We carried out a review of the data available to us about Bakewell Cottage Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bakewell Cottage Nursing Home, you can give feedback on this service.
Bakewell Cottage Nursing home is a care home providing accommodation in one adapted building, for up to 38 people who require nursing or personal care. This may include adults with a physical disability, dementia, a sensory impairment, learning disability or an autistic person. At this inspection, there were 35 people receiving care at the service, including 32 receiving nursing care.
At the time of the inspection, the service did not care or support for anyone with a learning disability or an autistic person. However, we took account of the care provision under Right Support, Right Care, Right Culture, against the areas we inspected, as it is registered as a service for this population group.
People’s experience of using this service and what we found
Overall, ongoing and sustained service improvement was demonstrated. However, the registered provider’s accountability and oversight arrangements were not wholly effective, to consistently ensure timely action and improvement following their management assurance checks for the quality and safety of people’s care.
People were protected from the risk of harm or abuse at the service. Risk management strategies for people’s care and emergency contingency planning, were effectively informed and understood by staff. Action was assured to fully ensure the safe storage of equipment used for people’s care at the service
People’s medicines were safely managed to ensure people received them when they should. People and relatives were confident people received safe care from staff at the service.
We were assured the provider was meeting with requirements and nationally recognised government guidance, concerned with the prevention and control of infection, including COVID-19.
Staff were safely recruited, deployed, and they understood and were highly motivated to carry out their role and responsibilities for people’s care.
Right Support: 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.
Right Care: Care was person centred and promoted people’s dignity, privacy and human rights.
Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff, helped to ensure people could lead confident, inclusive and empowered lives.
There was a registered manager for the service who understood and followed the requirements of their role. Overall, staff were effectively managed, informed and supported to perform their role and responsibilities for people’s care.
People, relatives and staff were confident in the culture, ethos and day to day management of the service. All were regularly consulted to help inform and improve people’s care when needed.
Effective partnership working was established with relevant external professionals, agencies and authorities, to help inform and agree people’s care in their best interests.
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 requires improvement. (Published 22 February 2020).
Why we inspected
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.
We undertook a focused inspection to review the key questions of Safe and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to good, based on the findings of this inspection. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bakewell Cottage Nursing 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.
Bakewell Cottage Nursing Home is a care home located close to the centre of Bakewell. There are 36 single occupancy bedrooms. At the time of the inspection there were 35 people living there.
People’s experience of using this service and what we found
Governance systems had improved since the last inspection. However, some improvements were still in the process of being implemented and required more time to fully embed. The registered manager had developed a positive culture that was person-centred.
The provider could not demonstrate they had always adhered to safe recruitment practices. We recommended that the provider review the way documents relating to recruitment were stored to show they were adhering to Schedule 3 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3).
Improvements in medicine management had been made since the last inspection. However, further improvement was required as the provider had not ensured some guidance was readily available to staff.
People had access to snacks and drinks throughout the day and night, however, some people felt the choice of food was limited. 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 received appropriate training to carry out their role effectively.
The registered manager ensured people were treated with kindness and compassion. This was reflected in all the feedback we received. People were supported by staff wo respected and promoted their privacy, dignity and independence.
People were supported to take part in activities that were varied and designed with their personal preferences in mind. People were supported to develop and maintain relationships with people that were important to them. Visitors and relatives told us they were always welcomed.
Rating at last inspection (and update)
The last rating for this service was Requires Improvement (published July 2019) and there were breaches in Regulations. This report is the third consecutive Requires Improvement rating for this service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Although improvements have been made in all areas of the service and all regulatory breaches have been met, we have found evidence that the provider needs to continue to make further improvements. Please see the Safe and Well-led sections of this report for details.
Why we inspected
This was a planned inspection based on the previous rating.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The registered manager had been in post since September 2018. They were in the process of implementing improvements across the service.
People’s experience of using this service: Systems and processes were not in place to keep people safe. People told us they felt safe and well supported, but we found areas where risk assessments and safety monitoring were not sufficient.
Incidents that required safeguarding or referring to healthcare professionals weren’t always completed in a timely manner.
Overall medicines were well managed, however we found one person who did not have the required documentation to support their medicine management.
People in communal areas were supported by enough staff to meet their needs and provide companionship. However, people who spent time in their rooms were sometimes seen to be isolated and lacking support.
There were examples of poor infection prevention and control procedures, although all the required personal protective equipment was available to staff.
The approach to learning lessons when things have gone wrong required improvement. The registered manager had implemented some improvements since the last inspection, though further improvements were required.
People in the communal dining room enjoyed the food provided. However, people who ate in their rooms were at times served food that had been left uncovered whilst staff assisted other people.
Some people had gained and maintained weight, others had lost weight, and this was not always appropriately monitored or managed.
We saw times where people’s dignity was compromised. The registered manager had identified that more could be done and had plans to continue to improve the way they promoted independence for people.
There were dedicated activities co-ordinators who planned and offered a varied activities schedule. However, there were people who did not spend time in the communal areas who were isolated and were not provided with meaningful activities.
