We inspected Badby Park on 29 November 2018. The inspection was unannounced. Badby Park 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. The home can accommodate up to 68 people. The service supports people with Acquired Brain Injury and degenerative neurological conditions such as dementia. The service also provides high dependency support for complex care and rehabilitation.

On the day of our inspection 65 people were living in the home.

At our last inspection on 11 April 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks in relation to people’s daily life had been identified and planned for. There were enough staff, who were safely recruited to ensure people received care when they needed it. People received their medicines as prescribed from staff who were trained to manage medicines in a safe way. There were systems in place to minimise the risk of infections.

People continued to receive an effective service. Staff were trained and supported to understand and provide care that met people’s individual needs. People were supported with their health and nutritional needs and had access to appropriate healthcare services when required. The policies and practices within the home supported people to exercise choice and control in their lives and care was provided in the least restrictive way.

People continued to receive care that promoted their dignity and privacy and respected their individuality. Staff understood what was important to people and provided care in a kind and supportive manner.

People continued to receive a responsive service. Their needs were assessed and planned for and regularly reviewed to ensure they continued to receive the care they required. Staff knew and understood people’s needs well and people and their relatives were consulted about the care they received.

There was a complaints procedure in place and action had been taken to address any complaints that had been raised.

The service strived to remain up to date with legislation and best practice and worked with outside agencies to continuously look at ways to improve people's experiences.

The home was well led and the manager encouraged an open and inclusive culture where people could speak out about their views and any concerns they had. Systems were in place to regularly check the quality of the services provided and the provider and registered manager took timely action to address any identified issues.

This inspection took place on the 11 April 2016 and was unannounced. The service is registered to provide accommodation for people who require nursing and personal care for up to 68 people. The service caters for people with Acquired Brain Injury and degenerative neurological conditions such dementia. The service also provides a high dependency for complex care and rehabilitation services. At the time of our inspection there were 61 people living there.

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.

At the last inspection in January 2015, we asked the provider to take action to make improvements to ensure that people’s human rights were protected; people experienced restrictions in their movement and people who lacked capacity to make decision for themselves had not had the required assessments completed nor had there been any best interests decisions or authorisations sought for the restrictions in place. We asked the provider to send us an action plan setting out the action they would take to protect people’s rights and strengthen systems to support the Mental Capacity Act 2005 (MCA), and associated Deprivation of Liberty Safeguards (DoLS) within an appropriate time frame and this action has been completed.

At the last inspection in January 2015 we asked the provider to take action to make improvements to the way that medicines were managed because people had not received their prescribed medication and because staff had not ensured that prescriptions had been dispensed in a timely way. We also asked the provider to send us an action plan setting out the action they would take to improve the way that medicines were managed and ensure that people received their medicines as they were prescribed and this action has been completed.

At the last inspection in January 2015 we asked the provider to take action to make improvements to the management of records because there were numerous examples where people’s records were not maintained in good order or fit for purpose. We asked the provider to send us an action plan setting out the action that they would take to improve the standard of record keeping in the home and this action has been completed.

Systems were in place to ensure people were protected from harm; staff had received training and were aware of their responsibilities in raising any concerns about people’s welfare. The provider had robust recruitment systems in place; which included appropriate checks on the suitability of new staff to work in the home. Staff received a thorough induction and training to ensure they had the skills to fulfil their roles and responsibilities. Staff training was regularly refreshed to ensure staff were following current guidance and good practice. There were enough suitably skilled staff deployed to meet people’s needs.

People’s care was planned to ensure they received the individual support that they required to maintain their health, safety, nutrition, mobility and to maximise their independence. People received support that maintained their privacy and dignity and whenever possible had opportunities to be involved in making decisions about their care and their participation in the organised activities that were taking place in the home.

People were assessed prior to admission to ensure the service was able to meet their needs and these assessments formed the basis of the individual plans of care. The individual plans of care contained all of the required information, were well maintained and regularly reviewed. Staff were knowledgeable about the individual care needs of the people they supported.

People had informatio

In total we spoke with six people who used the service during our inspection at Badly Park; however many were unable to recall or express their views about the service; in these circumstances we used observation to inform our inspection activity.

One person told us “the staff asked me about lots of things, about my preferences, what I like doing, do I go to church and stuff” another person told us “the staff are lovely, you can tell them if you need something”.

