Buckingham House

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

People were protected from harm. Risks were assessed and mitigated; any near misses were seen as an opportunity to put things right, learn and improve. Incidents and complaints were appropriately investigated and reported. There was a good understanding of safeguarding and how to take appropriate action. People were supported with taking their prescribed medicines in a safe way, by staff who had been trained. The home was clean and the team responded well to infection outbreaks to prevent spread.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they were involved in discussions about how to minimise risk of harm. For instance, relatives told us how staff helped to manage people’s risk of choking. Staff told us they knew how to report concerns about people’s safety. They felt able to raise concerns with the registered manager and felt they would be listened to, and action taken. Staff knew they could refer to a lessons learnt folder and told us learning from events was discussed in handover meetings. We observed there were processes in place for the staff team to report any concerns. Daily meetings were held with the registered manager or person in charge. These were opportunities to share any learning points to prevent harm to people. Following an incident, post incident review and lessons learnt forms were completed. The provider had oversight of learning. The regional manager shared learning with all registered managers who they line managed, to improve care for all.

People had access to external healthcare professionals when needed. Staff supported people with attending healthcare appointments. Relatives told us they were kept up to date with people’s referrals and appointments. Staff told us they ensured people’s care plans were reviewed prior to external health appointments to ensure an up to date information was shared and updated after, if any changes had been made. We had received a complaint about the skills and action taken by staff when a person’s health had deteriorated. We found the service had learnt from this complaint. We found improved systems were now in place to ensure people received timely support from external healthcare professionals. External healthcare professionals told us they were keen to develop better working practices with staff and were optimistic about the future.

People and their relatives told us they were safe at Buckingham House. One person told us, “It’s quite a nice area, this place is very nice and safe.” This was supported by what relatives told us, “Definitely [person] is kept safe, carers are all very good and kind, [person] feels safe, security is good with keypads in place,” and “Yes, [person] is definitely kept safe which gives me peace of mind, 2 falls a couple of months ago, I was informed immediately, ambulance called.” Staff demonstrated a good understanding of how to safeguard people from abuse. Staff told us they would not hesitate to raise concerns to the registered manager, and to external parties if needed. Staff had received training on how to protect people from abuse. We observed staff supported people in a safe way. We found staff promoted safety by carrying out regular checks on people throughout the day and night. People can only 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 2005 (MCA). We observed some people had restrictions placed on their movement. Where restrictions were in place, these were lawful. For instance, bed rails or lap belts on wheelchairs. We found people and staff had access to information about how to raise safeguarding concerns. Relatives told us “Care plan gets updated, communication is good, no sign of any form of abuse” and “Always treated with dignity and respect, no abuse ever seen.” There were systems, processes, and practices to make sure people were protected from abuse and neglect. Records showed the registered manager and provider monitored events like falls and unexplained bruising, to ensure any patterns of concern were identified.

People were supported to keep well and free from avoidable harm. Risks posed to people were assessed and mitigated. People and their relatives told us staff managed risk posed to them. Comments included, “There are plenty of staff around to manage any risks and if they need to, they intervene quickly and help me and [family member]” and “They [staff] are very good. Before [person] had a wheelchair, they demonstrated to us, how to get them up and out of a chair.” Staff and leaders reviewed risk assessments on a regular basis. Staff felt any changes in people’s needs were updated and communicated to them. Staff had access to risk assessments at all times. We observed staff supported people in a safe way. People who were at risk of pressure damage or risk of falling from bed had appropriate equipment in place. People were protected from potential harm. Individual risk assessments were in place to protect people when receiving care and support. We found care plans contained risk assessments regarding falling, pressure damage and malnutrition, as examples. Systems were in place to discuss any changes to people’s risk of harm. We found referrals to external healthcare professionals were made in a timely manner.

