Archived: Bletchley House Residential Care and Nursing Home

This inspection took place on 22 February 2017 and was unannounced.

The inspection was carried out by two inspectors.

Prior to this inspection we had received concerns that there was only one hoist to share between 22 people who were using the service. The service did not have a suction machine. When people were using bed rails they were not protected by bumpers. Staff had not been trained in the use of syringe drivers and end of life care.

This report only covers our findings in relation to these concerns, therefore the rating from the previous inspection remains unchanged. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ACS Care Services Ltd on our website at www.cqc.org.uk.

There was a manager in post who was in the process of registering with the Care Quality Commission (CQC).

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.

Staff had access to a body hoist and a standing hoist to assist people.

A suction machine had been purchased and in place.

People were protected with bumpers when using bed rails.

People who needed a syringe driver were not being admitted as staff had not been trained in the use a new type.

Staff had received training in End of Life Care.

We carried out an unannounced comprehensive inspection of the service on 1 and 3 June 2016. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 18 (2a) HSCA 2008 (Regulated Activities) Regulations 2014. Staffing.

We undertook this unannounced focused inspection on 20 December 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ACS Care Services Ltd on our website at www.cqc.org.uk.

There was a manager in post who was in the process of registering with the Care Quality Commission (CQC). 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.

We reviewed the supervision system in place and found that it had been strengthened. We saw that staff received regular one to one supervision with a manager on a regular basis. Staff confirmed they had taken place and found them worthwhile.

While improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating at the next comprehensive inspection.

This inspection took place 1 & 3 June 2016 and was unannounced.

The inspection was carried out by two inspectors.

Prior to this inspection we had received concerns in relation to the staffing levels and the management of the service.

There was not a 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 provider had employed two new managers in the past year, but both had left before completing their registration with the Care Quality Commission (CQC). The service was being overseen by a registered manager from one of the providers other homes.

The service was being supported by a registered manager form another of the providers homes with support from a head of care and the regional quality officer.

Staff did not feel well supported by previous managers and the provider. They had not received any form of individual supervision opportunities for the past 12 months.

We identified that the provider was not meeting regulatory requirements and was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.

Staff received an induction process and on-going training. They had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people.

People were able to make choices about the food and drink they had, and staff gave support when required to enable people to access a balanced diet. There was access to drinks and snacks throughout the day.

People were supported to access a variety of health professional when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times.

People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure was in place and accessible to all. Complaint had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw where people's liberty may have been deprived; the provider had submitted Deprivation of Liberty Safeguards (DoLS) applications to the supervisory body in line with the current legislation. This meant that the provider understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and implemented them to protect people.

People's needs had been assessed but their care plans and risk assessments had not been updated to reflect changes in their care needs. This meant that people could be at risk of receiving care and treatment that was not safe and appropriate and not reflective of their current needs. A compliance action has been set and the provider must tell us how they plan to improve in this area.

We found certain areas of the home were not clean and hygienic. Therefore, people were at risk of acquiring an infection. A compliance action has been set and the provider must tell us how they plan to improve in this area.

Is the service effective?

We found that suitable arrangements were not in place to ensure that staff obtained the necessary skills and knowledge to meet people's assessed needs.

Staff were provided with irregular supervision and none of them had been recently appraised. A compliance action has been set and the provider must tell us how they plan to improve in this area.

Is the service caring?

People spoken with were complimentary about the staff supporting them. One person said, 'The staff are very kind and they answer my buzzer within a reasonable time.' Another person said, 'The staff here are patient.' We observed that staff interacted with people appropriately and were attentive to their needs.

Is the service responsive?

We found that there was not enough detailed information in some people's care records in relation to their identified needs and how care should be provided. This meant that people's support needs may not always be appropriately met.

Records relating to people's care and treatment were not accurate and appropriately maintained. This meant that people were not protected from the risks of unsafe or inappropriate care and treatment. A compliance action has been set and the provider must tell us how they plan to improve in this area.

Is the service well-led?

In this report the name of a registered manager appear who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The home has employed a manager who is undergoing assessment for their registration.

Staff told us since the new manager had been employed communication in the home had improved and that they were approachable and supportive.

We also found that improvements had been made to both record keeping at the home and to the suitability of the premises.