Only one person was able to comment on the food that was provided, they said “the food is nice, you can choose”. A relative told us “My husband has a restricted diet but the dietician has been to see him and the chef’s been up to see if there is anything different he would like, it’s his choice”.

One person told us “I feel safe here”, however another person told us “I was upset because another person living here wasn’t very nice to me, but the staff sorted things out and it’s all right now”. However the provider may wish to note that one person when asked what they would do if something was wrong or something had happened that they did not like told us “I don’t know; I’m not sure what I could do”.

The person that we spoke with said that they were able make choices about their food, routines and how to spend their time. They told us that there were activities going on in the home that they could join in with if they wanted to.

They told us that they felt they were well looked after at Badby Park, that the staff knew how they needed and wished to be supported. They also told us they were kept up to date about their care and treatment options; that they felt safe living there and could raise concerns should they need to do so.

The person we spoke with told us they thought the staff had the skills they needed to care for them and they thought were well looked after by the staff who worked at Badby Park. They also told us they were happy with the quality of the service provided at Badby Park.

However other evidence relating to outcomes four and 16 did not support this.

We spoke with four people who use the service. All told us that they were happy with the care and support that they received from staff. One person told us, “staff are helpful and kind.” Three people who use the service told us they did not have to wait long for staff assistance when they needed it. We also spoke with six members of care and nursing staff from across the three units at Badby Park to ask for their comments about the service.

This inspection took place on the 12 and 13 January 2015 and was unannounced.

Badby Park is registered to provide accommodation and care for up to 68 people.  The service specialises in the care of people with progressive neurological conditions and acquired brain injury. The service is designed to cater for people with disabilities.  At the time of our inspection there were 60 people using the service.  

There is a registered manager at Badby Park: 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.   

People did not always receive their medication as it was prescribed and medication was not always stored appropriately. We have asked the provider to make improvements to this system to ensure people receive their medication safely. 

Staff recruitment systems were robust and staff understood their roles and responsibilities in protecting people from abuse.    

Risk assessments were in place to reduce and manage the risks to peoples’ health and welfare; those identified as at risk had access to appropriate equipment such as pressure relieving mattresses and movement and handling equipment. 

People also had access to specialist nurses to advise on the management of pressure ulcers and people were weighed regularly to assess their nutritional well-being. 

People were protected from the risks associated with the recruitment of new staff by robust recruitment systems, staff training and adequate staffing levels. People who used the service had access to a wide range of health professional employed by the service and other NHS health professionals.

However people’s human rights were not always protected because peoples’ freedom of movement had been restricted without formal assessment, best interests decisions or authorised restrictions.

We have asked the provider to make improvements to this system to ensure peoples’ human rights are protected.  

New staff undertook a robust induction training followed by a period of supervised practice. Existing staff also undertook timely training to maintain and refresh their knowledge and skill. Improvements had been made to the clinical leadership of the service with the appointment of senior nurse managers with specific experience and skills relevant to the people who used the service.

People were supported to maintain a balanced and varied diet, with alternatives available should they not want any of the options listed on the menu. Staff provided compassionate and respectful assistance and encouraged people to eat their meal.

People were not always supported to maintain their privacy and dignity and we have asked the provider to make improvements to ensure that all people are supported to protect their privacy and dignity. Staff did not always involve people in decisions about their care and support and failed to engage with people they were supporting.  People had mixed views about the activities programme and it was not always clear what activities were available for people who were unable to engage in group activities. We have asked the provider to make improvements to ensure that people are involved in decisions about their care and are able to be engaged in meaningful activity.

The provider had a robust complaints policy and people knew how to raise concerns and complaints. Complaints and allegations were fully investigated and corrective action was taken to prevent reoccurrence. 

Record keeping was not robust because charts were not always fully completed or checked to ensure that people were receiving the care they required. We have asked the provider to make improvements to the standard of record keeping in the service. 

Staff received the information and managerial support they needed to do their job, including handovers at the change of shift provided staff support and communication about peoples’ changing needs. 

Quality assurance systems were in place and had been strengthened by the recent appointment of a nurse with experience of quality assurance who was involved in audits of individual plans of care, risk assessments and the use of other records. 

The provider was not meeting all of the legal requirements. You can see what action we told the provider to take at the back of the full version of the report.