We inspected Bickham House on 8 September 2015 and the inspection was unannounced. Our last inspection took place on 15 April 2014. At that time we found the service met the five standards we inspected against.
Bickham House is a large detached Victorian building which provides accommodation for up to 26 people. There were 22 people using the service at the time of the inspection. The home operates as a registered charity. All bedrooms are single rooms and there is a large and well-maintained garden. The house also has a large communal lounge area with separate dining room. Bickham House is situated in Bowdon, which is near Altrincham.
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 told us they felt safe at the home. Staff could explain the different forms of abuse people may be vulnerable to and said they would report any concerns to the manager.
Recruitment processes were not robust as thorough checks to make sure staff were safe and suitable to work in the care sector were not always completed before staff started work and were not well documented. This was a breach of the Regulation relating to the safe care and treatment of people.
There were enough staff on duty to make sure people’s care needs were met.
Staff told us they felt supported by the manager and that training opportunities were good. People and relatives we spoke with told us the staff were caring.
The home was well maintained and comfortably furnished. People’s bedrooms were personalised and we found the home to be clean and tidy.
We saw people had access to a range of healthcare services, including GPs, district nurses and chiropodists which meant that people’s holistic health care needs were met.
Although we found some good practice in the way medicines were managed, we did identify some issues with the storage of controlled drugs and recording of the application of topical creams and lotions. We also found that medicines at the home were not being audited regularly. This was a breach of the Regulation relating to the safe care and treatment of people.
On the day of our visit people looked well cared for. We observed staff speaking respectfully to people who used the service. Staff demonstrated they knew people’s individual preferences and what they needed to do to meet people’s care needs.
We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS) and saw good practice in the way that people were supported to make decisions.
People told us they were happy with the meals. There was a choice available for each meal and the chef was knowledgeable about dietary preferences.
People told us they thought the staff were caring and that they promoted their dignity and privacy. We observed interactions between people and staff that were relaxed and friendly.
We looked at people’s care files and daily records. Apart from two examples which we raised with the registered manager, all entries were written using positive language which demonstrated the staff respected the people they supported.
The service had implemented good practice in end of life care and had received positive feedback from families whose relatives had been cared for at the home at the end of their lives.
People’s care plans included detailed personal histories and their likes and dislikes and this was used to plan their care. We saw examples of when people had requested changes to their care plans and the service had made this happen.
Activities were planned for the people using the service and we saw activities on the day of our inspection. People and their relatives told us they would like to do more activities, especially trips out of the home. We recommended that the service ask the people what type of meaningful and person-centred activities they wished to take part in and make provision for them.
We observed that the lunch meal was quiet and staff were focused on serving food and collecting plates rather than interacting with the people who were eating. We recommended that the service investigate ways of improving the dining experience for the people living in the home.
Although we saw some examples of dementia-friendly signage, we recommended that the service investigates and implements good practice in modern dementia care to improve the quality of life for those living with dementia.
Visitors told us they were always made to feel welcome and if they had any concerns or complaints they would feel able to take these up with the registered manager.
We saw there were systems in place to monitor the quality of the service. When areas for improvement were identified action was taken to address them. People using the service were asked for their views at meetings and via questionnaires.
We found two breaches of regulations and you can see what action we told the provider to take at the back of the full version of the report.