The inspection took place on the 5, 6 and 12 November 2014. The inspection was unannounced. This is the first inspection of the service since being registered with the Care Quality Commission (CQC).
The Royal Buckinghamshire Hospital is registered as a care home with nursing to provide care for up to 14 people. The aim of the service is to rehabilitate people and promote their independence. As a result the provider employs a team of nursing and care staff, physiotherapists, occupational therapists and a resident medical officer (RMO)
At the time of our inspection there were seven people living in the home. There was 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.
Although people told us they felt safe we found The Royal Buckinghamshire Hospital was not providing safe care and people’s safety was compromised in a number of areas. Risk assessments were in place but did not provide clear guidance for staff to minimise risks to people. As a result we saw risks in relation to moving and handling and pressure sores were not properly addressed and managed.
We found aspects of safety of the building was compromised. This was because risk assessments were not in place in relation to fire safety practices and security of the building. Doors that should be locked were left open, fire doors were propped open, smoke detectors were covered, a radiator was loose and another radiator was uncovered. Contingency plans were not in place either to provide guidance on the actions to take in the event of an emergency.
The records in relation to safe recruitment practices were not up to date. This was because staff files did not include evidence that the required recruitment checks had taken place.
We found safe systems were not in place in relation to infection control. This was because appropriate measures were not taken to manage and reduce the potential risks of cross infection. Staff did not know who had responsibility for infection control in the home. Cleaning schedules were not detailed either to ensure staff were clear of their responsibilities in relation to cleaning and infection control prevention.
In the records viewed we saw medicines was given as prescribed however a medication administration policy was not in place to provide guidance for staff on all aspects of medicines administration to ensure medicines was safely administered.
Staff were not inducted into their roles and some staff were unclear of their roles. They did not have the required training and no assessment procedures were in place to ensure they had the appropriate skills and competencies to carry out specific tasks. Senior staff were facilitating training but they had not been trained to deliver the training. Staff felt supported and nurses and carers received one to one supervisions however, senior staff were not formally supervised.
People’s care plans did not provide clear guidance for staff on how people’s care needs were to be met. As a result some people were at risk of receiving inconsistent and unsafe care.
Quality monitoring systems were in place and the provider had identified some of the issues we found but had not yet acted on them. We found however some audits had not picked up the shortfalls we identified and therefore the monitoring and auditing processes were ineffective. We have made a recommendation in regards to the management of the service.
Accurate records were not always maintained in respect of each person who used the service and records in respect of staff were not accessible and available either.
People told us they thought the service was well managed. Staff told us the senior member of the team was available, approachable and supportive to them but the registered manager was less accessible and did not have a presence in the home to monitor and ensure it was well led.
People told us they were happy with their care and commented “the care is fantastic and the rehabilitation therapy is exceptional”. We found staff were caring and supportive of people.
People’s health needs were identified. People had access to a range of health professionals on site as well as being able to access other health specialist if required. We found people’s religious and cultural needs were met and a translator was available on site to ensure they could communicate with people who’s first language was not English.
People were not sure of the formal process for making a compliant but they said they would feel able to talk to staff. The service has a complaints procedure in place and complaints were logged.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which from the 1 April 2015 is 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 this report.