Archived: Bishops Waltham House Care Home

Bishops Waltham House Care Home is a residential service providing care and accommodation for up to 32 older people including those living with dementia. There were 27 people using the service at the time of this inspection.

People’s experience of the service and what we found:

The future of Bishops Waltham House Care Home was being considered, by the provider organisation Hampshire County Council, as part of a wider consultation about how to meet the counties long term care and nursing needs. People and staff were all very positive about their experiences of living, and working, in the home and this was an unsettling time for everyone. Staff were being well supported during this period of time, and people continued to receive compassionate and person-centred care.

People told us they felt the home was safe. Staff had received safeguarding training and safeguarding concerns had been responded to appropriately.

The risks people faced were assessed and actions identified to reduce those risks in the least restrictive way.

People were supported by staff who had been recruited safely and received appropriate training, to enable them to meet people’s individual needs. There were enough staff to meet people’s needs.

Systems were in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments.

People lived in a clean home, where staff understood how to reduce the risk 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. Staff supported people to maintain their skills and independence.

People were encouraged to provide feedback about the service they received, both informally and formally. People told us they were listened to.

People, staff and visiting professionals spoke positively about the management of the home. Staff understood their roles and responsibilities and felt supported by the management to raise any issues or concerns.

The quality of people’s experience was monitored, and action taken, when needed, to promote their safety and well-being.

Auditing and monitoring had identified the need to improve recording and actions were being taken to progress this.

There was an inclusive and person centred culture evident in the home. People commented on the control they retained over their lives.

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 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The inspection was unannounced and was carried out on 21 and 23 June 2017.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their visitors told us they felt the home was safe. Managers and staff had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The risks relating to people’s health and welfare were assessed and these were recorded and actions identified to reduce those risks in the least restrictive way. The assessments were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs. There were enough staff to respond to and meet people’s needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.

Staff developed caring and positive relationships with people, were sensitive to their individual choices and treated them with dignity and respect. The managers and staff were skilled at supporting people at the end of their life and worked hard to ensure both the person and their relatives were looked after well at a difficult time.

The managers and staff understood the importance of involving people and their relatives in their care and providing support that was personalised to their individual needs. People were supported to maintain relationships and links with the community that were important to them.

The service was responsive to people’s needs and staff listened to what people said. Staff were prompt in raising issues about people’s health and people were referred to health professionals when needed. People were confident they could raise concerns or complaints and that these would be dealt with.

People were encouraged to provide feedback about the service they received, both informally and through meetings and a survey questionnaire.

People, their visitors and external professionals spoke positively about how the service was managed. Staff understood their roles and responsibilities and felt supported by the management to raise any issues or concerns. The quality of the care and treatment people experienced was monitored and action taken to promote their safety and welfare, as well as that of visitors and staff. Accidents and incidents were monitored and remedial actions taken to reduce the risk of reoccurrence.

The service provides accommodation and support for up to 36 older people including people with dementia. At the time of our inspection 30 people used the service.

The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service is required by a condition of its registration to have a registered manager.

The registered manager had taken on management responsibility for two services in the past six months and the deputy managers had taken over the day to day running of Bishops Waltham House Care Home. The registered manager would solely manage the service again from 1 April 2016.

Governance systems were in place to monitor the quality of the service and identify the risks to the health and safety of people. However, the audits completed by the provider and staff had not always been effective in identifying issues of concern. Where these systems had been effective in identifying shortfalls, action had not always been taken to improve the quality of care and ensure the safety of people.

People can be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA) 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). During this inspection we found where people lacked the capacity to agree to the restrictions placed on them to keep them safe, the provider made sure people would have the protection of a legal authorisation and had made the appropriate DoLS applications to the local authority. However, records did not show restrictions were only placed on people as a last resort, after less restrictive approaches had been considered. We have made a recommendation to support the provider to ensure the management team and staff would fully implement the provider’s policy in relation to the MCA 2005 and DoLS.

