Background to this inspection
Updated
24 February 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by 2 inspectors, a specialist advisor who was a nurse and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Boldmere Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with 3 people who used the service and 10 relatives about their experience of the care provided. We spoke with 8 members of staff including the registered manager, area manager, senior carers and care workers.
We reviewed a range of records. This included 10 people's care records, accident and incident records, use of restraint records and multiple medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
We continued to seek clarification from the provider to validate evidence found, including information about the provider's staff training programme and safeguarding policies.
Updated
24 February 2023
About the service
Boldmere Court is a care home providing nursing, personal care and accommodation for up to 68 people. The service provides support to older people, people with dementia, people requiring mental health support, people with a physical disability and younger adults. At the time of our inspection there were 63 people using the service.
People’s experience of using this service and what we found
Risk assessments required more information on techniques for staff to support people when displaying distressed behaviour. Risk assessments did not always contain enough or up to date information.
Some people received time critical controlled medicines however they did not always receive their medication at the required prescribed time.
Records in relation to the use of restraint were not clear and transparent to show if the restraint used was the least restrictive technique for the shortest possible time in line with best practice guidance.
Best interest documentation sometimes lacked sufficient information to demonstrate restrictions had been arranged in people’s best interests.
The provider’s handover documentation did not always have sufficient information to ensure staff were up to date with people’s conditions and health needs.
Audits undertaken by the provider were not always effective at monitoring the quality of the service, some risk assessments lacked detail to clearly identify what mitigation was in place. In addition, some care plans did not contain enough detail.
One person’s bedroom was in an unsafe condition. The provider had safeguarding systems and processes in place to keep people safe. People felt safe and were supported by staff who knew how to protect them from avoidable harm.
Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for the service under the previous provider was requires improvement, (published on 03 June 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
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.
The inspection was prompted in part due to concerns received about care delivery. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well Led.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well Led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, the need for consent and governance.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how changes will be implemented. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.