Archived: Bispham Gardens

Updated 19 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Prior to the inspection taking place, information from a variety of sources was gathered and analysed. This included speaking with the commissioning groups responsible for commissioning care, health professionals and Healthwatch. Healthwatch is a national independent champion for people who use healthcare services. We used the information provided to inform our inspection plan.

We reviewed information held upon our database about the service. This included notifications submitted by the registered provider relating to incidents, accidents, health and safety and safeguarding concerns which affect the health and wellbeing of people.

We looked at information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We used this information to help us plan our inspection visit.

This comprehensive inspection took place on 03 and 06 September 2018. The first day of the inspection was unannounced. The inspection was carried out by one adult social care inspector, a specialist advisor who was a nurse and an expert-by-experience. The expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience had a background supporting older people.

Throughout the inspection process we gathered information from a number of sources. We spoke with four people who lived at the home and eight relatives of people who lived at the home to seek their views on how the service was managed. We also spoke with the registered manager, deputy manager and three members of the senior management team. We spoke with five members of staff responsible for providing direct care, one chef, the kitchen assistant and the head of maintenance. We activated the call bell three times during our visit to assess staff availability and response times.

As part of the inspection process 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.

To gather information, we looked at a variety of records. This included care plan files related to nine people who lived at the home. We observed the administration of medicines and looked at administration and recording forms related to the administration of medicines and topical creams. We also looked at other information which was related to the service. This included health and safety certification, training records, team meeting minutes, policies and procedures, accidents and incidents records and maintenance procedures.

We viewed recruitment files relating to five staff members and other documentation which was relevant to recruitment including Disclosure and Barring Service (DBS) information. We looked around the home in both communal and private areas to assess the environment and check the suitability of the premises.

Updated 19 September 2018

This inspection visit took place on 03 and 06 September 2018 and was unannounced on the first day.

Bispham gardens is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Bispham Gardens Nursing Home is registered to provide accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 28 people. Accommodation is on the ground floor. There are several communal areas including a quiet lounge, conservatory and dining area. At the time of our inspection visit there were 23 people who lived at the home.

There was a registered manager in place. 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.

At the last inspection in December 2017, we found four breaches of regulation. We found breaches in the regulations related to Safe care and treatment, good governance, safeguarding and person-centred care. We issued requirement notices for these breaches in regulation. In addition to the requirement notices we made recommendations related to dignity, consent, decision making, staff deployment, management of complaints and supervision

Following the inspection in December 2017 we asked the registered provider to act to make improvements in the areas we had noted. The registered provider was required to send the CQC an action plan, outlining how they intended to make improvements. We used this inspection process carried out in September 2018 to check the action plan had been followed and improvements made.

At this inspection, we looked at the storage, administration and documentation around medicines and found these followed best practice guidance. However, we noted best practice was not consistently followed around medicine administration. The registered manager told us this would be addressed using supervision and retraining.

The service had systems to record safeguarding concerns, accidents and incidents and acted as required to make improvements and minimise future risks. The service monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents to the Care Quality Commission when required.

The registered manager had robust systems to ensure people’s care, treatment and support was delivered in accordance with best practice guidance and current legislation. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

Care plans held information that guided staff on people’s likes dislikes and health conditions. People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care.

Staff deployment was organised with staff being allocated daily tasks. However, there was mixed feedback on staffing levels.

We observed positive interactions between staff and people at Bispham Gardens. Staff used humour and appropriate touch and treated people with respect and patience.

Staff we spoke with told us they felt supported by the management team and were encouraged with their personal development.

Staff we spoke with confirmed they did not commence in post until the registered manager completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles.

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us any concerns raised had been addressed by the registered manager.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff meetings and daily discussions with people who lived at the home to seek their views about the service provided. People told us the management team were approachable and the registered manager took regular walks around the home to assess the environment.

We looked around the building and it was clean and safe place for people to live. We found equipment and the environment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required.

Staff delivered end of life support that promoted people’s preferred priorities of care.

We observed interactions over lunch time and noted people had their meal in the dining room or in their bedroom. We received mixed feedback on the food available.

People told us there were a range of activities provided to take part in if they wished to do so. There was a comprehensive daily and weekly activities schedule at the home. We observed activities taking place and saw these were enjoyed by people who participated.