The registered manager had not consistently followed the requirements of their registration to notify CQC of specific incidents relating to the service. We had not been notified of the outcomes of the service’s applications to deprive people of their liberty so that we could monitor whether the service met the DoLS requirements.

The provider had a staff recruitment process in place to identify applicants who were suitable to work with people. However, the registered manager had not always followed this process through to completion to ensure a full employment history would be readily available for all staff. We have made a recommendation to support the provider to improve the availability of staff recruitment information.

During our visit people using the service told us they felt safe. Staff were able to demonstrate their understanding of the risks to people’s health and welfare and people told us that they received care that met their needs. However, we found that care plans did not always reflect individual risks to people and offer guidance and support to staff on how these should be managed. Staff we spoke with were confident of how to manage risks to people on a daily basis. New staff or agency staff may not have all the information they needed to know how to keep a person safe and meet all of their needs, wishes and preferences if reliant solely on the care plans for this information.

People were protected from unsafe administration of their medicines because staff followed the provider’s medicines policy. Staff had received a programme of training to support them to effectively meet people’s needs. Staff told us that they felt supported in their roles by their managers and had received regular supervision. The service had introduced a new electronic supervision system and was developing a way of effectively monitoring when supervision was due, to ensure action could be taken if supervisions had not been completed on time.

Staff told us senior staff provided clear and direct leadership. We found, from staff records and from speaking with them, they understood their roles and responsibilities and there was a clear structure of accountability.

There were enough staff to keep people safe and support people to do the things they liked. The service had identified that people’s needs were becoming increasingly complex and was working with the provider to continuously review staffing levels.

The service promoted a culture which focused on providing individual person centred care. Staff were quick to respond to changes in care needs, however these changes were not always updated in the person’s care records so that staff would know from people's records how their needs had changed. Staff were encouraged to raise concerns and were confident in doing so. The registered manager was keen to ensure that people were involved in the care provided at the home and had systems in place for receiving feedback from people and their relatives which they used to make improvements.

People were encouraged to participate in the lunchtime meal in the dining room or they could choose to eat in their rooms if they preferred. Staff had a good knowledge of people’s nutritional needs and people were supported to eat and drink enough to maintain a balanced diet.

People were well supported to maintain good health and have access to healthcare services. Staff and the manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met. The service had a good relationship with the district nursing team.

Staff demonstrated that they knew and understood people’s wishes and preferences. People told us they were happy with the care provided. We observed interactions between staff and people which were warm and caring and people’s independence was promoted in accordance with their wishes. Staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times and were able to describe how they ensured this. People were encouraged and supported by staff to make daily choices about how they would like to have things done.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We saw that systems were in place to gain and review consent from people who used the service, and to act on their wishes. A person who used the service said 'the staff always ask if they can do my care and are very co-operative'. Care and support was planned and delivered in a way that was intended to ensure people's safety and welfare. One person told us 'I love it very much here, I am happy and safe. The staff look after me really well'. Another person said a senior member of staff 'saw me the other day for my yearly review. We chat about my care and if I am happy here'.

We saw that appropriate arrangements were in place to protect people against the risks associated with medicines. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. A person who used the service told us 'the staff are well trained. We get involved by sitting on the interview panels and we say whether we think they will fit in with us or not, we enjoy that'. We saw that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Four of the people we spoke with confirmed that their care and welfare needs were being met and made positive comments about the service. For example, one person said the staff 'look after me very well. I would recommend this place to anyone'. They said that staff responded appropriately to their needs and 'always get things sorted', for example if they needed a doctor. However, other evidence did not support this. The service was not able to demonstrate that care and treatment was always planned and delivered in such a way that met people's needs and ensured their safety and welfare. Audits and reviews were carried out but did not always show what action had been taken as a result of the findings.

The majority of the people we spoke with said that they felt safe using this service and were confident that the provider would deal appropriately with any issues. One person said the staff were 'a good crew. I never hear them complaining. If they can't do something for you they'll ask someone else'.