Bedford Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Overall, people received safe care from staff who were well trained and received supervision and support in line with the provider’s policy. Feedback from people, relatives and staff regarding staffing levels was mixed. We found the current system being used for determining how many staff should be deployed to meet needs, was not wholly effective and needed to consider this more holistically. The discharge to assess process was not being carried out as effectively as it could be. However, the provider was already aware and taking steps to address this. Risks to people were assessed, with plans in place for how these would be mitigated. Accidents, incidents and complaints were logged and reviewed consistently, with actions documented and learning considered and shared with the wider staff team. The provider had safe systems for appropriate and safe handling of medicines. Where shortfalls were identified during the assessment, staff acted responsively, making the necessary improvements.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's care and wellbeing was promoted through processes in place to log, manage and learn from complaints, accidents and incidents. For example, reviews of accident data had identified some people’s falls were occurring at break times. It was discovered staff were taking breaks together, which reduced the number of staff on the floor. This practice had been stopped with breaks taken individually, to ensure more cover on the units. It had also been identified there was an increase in falls in the evening, when the night shift were on duty. Day staff were tasked with supporting people to get settled prior to night staff starting shift. Both of these changes had helped in reducing incidents.

The manager explained how the complaint, incident and accident process was completed. In all instances either staff or management would log the information on the provider’s electronic system. The manager was then responsible for reviewing this and assigning a risk score. The level of identified risk determined what actions and/or tasks were automatically generated by the system, which were then assigned to staff members for completion.

Complaints, accidents and incidents were all logged and managed on the provider’s dedicated electronic system. We reviewed examples of how both complaints and accidents had been dealt with. In regard to complaints, once entered onto the system, an acknowledgement letter was sent out within 3 days and an investigation commenced. Action plans were then generated before an outcome letter was provided to the complainant. Due to how the system was designed, the manager was unable to progress to the next stage in the process until each action had been completed. The provider had ongoing oversight of this system, to ensure the process was being completed correctly. We noted for a recent complaint about a medication error caused by an agency worker, the provider had shared their electronic medicines record training programme with the agency. All of the agency staff who worked at Bedford were required to complete this, to minimise the risk of this error occurring in the future. When falls had occurred, we noted the manager reviewed the person’s falls history and checked if a referral to the local falls team had been completed previously, if not one was made. Post falls monitoring was completed for up to 72 hours, to ensure the person did not develop any complications. We noted accidents, incidents and falls along with actions taken and lessons learned were discussed at daily huddle meetings and monthly clinical governance meetings, which were attended by heads of department. Unit coordinators were responsible for collating this information prior to meetings.

The home included a number of discharge to assess beds. These beds are used for people who are considered ready to leave hospital but not well enough to return to their previous place of residence. In these circumstances they are discharged through the Discharge to Assess (D2A) pathway into a care or nursing home to receive additional support and further assessment. We found the D2A process was not being carried out as effectively as it could. This was due to issues with both the home and the Integrated Care Board who commissioned the placements. At the time of our assessment there was not a clear, documented standard operating procedure (SOP) in place, which clearly explained roles, responsibilities, admission and exclusion criteria. The current contract was for the provision of 15 D2A beds, however, Bedford Care Home were actually providing 30 beds across 5 of the 6 units. The provider had been trying to arrange a meeting to discuss this, but at the time of assessment had not yet been successful.

From information received prior to the assessment and from speaking with staff who helped support the D2A process, it was apparent communication and messaging needed to be clearer, so people and relatives better understood the D2A process and what this entailed. This messaging needed to be provided whilst people were still in hospital. A staff member told us, “Families are not always happy as its being sold as rehab and then they find it’s a nursing home and not what they expected.” The D2A process was facilitated by care home staff and NHS therapy staff, such as physiotherapists and occupational therapists. We spoke with both, to ask them about their experiences. Therapy staff reported issues with the care home staff’s understanding of the D2A process, communication, staff being rushed, therapy not being supported, and therapists having to spend time completing care tasks, such as toileting, as staff were not available to do this. Whereas care home staff stated therapy input on their unit was limited, with therapists only coming onto the unit for short periods of time. Staff also raised concerns about the admission process, and people arriving without necessary things such as medicines, dressings, equipment, which they stated was the fault of the hospital.

Professionals who commissioned the Discharge to Assess (D2A) beds confirmed they were working with the provider to ensure the process was as effective as possible for people. Twice weekly multi-disciplinary meetings were held to review placements and the D2A process overall.

Following the assessment visit, the provider confirmed a standard operating procedure had been drafted and was awaiting sign off. They had also held a meeting to discuss the D2A contract prior to this being renewed. Meetings between the care home manager and therapy staff had been completed to address the concerns raised and ensure better channels of communication were maintained.

Overall, people told us they felt safe living at Bedford Care Home. Relatives also told us their loved one’s received safe care. Comments included, “I come 2 to 3 times a week and [relative] is looked after and they care for them”, “I am definitely safe and well looked after” and “I feel safe in the home.” Safeguarding concerns were managed effectively. Referrals had been made in line with local authority guidance. Records showed each concern had been investigated and actions taken to promote people’s safety moving forwards.

