Bafford House

Updated 28 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 3 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Bafford House is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bafford House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

This inspection was announced. We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 6 June 2023 and ended on 9 June 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and other professionals who had been working with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and observed staff working with others with more complex needs. We 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 / received email feedback from 12 people’s relatives and 5 health / social care professionals. We spoke with 10 members of staff including the provider, deputy manager, 5 care staff, the cook, the housekeeper and the cleaner. We reviewed a selection of care records, medication administration records and staff recruitment files. We reviewed documentation relating to management of the service, such as training records, audits, provider policies and procedures.

Updated 28 July 2023

About the service

Bafford House is a residential care home providing personal care to up to 19 people. The service provides support to older people, who may be living with dementia, mental health needs or learning disability. At the time of our inspection there were 13 people using the service.

The service accommodates people over 3 floors in one adapted building. Some bedrooms have en-suite toilet and washing facilities. People had access to a lounge on the ground floor, a dining room on the lower ground floor and a large garden. A lift enabled wheelchair access to all floors.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care:

While there had been improvements since our last inspection, we found people living at Bafford House were not always protected from risks related to the premises, potential risks from others, or risks related to choking. Staff had received training in some key areas including fire, infection control, first aid, moving and handling and dementia awareness. However, gaps in staff training and support remained which may adversely impact the safety and quality of care people receive.

Further improvement was needed to ensure the safety and quality of the service met expected standards.

People's medicines, incidents and behaviours were reviewed with health and social care professionals to ensure any restrictions were in people's best interests and people’s care and treatment remained appropriate. People’s ongoing physical needs such as chiropody, optical and dental care were met. Advice was sought from health care professionals to ensure people's more complex needs were met. Professionals told us their advice was followed.

Right Support:

People living at Bafford House had choices about how they spent their day, and while they were encouraged to spend time with others, to eat and socialise, their wish to be alone was respected. 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.

Several people had asked to go out, to the shop, library, hairdresser and bank, and these requests were met. However, wider opportunities for people to follow their interests and participate in meaningful activities were very limited, as there was no dedicated staff time for meeting people’s social and mental stimulation needs. Activities requiring little planning, such as ball games, skittles, arts and crafts and singing, were provided. Staff, relatives and professionals expressed concern about the impact this may have on people living with dementia or a learning disability.

Right Culture:

People told us they liked living at Bafford House and felt safe there, some people described staff as friends. A relative said, “It is a very loving and caring place.” The provider and deputy manager spent a lot of time in the service and were well known to people, relatives, staff and professionals. The provider worked openly and cooperatively with others and people were involved in key decisions that affected them, for example, discussions about end of life, or moving rooms.

The provider had employed a cook, cleaner and housekeeper since our last inspection and this had a positive impact on people and staff. The provider had also employed an external consultant, worked with the local authority medicines team and NHS infection prevention and control team to improve the service. They had taken initial steps to improve internal monitoring and oversight of the service, however, these systems were not yet effective in identifying and addressing shortfalls.

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 inadequate (published 2 December 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. The overall rating for the service has changed from inadequate to requires improvement, based on the findings at this inspection.

The provider has not met regulatory requirements for the last four consecutive inspections.

The service has been in Special Measures since 2 December 2022. During this inspection we found ongoing breaches of regulations. While the service is no longer rated as inadequate overall, or in any of the key questions, the service remains in Special Measures.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 November 2021 and breaches of legal requirements were found. Enforcement action was taken in relation to good governance and safe care and treatment and the provider was informed what action they must take by when to meet legal requirements. The provider also completed an action plan to show what they would do and by when to improve need for consent.

We completed an unannounced focused inspection on 30 May 2022 to check they had followed their action plan and to confirm they had met legal requirements. The provider had met legal requirements in respect of need for consent but had not fully met legal requirements in respect of good governance and safe care and treatment. We also found a new breach in relation to staffing.

We completed an unannounced focused inspection on 12 October 2022 to check the provider had followed their action plan and to confirm they had met legal requirements. The provider had not met legal requirements in respect of good governance, safe care and treatment and staffing. We also found a new breach in relation to fit and proper persons employed.

This comprehensive inspection was carried out to check for significant improvement, following action we took against the provider after the last inspection. The provider demonstrated significant improvement in some key areas, but we found evidence the provider needs to make further improvements and legal requirements remained unmet.

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.

You can see what action we have asked the provider to take at the end of this full report.

The provider took immediate action to mitigate risks to people in response to our feedback at this inspection. Please see the safe and effective sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bafford House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to good governance, safe care and treatment, staffing, fit and proper persons employed and safeguarding.

Please see the action we have told the provider to take at the end of this report.

Where we find standards of care fall below those people have a right to expect, we do not hesitate to take action to protect people. In this case we took enforcement action to ensure people living in the service were safe.

Having satisfied ourselves improvements had been made to the service, and the provider accordingly agreeing to update a monthly action plan, in relation to actions taken to address regulatory concerns raised, the decision to cancel the providers registration was no longer deemed appropriate at this time.

Follow up

The service remains in ‘special measures’. This means we will keep the service under review and we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, we will take action in line with our enforcement procedures. This will usually lead to cancellation of the provider’s registration or to varying the conditions of registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider monthly following this report being published to discuss changes they are making to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.