The building is a purpose-built care home, designed to meet the needs of older people and people living with disabilities. For example, adapted bathrooms and toilets, provision of handrails in corridors and space to manoeuvre hoists and other equipment. There was level access throughout the building to enable people to be as independent as possible. People living with dementia had access to items which provided them with stimulation. We did not observe any risks to people from the environment. Areas where there was potential risk, such as sluice rooms and cleaning cupboards, were kept locked when not in use. Window restrictors had been fitted throughout the building. The building was well-maintained. Gas appliances, the electrical system and water supply had been tested and met safety standards. Equipment to assist people with moving had been serviced and was safe to use. Staff received training in health and safety, fire safety awareness and manual handling, to assist people in a safe way. Fire safety checks and servicing of the fire system took place. An action plan had been put in place following recommendations made by the fire safety officer from the local authority. There were personal emergency evacuation plans in place, to outline the assistance people would need in the event evacuation was necessary. There were records of fire drills taking place at the home. It was not evident from these staff routinely received practice in how they would evacuate people or in use of evacuation equipment. This meant the needs of people, including those with high dependency needs or who were cared for in bed, had not been fully considered in the drills. Staff were therefore not sufficiently trained or rehearsed in what to do in the event of a fire, to keep themselves and people who use the service safe. This is an area for improvement. We raised with the provider who reassured immediate action would be taken.

People were supported by staff who had been safely recruited. This included a check for any criminal convictions, gaps in their employment history and uptake of references. Staffing rotas were maintained, to ensure there were sufficient staff to meet people’s needs. We observed people were assisted in a timely manner and call bells were answered promptly. People spoke positively about staff. Comments included “(Name), the carer, is very good, has an excellent understanding of [person]” and “Staff are all caring.” People said they felt staff were well-trained and there were enough of them on duty. For example, “Enough staff now...nurses are excellent and, on the whole, well trained,” and “Enough staff now, all permanent, makes a big difference as they all know her so well now, person-centred care, dignity and respect always.” Some people we spoke with commented on there being staff turnover in the past and changes to management, but they felt the home had improved since then. As one person said, “On an even keel now.” People were cared for by staff who were supported in their roles and given opportunities to develop their skills. They received regular supervision (one to one meetings with their line managers) to discuss how they were working. There was a comprehensive training programme to develop and update skills, to meet people’s needs. There were a range of meetings, such as handover meetings, heads of department meetings and staff meetings to share information, highlight concerns and discuss ways of working.

People benefitted from the environment that was clean, staff knew how to manage the risk and spread of infection. However, some of the areas of the home were more difficult to clean due to the deterioration of the integrity of the fixtures and fittings. People and their relatives told us they did not have any concerns about the risk of infection. However, they did comment on the need for refurbishment. We discussed this with the registered manager who advised the need for improvements in the décor had already been identified and a refurbishment plan was in place. People and relatives told us they were happy with the cleanliness of the building. Comments included, “Everywhere is kept clean and tidy, no smells, the environment meets her needs,” “Home is kept very clean” and "The cleaners are always there. The rooms are cleaned every day and deep cleans at intervals.” Staff were happy with the level of cleanliness and told us they had access to personal protective equipment. We observed the laundry was well-organised and in good order. There were designated in/out and clean/dirty areas, to prevent the risk of cross-infection. Housekeeping staff worked throughout the day to ensure people were not put at risk of infection. Staff had access to policies and procedures to ensure they kept up to date with any changes in guidance. Routine audits were carried out to assess the effectiveness of infection control and prevention systems.

People received safe support with their medicine. People and their relatives told us they were happy with the support they received with their medicines. Comments included “We always chat about it [medicines] every day, they know what they are doing” and “The nurses are very good about that. I’ involved up to a point. I have a list of medications but I’m quite happy to rely on what they give me. I think it’s quite satisfactory.” We found evidence of medicines reviews carried out by the local GP practice. People’s care plans had the necessary information to support people with their health needs and prescribed medicines. Medicines were administered in a timely manner and recorded on the medicines administration record. The staff carried out medicine reconciliation effectively. Medicines reconciliation is the process of accurately listing a person’s current medicines. Staff and managers understood the principle of medicines optimisation and said they helped people get medicine reviews. Staff said they were given induction and training and were competency assessed to handle medicines safely. Medicines were given to people in a person-centred and caring way. Some people were prescribed medicines to be taken on a ‘when required’ (PRN) basis. Guidance in the form of PRN protocols were in place to help staff give these medicines consistently. Medicines were stored securely and safely. Staff recorded the date of opening for liquid medicines. The medicines administration recording system was fit for purpose and stocks of prescribed medicines were managed appropriately. There was a medicine policy in place and staff were aware of how to use it. The staff carried out regular medicine audits and they identified concerns related to medicines management and the actions that were taken to improve practice.