About the service:

Basingfield Court Residential Home is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.

The service supported older people, some of whom were living with dementia. At the time of our inspection there were 49 people living in the service.

People’s experience of using this service:

¿ We received positive feedback about the service and the care people received. The service met the characteristics of good in all areas.

¿ People received safe care. Medicines were managed safely and there were enough skilled staff deployed to meet people’s needs and keep them safe.

¿ People were supported by skilled staff who had completed the appropriate training.

¿ Staff had respectful caring relationships with people they supported. They upheld people’s dignity and privacy, and promoted their independence.

¿ People’s care and support met their needs and reflected their preferences. The provider upheld people’s human rights.

¿ There was a positive, open and empowering culture. Staff roles and responsibilities were clear. Staff worked in partnership with professionals to deliver care and support and maintained links with the local community.

Rating at last inspection:

At the last inspection the service was rated Good overall with a rating of requires improvement in safe. At this inspection the service was rated Good overall.

Why we inspected:

This was a planned, comprehensive inspection of the service.

Follow up:

We did not identify any concerns at this inspection. We will therefore re-inspect this service within the published timeframe for services rated Good. We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The inspection took place on the 20 and 21 November 2017 and was unannounced. Basingfield Court Residential Care Home is registered to provide care without nursing for to up to 52 older people who may be living with dementia, a physical disability or sensory Impairment. At the time of the inspection there were 37 people living there, with one person away having a family home visit.

The service did not have a registered manager. 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.

On 2 and 3 April 2017 we inspected Basingfield Court Residential Care Home and judged the provider to be in breach of three regulations.

Although people told us they felt safe, we found there were shortfalls which compromised people's safety and placed them at risk from receiving unsafe care. These shortfalls amounted to a breach of Regulation 12 of the HSCA Regulations 2014 (Safe care and treatment).

The provider was served with a warning notice in relation to safe care and treatment which they were required to meet by 31 May 2017. We told the provider they needed to take action to meet the legal requirements of this regulation. They sent us a report setting out the action they would take to make necessary improvements to meet the regulation.

At this inspection we found the provider had taken the required action to meet the requirements of the regulation and to ensure people experienced safe care and treatment.

The provider had acted on the risks and shortfalls that had been previously identified to ensure people were safe. Whilst we recognised that improvements had been made to ensure people experienced safe care and treatment, many of the changes had not yet been sustained in the longer term to be fully embedded in practice. The improvements that have been made will need to be embedded to demonstrate that they are sustainable and can be maintained without the additional provider support and oversight. At the time of this inspection the service was only 75% occupied, therefore the provider needs to demonstrate that the improvements are also sustainable when there is an increase in the number of people living in the home. It is too early to state that the improvements are sustainable.

At our inspection in April 2017, the provider did not have effective systems and processes in place to assess, monitor and improve the quality and safety of the service provided. The provider did not maintain an accurate, complete and contemporaneous record for each person, including a record of the care provided and of decisions taken in relation to the care provided. There were shortfalls in the management of the home which compromised people's safety and placed people at risk from receiving unsafe care. This was a breach of Regulation 17 HSCA 2008 Regulations 2014 (Good governance).

The provider was served with a warning notice in relation to good governance, which they were required to meet by 31 May 2017. We told the provider they needed to take action to meet the legal requirements of this regulation. They sent us a report setting out the action they would take to make necessary improvements to meet the regulation.

At this inspection we found the provider had taken the required action to meet the requirements of the regulation to ensure people were protected from the shortfalls in the management of the home which had compromised people’s safety.

At our inspection in April 2017 the provider had failed to demonstrate that sufficient staff were always deployed to meet people's care and treatment needs. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing).

We asked the provider to send us a report detai

The inspection took place on 03 and 04 April 2017 and was unannounced. Basingfield Court Residential Care Home is registered to provide care without nursing for to up to 52 older people who may also be living with dementia or have a physical disability or sensory Impairment. At the time of the inspection there were 48 people living there, two of whom were in hospital.

The service had a registered manager. 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.

We were not assured that the potential risks to people from developing pressure ulcers were safely managed. Staff did not ensure professional’s guidance was always followed to ensure people received safe care. Staff had not received the required training to safely assist a person with an aspect of their medicines administration. We were not assured that potential risks to people when identified were always managed appropriately. Equipment had not always been maintained to an appropriate standard to ensure people’s safety.

People and staff told us there were insufficient numbers of staff always on duty to meet the individual needs of people using the service. There were not always sufficient staff deployed in the event of staff sickness and arrangements to cover staff sickness were not effective. This had resulted in insufficient staff being deployed on some night and day shifts. There were not always sufficient staff deployed to provide people with safe and timely care.

Staff stored medicines securely and within their recommended temperature ranges. Staff signed when creams had been applied to people. We were not assured that a person’s allergy information was consistent or correct to protect them from the risk of harm. People’s care plans for the management of anxiety did not describe when to use the prescribed medicines for people’s safety.

Processes in place to audit and monitor the service were not being used effectively to drive service improvement for people. We were not assured that full and complete data was supplied through the auditing and reporting processes to ensure the provider could effectively monitor the service. The failure to complete any trends analysis of incidents meant opportunities had been missed to identify any trends and patterns for people in order to minimise the risk of repetition. Robust records of people’s care were not maintained to ensure their safe care.

People told us they did feel safe from abuse. Processes and staff training were in place to safeguard people. Apart from one incident which was addressed during the inspection, processes were followed to ensure people were safeguarded from the risk of abuse. The provider ensured safe staff recruitment practices were followed.

