to be independent and do what they could for themselves. People’s privacy and dignity was respected by staff.

People received personalised care that was appropriate to meet their needs. People’s communication needs were met and staff communicated with people in a way they understood. People were encouraged to engage in activities of their choice. People’s concerns and complaints were listened to by the care manager, investigated and action taken where needed. People’s end of life wishes were discussed with them so their preferences were known at that stage of their life.

Effective audit systems were in place to check the quality of the service. People and relatives told us the care manager was visible and approachable. The care manager promoted a person-centred approach to people’s care which staff understood and followed. The care manager understood their responsibilities and statutory notifications were submitted to CQC as required by law. People, relatives and staff were encouraged to provide feedback to improve the service. The care manager was proactive in continuous learning and sought further training opportunities for staff. The service worked closely with other agencies to ensure people’s needs were met.

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 22 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

During this inspection 8 March 2017 we saw improvements had been made to ensure people were provided with a safe, effective, caring, responsive and well led service. The provider had reviewed the internal management team and changes had been made. We judged sufficient improvements had been made. However, we will continue to closely monitor and review the service to ensure further improvements are made and people are provided with a safe service.

Butterhill House provides support and care for up to 28 people, some of whom may be living with dementia. At the time of this inspection 11 people used the service.

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 received support from staff that met their individual needs and preferences, however, people were not always provided with opportunities to participate in activities that interested them.

People felt safe and staff knew how to protect people from avoidable harm and abuse. People's risks were assessed and managed to help keep them safe and we saw that care was delivered in line with agreed plans.

Medicines were administered and managed in a way that protected people from the risk of harm.

The principles of The Mental Capacity Act (MCA) 2005 were being followed as the provider was ensuring that people were consenting to the provision of their care and treatment. Where people lacked the mental capacity to consent they were supported by people who knew them to act in their best interests.

People were supported with their nutritional needs and monitoring was in place to ensure people ate and drank sufficient amounts.

Advice was sought from health and social care professionals when people were unwell. This advice was documented and followed by staff to maintain and support people’s physical and emotional wellbeing.

People were treated with dignity and respect and their right to privacy was upheld. The care people received was personalised and responsive to people's individual care and support needs.

There were enough suitably trained staff to keep people safe and meet their needs in a timely manner. Staff had been recruited using safe recruitment procedures which ensured they were of good character and fit to work with people who used the service.

The provider had systems in place to monitor and improve the quality and safety of the service. Improvements had been made to the systems in place to monitor accidents and action had been taken by the registered manager to reduce the risks of further occurrences.

People and staff told us that the registered manager and provider were approachable and staff felt supported to carry out their role.

We found that the service remains Inadequate and it will remain in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Butterhill House provides accommodation and personal care to up to 28 people. At the time of this inspection 17 people were using the service.

There was no registered manager in post and the service was being managed by the provider and consultants who were in the process of registering as the new providers of the service. The new potential providers told us they had recruited a new manager who was due to start in October 2016. 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 were not being safeguarded from abuse as incidents of potential abuse had not been reported or investigated to prevent the incident occurring again.

There were still insufficient staff to meet people's needs safely. People were at risk of malnutrion and infection due to a lack of care staff and domestic staff. The provider could not be sure that staff employed were of good character and fit to work with people.

People's medicines were still not managed safely. People did not always get their medicines at the prescribed times and were at risk of not having their medicines due to poor staff practise.

People's individual risk assessments were not followed by staff to ensure that the care they received was safe and minimised the risk of harm. People did not always have the equipment they needed to keep them safe from harm.

The principles of the Mental Capacity Act 2005 (MCA) were not followed to ensure that people were consenting or being supported to consent to their care and support.

People's nutritional needs were not being met and people had lost weight and were at risk of malnutrition.

Health professional advice was not followed and people's health care needs were not always met.

Staff did not receive effective support and supervision to ensure they were competent in their role and this put people at risk of harm due to poor practice.

Systems in place to monitor the quality of the service continued to be ineffective. The management systems were insufficient to provide leadership and guidance to the care staff. People were at continued risk of receiving poor, inconsistent and unsafe care.

No improvements had been made since the last inspection and the provider continued to be in breach of several Regulations of The Health and Social Care Act 2008(Regulated Activities) Regulation 2014.

The overall rating for this service is Inadequate which means it will be placed into special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Butterhill House provides support and care for up to 28 people, some of whom may be living with dementia. At the time of this inspection 21 people used the service.

