Archived: Bakers Court Care Home

Bakers Court Care Home is a nursing home providing personal and nursing care to up to 78 people aged 65 and over in one building across three floors. At the time of the inspection, 71 people were using the service.

People’s experience of using this service

The provider had increased the numbers of staff on duty, but staff were not deployed effectively to meet people’s needs. People did not receive a good dining experience. Care plans did not always include the level of detail needed to provide people with person-centred and safe care. The provider’s quality assurance systems did not address the issues we found at this inspection.

People had risk assessments to minimise the risks of harm or abuse they may face. However, risk management plans were not always reviewed and updated when people's needs changed. Staff knew what action to take if they suspected somebody was being harmed or abused. Medicines were managed safely. People were protected from the risks associated with the spread of infection.

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’s care needs were assessed before they began to use the service. Staff were supported to carry out their role with training, supervision and appraisals. People were supported to maintain their health. Staff understood their responsibilities under the Mental Capacity Act (2005).

Staff were knowledgeable about people’s individual needs and they knew how to provide a personalised care service, although people’s personal preferences were not always well documented. People’s communication needs were met. The provider had a system in place to handle complaints. People who were at the end of their life had their wishes for their last days documented.

People and their relatives gave mixed feedback about the leadership of the service. Staff spoke positively about the management of the service. The provider held regular meetings for people using the service, their relatives and staff. The provider sought feedback from people using the service and relatives to identify areas for improvement. The provider worked in partnership with other agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 January 2019) and there were breaches of regulation. The provider completed an action plan after the inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care of people using the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bakers Court Care Home can accommodate 78 older adults some of whom may have dementia or mental health difficulties in a purpose built three storey building. At the time of this inspection, 64 people were using the service.

This inspection took place on 5 and 9 November 2018. The inspection was unannounced. This was the first inspection since the service was registered under the provider HC-One Oval Limited in December 2017. During this inspection, we found two breaches of the regulations and the service is now Requires Improvement. We found there was not always enough staff to meet people’s needs, care plans lacked detail and the provider’s quality assurance systems did not identify the issues we picked up on at inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Recruitment checks were carried out before new staff began working at the service. Staff knew how to report safeguarding concerns and whistleblowing. People had risk assessments carried out to mitigate the risks of harm they may face. Building and safety checks were carried out in line with building safety requirements and equipment was checked to ensure it was safe to use. There were systems in place to manage medicines safely. People were protected from the risks associated with the spread of infection. The provider used accidents and incidents to make improvements to the service.

People’s needs were assessed before they began to use the service to ensure the right care could be provided. Staff were supported with regular supervisions to help them to carry out their role effectively. However, staff training was not always up to date in key areas. The provider had communication systems in place for staff to be updated on people’s well-being and changes in care needs. People were supported to eat a nutritionally balanced diet and to maintain their health. However, the dining experience for people was not always positive. The provider and staff understood the requirements of the Mental Capacity Act (2005).

People and their relatives were involved in decisions about the care and thought staff were caring. Staff knew people well and understood their care needs. People were supported to maintain their independence and their privacy and dignity was promoted.

Staff were knowledgeable about equality and diversity.

Staff understood how to deliver personalised care. People were offered a variety of activities and their communication needs were met. Complaints and compliments were recorded and used to improve the service. The provider had a system to capture people’s end of life care wishes.

People, relatives and staff spoke positively about the management of the service. The provider had a system in place to obtain feedback from people using the service, relatives and visitors. People, relatives and staff had regular meetings to be updated on important issues and service development. The provider worked in partnership with other agencies to improve the service provided.

We have made three recommendations about staff training, the dining experience and working within the requirements of the Mental Capacity Act (2005)..

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 thought the service was safe. Staff were knowledgeable about safeguarding and whistleblowing procedures. The provider had a recruitment system in place to ensure the suitability of staff working at the service. Staff were not always deployed effectively to ensure people’s needs were always met. Risk assessments were carried out with management plans in place to enable people to receive safe care. There were safe medicines management systems in place. The provider had systems in place to reduce the risk of spread of infection.

Staff received appropriate support through supervisions, appraisals and training opportunities. Appropriate applications for Deprivation of Liberty Safeguards had been applied for and authorised. Staff were aware of the need to obtain consent before delivering care. People’s dietary needs and preferences were met through a varied and nutritious menu. People also had access to healthcare professionals as needed to meet their day to day health needs.

People thought staff were caring. Staff were knowledgeable about how to develop caring relationships with people who used the service. People’s privacy and dignity was respected. Staff had awareness of equality and diversity issues. People were encouraged to maintain their independence.

Care plans were detailed, showed people’s preferences and people confirmed care was delivered in line with their preferences. Staff were knowledgeable about providing a personalised care service. A variety of activities were offered in line with people’s preferences. People and relatives knew how to complain and the provider dealt with complaints in accordance with their policy. The provider also kept a record of compliments about the service.

People and relatives said they felt comfortable raising concerns with the registered manager. Feedback was sought from people who used the service through surveys and regular meetings. Staff had regular meetings to enable them to contribute to service development. The provider had a variety of quality assurance systems in place to identify areas for improvement.

We have made two recommendations around supporting people with specific health conditions and the deployment of staff. Further information is in the detailed findings below.