We identified some potentially unsafe practice linked to mealtimes. Specifically, a couple of people were not supported to sit up properly in bed, before commencing eating their lunch. We spoke with staff at the time who ensured this was addressed. We also shared this with management, who agreed to discuss with the wider staff team during daily huddle meetings.

Deprivation of Liberty Safeguards (DoLS) had been applied for as and when required. A tracker was used to monitor applications, document when these had been granted and expiry dates. Any conditions linked to DoLS were contained in people’s care records. The quality and comprehensiveness of best interest decision making and record keeping, where people lacked capacity to make their own decisions, varied across the care plans we reviewed. We noted some good examples, which detailed who had been involved in the decision making progress, the decision made and why it was in their best interest. Other examples were much less detailed. This had already been identified by the provider, with actions in place to make improvements.

People’s care records contained a range of risk assessments. People we spoke with could not recall being involved in this process. However, relatives told us they had discussed needs and risks with staff. Comments included, “We have had discussions with staff about what [relative] is and isn’t capable of” and “Yes, I did risk assessments with the home.”

Where people were at risk of, or were experiencing a number of falls, analysis was completed to identify patterns and trends to try and reduce risks. We noted good evidence of actions taken on one unit in response to an increase in falls. It was identified these were occurring in the early morning or at night. The provider reviewed the staff skill mix, facilitated some staff moves to improve this and also reassessed a number of people and identified their needs would be better met on one of the nursing units. These actions had resulted in a reduction in falls, both on the unit and for these people.

Each person’s electronic care records contained a summary page on which key risks were documented. The type and number of risk assessments completed, was dependent on people’s needs and where risks or issues had been identified. For example, where people had issues with mobilising, they had mobility and manual handling risk assessments. People who were at risk of choking when eating, had risk assessments in place specific to this issue. A number of standardised assessments were completed to monitor people’s health and wellbeing. This included nutritional risk assessments and ones concerned with people’s skin integrity and risk of developing pressure sores.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives provided mixed feedback about staffing levels. Comments included, “It depends on the number of residents, so sometimes it is ok but sometimes they need more”, “At the moment no, they need more carers, as they tend to work too hard. When we need them they can be too busy”, and “ I think there is enough staff , they are there when I need them.”

Staff also had mixed views. We were told staffing numbers fluctuated which impacted on how much time was available to provide care and meet people’s needs. One stated, “We don’t normally have 5 carers on here. I think that will make a difference today. Yesterday we were really behind, and people were got up late so breakfasts were late and soon after people had their lunch. We do operate around tasks most of the time.”

Our observations during the assessment supported the view that care was very much task orientated, with staff having limited time to provide a more person centred approach. Staff were constantly on the go, moving from one task to the next. This meant people did not always receive the level of input necessary. For example, we observed one person who was reluctant to sit and eat lunch. Staff walked the person to the dining table asked them to sit down and eat lunch, as soon as the staff member walked off, the person stood up and wandered away. This process happened several times, until a member of the management team arrived and sat with the person, providing ongoing encouragement which resulted in them eating their food.

Staff were also tasked with completing additional tasks which took them away from care delivery. This included retrieving the food trolleys from the main kitchen prior to meal times and washing up after people had eaten. We noted from minutes, relatives had raised this as an issue during meetings. The provider used a dependency tool, to determine how many staff were needed. Our observations indicated a more holistic approach was required to ensure enough staff were deployed to meet people’s needs consistently and effectively. Staff received enough training and ongoing support to carry out their roles. A recent recruit told us they had completed a full induction, completed a number of e-learning modules which included competency based questions and shadowed for a couple of weeks, before commencing the role. Training compliance was monitored using an electronic system. There were 11 sessions the provider considered mandatory, these included training in safeguarding, manual handling, health and safety, Mental Capacity and Deprivation of Liberty Safeguards. The average completion rate across all training sessions was 93%. Staff received 4 supervision sessions per year and an annual appraisal. Meetings were monitored via a tracker. This showed the majority of staff had completed meetings in March and June 2024.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Managers told us that staff had completed medicines training and had been assessed to ensure that they gave medicines safely. We were shown evidence of training records to confirm this. Managers told us medicines audits were completed at regular intervals to identify issues and drive improvement. Following the assessment, the service was addressing the shortfalls we had identified and evidence of the improvements that had been made was provided. Medicines incidents were recorded, analysed and learnt from.

Care plans had up to date information about how to support people with their medicines. Records showed medicines were given at the correct times and appropriate intervals were left between doses. People who had thickening powder added to drinks because of swallowing difficulties were administered this safely and records were completed accurately. Information to support staff to safely give ‘when required’ medicines was in place and was person centred. We found when people were given medicine to help with anxiety, the reason for this was clearly documented and there was no evidence of over medication. Robust processes for applying and recording creams were not always in place. However, the service implemented a new recording process immediately post-assessment. Creams stored in people’s rooms were not always risk assessed to prevent inappropriate access.