The service did not have 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.

Risks to people were not always minimised through the effective use of risk assessments. There were insufficient suitably trained staff to keep people safe and meet people's care needs in a timely manner.

Staff did not always have the knowledge and skills required to meet people’s individual care and support needs. The provider did not have robust recruitment and vetting procedures. Staff did not always have the induction, training and supervision they needed.

People did not receive care that was personalised and reflected their individual needs and preferences.

The principles of the Mental Capacity Act 2005 were not followed to ensure that people were consenting or being supported to consent to their care and support.

Care was not always personalised and did not meet people's individual needs. Advice from health professionals was not followed; therefore the action needed to relieve people from discomfort and distress was not taken.

People's medicines were not managed or administered safely.

Leisure and social activities were provided occasionally and arranged by the care staff in addition to their care duties. People’s right to privacy and dignity was compromised.

Complaints were not always managed appropriately.

Systems in place to monitor the quality of the service were ineffective. The management systems were insufficient to provide leadership and guidance to the care staff. People were at risk of receiving poor, inconsistent and unsafe care. No improvements had been made since the last inspection.

Butterhill House provides support and care for up to 28 people, some of whom may be living with dementia. At the time of this inspection 20 people used the service.

The service had a registered manager. However, the person currently named on our register was not the same person who was now managing the service. 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.

Informal arrangements had been made to support people with their medicines if they needed them at night, however more formal arrangements were needed. Improvements were required to ensure the safe storage and administration of medicines.

The principles of the Mental Capacity Act 2005 were not consistently followed. People were at risk of unlawful deprivation. Referrals for a Deprivation of Liberty Safeguards assessment had not been made for some people who lacked capacity to consent to their care and treatment within the service.

Risks to people's health and wellbeing were identified and assessed but records were not always made with how to mitigate the risk. Action was not always taken to ensure people’s risk of harm was reduced.

Care staffing levels during the day were sufficient to meet the needs of people who used the service. Improvements were needed to make sure there were enough night staff available so that people were safe and had their support needs met in a timely way.

Limited leisure and social activities were provided for some people, but not all people got the support they needed to engage in any meaningful activity.

People generally told us they enjoyed the food and had enough to eat. Not all records for the purpose of monitoring people's fluid intake had been fully completed to ensure people's needs were fully met.

The provider had a system in place to assess, monitor and improve the quality of care. However improvements were needed to ensure a consistent approach to improving the service.

Staff were aware of the safeguarding procedures and knew where and to whom they could raise concerns.

The provider had a complaints procedure and some people knew how and who to complain to.

Below is a summary of our findings based on our observations of the service and people who used the service. We spoke with the staff who supported people and we looked at records. We considered our inspection findings to answer the questions we always ask '

Is the service safe?

The service placed people at risk because of the unsafe storage and administration of medication. We have asked the provider to tell us how they are going to improve their service in relation to medication practices.

The safety of people who used the service could be compromised because of the current practices with opening the fire doors and deactivating the alarms.

Staffing levels were assessed and monitored to ensure they were sufficient to meet people's identified needs. Recruitment for additional staff was on-going.

Is the service responsive?

The home did not provide enough stimulating and interesting things for people to do. We have asked the provider to tell us how they are going to improve this aspect of people's care.

Swift and timely action was not taken when concerns with equipment for the storage of food was identified.

Is the service caring?

People say they were treated well and with kindness and care.

People and/or their representatives were not involved with planning, agreeing or reviewing their plan of care. We have asked the provider to tell us how they are going to include people with making decisions about their care, treatment and support.

Is the service effective?

People told us they had enough to eat and drink throughout the day, and night if required, and meals were flexible to meet their needs.

People's day to day care and support needs were met.

Is the service well led?

The manager was aware of the improvements that were needed to the service. Plans for additional staff to be recruited, the replacement of equipment and the redecoration and refurbishment of the premises have been made.

At the time of this inspection the manager had been in post since January 2014. They were part way through the formal process of registration with us.

We considered our inspection findings to answer the questions we always ask;

' Is the service safe?

People were cared for in an environment that was now clean and hygienic. Improvements had been made in the standard of the premises although some areas still needed to be addressed. We have asked the provider to provide us with information about how it will continue to improve.

Staffing levels were sufficient to meet people's personal care needs. Some areas of training needed to be completed to make sure that people received care that was safe and appropriate to meet their needs. We have set a compliance action in relation to this and the provider must tell us how they plan to improve.