The registered manager had not submitted some statutory notifications that they are legally required to send to CQC.
Staff meetings were regularly held but staff supervision was inconsistent with many staff not having received regular supervisions.
The registered manager had implemented improvements in the way the service assessed and documented people’s ability to make choices. Where people couldn’t make choices for themselves, best interest decisions were comprehensively made and documented. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were happy with their care and liked the staff that cared for them. Staff treated people with kindness and had formed close relationships with people.
Rating at last inspection: The service was rated Requires Improvement at their last inspection. (published June 2018).
Why we inspected: This was a planned inspection based on the previous rating.
Enforcement: 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.
Follow up: We will continue to review information we receive about this service until the next scheduled inspection. If we receive any information of concern, we may inspect sooner than scheduled.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The home is registered to provide care for 38 people, at the time of our inspection there were 36 people living there. People were accommodated in single rooms across three floors within the building. There were two lifts within the building.
There was a registered manager in post at the time of our inspection. 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.
The inspection visit took place on 18 and 23 April 2018; the first day was unannounced. The timing of the second visit was agreed with the registered manager in advance. The service was last inspected in 2016, when it was rated good. At this inspection the service was rated overall as Requires Improvement; however it was rated good in caring and responsive as an acknowledgement of the caring nature of the staff. This is the first time the service has been rated Requires Improvement.
We identified three breaches of regulation at this inspection. You can see what action we told the provider to take at the back of the full version of this report.
The service was not always safe. Risk assessments were not always in place or were not always followed consistently. Information regarding known risks to people was not always shared with relevant people or agencies and we found a safeguarding referral had not been made when required. Some people were at risk of receiving ineffective medicines or not receiving ‘as required’ medicine to treat occasional symptoms, due to poor management of medicines.
Staff were skilled and knowledgeable about people’s care needs. People generally received effective care that met their individual needs. People received a varied and nutritionally balanced diet and independent eating was supported wherever possible. People had access to specialist and local healthcare services to support them to live healthier lives. Specialist aids were available to promote peoples independence and safe mobility. However, the registered manager did not always follow the principles of the Mental Capacity Act and could not always assure us that restrictive care was provided in people’s best interest or the least restrictive option.
People and their relatives were overwhelmingly positive about the kindness and compassion of the staff. Relatives said their loved ones were well cared for and staff treated them with respect and dignity. Choice and independence were promoted and people were involved in making decisions about their daily activities and their care.
Staff were responsive and had a good understanding of people’s needs, preferences and interests. We saw people engaged in activities of their choosing and spending time with their visitors in the privacy of their room or in the communal areas and garden. There was a complaints policy in place and relatives told us they would not hesitate to use it. There had only been two complaints recorded in the last 12 months. Staff supported people and their families with dignity and sensitivity at the end of their life and assured us their wishes and preferences were considered.
The registered manager was respected by people, relatives, health professionals and staff. People described the registered manager as firm but fair and always having the interests of people at the centre of what they did. There was a clear vision and focus on dignity, independence and personalised care and this was supported by the staff team. There were strong productive links with local services and agencies which led to joined-up care of people, as well as positive links with local community services and facilities, which led to a varied activity programme.
However, the governance and quality assurance systems in place were not robust or used effectively to analyse information and improve the service. This made it difficult to evidence achievements and positive outcomes or identify areas for development. Audits and policies were not robust, staff engagement and supervision was not consistent and provided little evidence of progression or development needs. It was not clear how the views of others influenced service development. Information was not always shared with relevant agencies in order to keep people safe and notifications were not always sent to CQC as required under the terms of registration.
There was a registered manager at this service. 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.
During our inspection we observed that the home had a calm atmosphere and staff were friendly and approachable. We observed staff delivering care which met people’s individual needs and supported them in a respectful and appropriate way.
People were involved in choices about their care. Staff were supportive and compassionate and took time to communicate with people in a friendly and reassuring manner. Staff had a good understanding of people’s needs and people’s privacy was respected.
People received care and support from staff who were appropriately trained and confident to meet their individual needs. Staff had access to additional training specific to the needs of people using the service. People were encouraged to access and maintain links with external health and community services, making effective use of the good relationships the registered manager had developed in the local community and with visiting healthcare professionals.
People, relatives, staff and visiting professionals spoke very highly of the registered manager and felt the service was well-led.
People were supported to maintain relationships with family and friends. Visitors were welcomed at any time and offered refreshments or meals if visiting over a meal time. Records we looked at were personalised and included decisions people had made about their care including their likes, dislikes and personal preferences. There was a varied activity programme for people based on individual and group preferences. Activities included one-to-one time on outings or in pursuit of personal hobbies or interests; as well as group activities which enabled people to meet up and were a social occasion.
Staff were aware of their roles and responsibilities for people’s care. People said that staff were approachable and felt there was an open and honest culture within the home, which encouraged people to raise any issues or concerns they might have.