Staff received an induction to their role; 88% of staff had completed the providers’ required training. The provider was aware that staff had not received supervision as required and plans were in place to address this to ensure people were cared for by staff who were appropriately supported in their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People did not provide positive feedback about the quality or variety of foods offered. Records showed the issue relating to the quality of the meals was long standing. A person’s meal did not meet the requirements of their diet. However, people had a pleasant lunchtime experience and were supported by staff to eat their meals where required.

Staff supported people to see health care professionals as required.

People we spoke with felt that the staff were doing all they could

People who used the services told us they were happy living in the home and were complimentary of the staff team. They told us they felt safe, cared for and listened to. Comments included, “I make my own tea and coffee, but carers also ask me if I would like something to drink” and “I think I am quite happy, I’m comfortable and looked after well”.

We spoke with relatives of people who used the services. They told us they were happy with the services provided and were kept informed, were listened to and given the opportunity to give their view of the services provided.

We found staff were knowledgeable of people’s specific health and personal care needs and had received training to update their skills and knowledge. Staff told us they felt supported by the provider and management team.

We looked at people's care plans and supporting documents. We found peoples care plans detailed their needs, and how to meet those needs.

The provider had ensured staff received appropriate professional development and support to safeguard and deliver care and support to the people who lived in the home.

We found people and their relatives had opportunities to contribute their views about the quality of the service. The provider had systems for monitoring services provided.

People told us that they were ''looked after very well''. The provider was establishing a new care planning system that clearly cross referenced with the risk assessments and gave detailed instructions of how staff were to meet the needs of individuals and minimise the risk of harm. Staff told us that the new system was simpler, clearer and easier to use.

We saw that staff provided care in a person centred and respectful way and that they were meeting the needs of the people who lived in the home. People told us that although they sometimes waited quite awhile for their lunch, being able to choose their food at the meal time was ''worth the wait''.

Some staff told us that there was not always enough staff on duty to ensure that the people who lived in the home were given the best quality care. However people who lived in the home and their relatives told us that there were always staff available when needed. They told us that they were ''very happy with the standard of care'' and their call bells were always answered quickly.

People were generally happy with the care and support provided at Basingfield Court.

People that were able to talk to us said that they were consulted about their care and support needs. They said that the home was always clean and tidy. Staff responded to peoples requests for assistance quickly. Everyone we spoke to said that although they had not needed to make a complaint, they felt confident that the service would respond positively should they need to do so.

Although people were happy about the way in which the service responded to their care and welfare needs we had concerns about how the service planned and responded to the care of people who were unable to clearly state their needs wishes and preferences. We also had concerns about current staffing levels. We recognised that the service is taking action to address both of these issues.

The inspection took place on 17 and 18 February 2015 and was unannounced.

Basingfield Court provides personal and nursing care for up to 52 older people, some of whom live with dementia, whilst others may have a physical disability or sensory impairment. At the time of our inspection 42 people were living at the home. The home is purpose built, with accommodation over three floors and most people have their own rooms with en-suite facilities.

The service is required to have a registered manager as a condition of its registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The previous registered manager at Basingfield Court had been on leave since May 2014 and left the service on 31 January 2015. During the inspection we spoke with the manager who had been in post since 11 December 2014 and the provider’s regional director. They told us that they had begun the selection process and were hopeful to appoint a registered manager shortly.

We last inspected this service on 5, 10 and 11 September 2014 and judged the service to be in breach of four regulations, relating to people’s care and welfare, managing medicines, staffing levels and assessing and monitoring the quality of the service. The provider sent us an action plan showing how they would make improvements to address these concerns. At this inspection we found the provider had made the necessary improvements in all areas where there had previously been breaches in legal requirements.

Since the inspection in September 2014 the provider had recruited more suitable staff and had increased the daily staffing levels. People’s needs had been appropriately assessed and reviewed regularly.

We observed medicines were administered safely in a way people preferred, by trained staff who had their competencies assessed annually by supervisors.

The manager had demonstrated clear and direct leadership. They had ensured systems were operated effectively to identify and manage risks and had monitored trends from identified accidents and incidents. They had taken action to improve the quality of the service and ensure that necessary learning was passed on to staff.

People at Basingfield Court told us they trusted the staff who made them feel safe. Staff had completed safeguarding training and had access to relevant guidance. They were able to recognise if people were at risk and knew what action they should take if required.

People’s safety was promoted through individualised risk assessments. Where risks to people had been identified there were plans in place to manage them effectively. Staff understood the risks to people and followed guidance to safely manage these risks.

Staff recruitment processes were robust. There were sufficient staff deployed to provide safe care and treatment. Staff understood their roles and responsibilities to provide care in the way people wished. They were responsive to people’s specific needs and tailored the care delivered for each individual.

People’s health needs were looked after and any concerns were promptly escalated to health care professionals for advice and guidance, which was then followed by staff. Staff were trained to deliver effective care, and where required, followed advice from specialists. This included training in caring for people with specific health conditions.

Staff had completed training on the Mental Capacity Act (MCA) 2005 and understood their responsibilities. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. Where people lacked the capacity to consent to their care, legal requirements had been followed by staff when decisions were made on their behalf.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. They were aware of a Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The manager had taken the necessary action to ensure staff recognised and maintained people’s rights.

People’s needs in relation to nutrition and hydration were documented in their support plans. People were supported appropriately by staff to ensure they received sufficient to eat and drink. Meals reflected people’s dietary needs and preferences. When necessary people had been referred to appropriate health professionals for dietary advice, which was then implemented by staff.

The provider aimed to enable people to maintain their independence and socialise as much as possible. People’s dignity and privacy were respected and supported by staff who were skilled in using individual’s unique communication methods.

When complaints were made they were investigated and action was taken by the provider in response. Complaints were analysed by the provider for themes and where these had been identified action had been taken.

The manager promoted a culture of openness and had made changes at the home to improve people’s care and staff morale. There was a clear management structure and systems in place to drive improvements.