The CQC monitors the operation of the Deprivation of Liberty Safeguarding which applies to care home. Plans were in place for staff to receive the training to make sure that they understood when an application should be made and how to submit one.

' Is the service effective

People that lived at Butterhill House and relatives we spoke with were happy with the care provided. One person said: "They look after me well. I'm happy here".

People's needs were assessed and plans of care were in place. People had not agreed to their plan of care. People could therefore not be assured that the plans included information about how they wanted their care provided. People's nutritional needs were assessed and plans were in place to show the support they needed to have these needs met. There were some gaps in the food and fluid records. This meant that the people's nutritional intake was not monitored effectively.

' Is the service caring?

People told us they were supported by people that were caring and kind. One person said: "The staff are nice". A relative told us: "The staff talk nicely to people". We observed that care staff spoke with people in a friendly and respectful manner.

Care plans did not always fully record people's preferences about their social care needs. This meant that staff may not provide care in the way that people wanted.

' Is the service responsive?

The home did not provide enough stimulating and interesting things for people to do. We have asked the provider to tell us how they are going to improve this aspect of people's care.

The home had a complaints procedure. Information was available to people to tell them how to raise areas of concern. There had been no complaints since the appointment of the new manager.

People had the opportunity to complete a survey about the service they received. This meant that the provider was seeking people's views about their care to identify areas for improvement.

' Is the service well led?

The service had a new manager. The manager was not registered with us (CQC). We were assured that they were in the process of submitting a registration application.

The manager had begun to put in place a system to check the quality of the service it provided. This included reviews of people's care as well as audits on the environment, the home's infection control practices and risks to people. The manager had plans to develop this further to make sure that any shortfalls in care were identified and acted upon promptly.

The views of staff were now being sought. This meant that their views were being taken into account and areas of concern were able to be quickly highlighted and acted upon.

On this inspection we saw that improvements had been made although the home was not fully meeting the regulations.

People were living in a home that was much more hygienic. Policies and procedures were being put in place to make sure that home was kept clean and hygienic. Practices had recently been introduced to prevent and control the risk of the spread of infections.

The current staffing levels were adequate to meet people's personal care needs. There was little staff time provided to support people to take art in activities and to meet their social care needs. The manager was completing a full review of the home's staffing levels.

People were not being protected against the risks of the spread of infections and the home was not being kept hygienic. We saw areas of the home that were not kept clean. This included bedrooms and communal rooms. The environmental health department had recently visited and had identified concerns over catering hygiene and safety.

The home was not being well maintained. Several areas including bedrooms needed attention to provide appropriate accommodation. Some areas of the home were not suitable as they did not promote people's privacy. Some bedrooms were interconnected and people could access other people's private accommodation.

There were inadequate numbers of suitably trained and experienced staff on duty to provide people with the support they needed. When there were insufficient care workers on duty ancillary staff were moved from their roles to provide care to people. This meant that there were not enough staff available to undertake domestic duties such as cleaning the home and undertaking the laundry.

People we spoke with said they were happy living at the home. Relatives said that they were satisfied with the care provided. One relative told us: "They treat my relative very well".

Following our last inspection the provider had sent us an action plan to show us how they were going to improve the service.

The arrangements for supporting people to have their meals had improved. Mealtimes were better organised and staff were available to provide people with the support they needed to eat and drink sufficiently. People's nutritional needs were assessed and the plan of care identified the support each person needed. People were provided with a choice of meals and could choose where to eat their food.

People were being supported to have their medication as prescribed. Staff had recently had training in managing medication and this included a check on their competency to administer medication safely.

The manager had put in place a number of checks to monitor the quality of care people received. Where shortfalls were identified these had been addressed.

People and most relatives told us they were pleased with the care provided. They told us they liked the home and had seen improvements in their relative's health and wellbeing. People were having their physical and mental health needs assessed and plans of care were developed. The home monitored people's health and acted when people were ill.

Most people living at the home had dementia care needs. We saw examples of good interactions with people but saw some people were left alone for significant periods without having anything to stimulate and occupy them.

People were provided with choices of food and drink. Improvements had been made in the support people received to eat and drink but this support could be inconsistent.

Suitable arrangements were not in place to make sure that people had their medication as prescribed. Some records were signed before medication was given and there was too little time elapsed between morning and lunchtime medication.

A system to monitor the quality of care was being put in place but did not yet give sufficient information that appropriate care was provided and that any concerns identified and acted upon.