This inspection took place on the 9 and 10 July 2018 and was unannounced. Baugh House Care Centre is a ‘care home’. People in care homes receive accommodation and nursing, or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Baugh House Care Centre provides residential and nursing care for up to 60 older people, some of who may be living with dementia. There were 41 people living at the service at the time of our inspection.

At our last inspection on 25 and 27 July 2017 we found breaches of Regulations 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to concerns that medicines were not always managed safely and the provider had not always followed safe recruitment practices when employing new staff.

At this inspection we found that improvements had been made in the management of medicines however, further improvement was required with the provider’s quality monitoring processes as we found gaps in six people’s medicine administration records where prescribed medicines had not been signed by staff as given to people and the reasons for omissions had not been documented. We saw that improvement had been made in that robust recruitment checks were being carried out before staff were employed to work at the home.

At this inspection we also found a breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that sufficient numbers of staff were not deployed throughout the home in order to meet the care and support needs of people using the service. You can see what action we told the provider to take at the back of the full version of the report.

All of the staff we spoke with said they enjoyed working at the home. However, there were mixed views about the support they received from managers. Some staff felt that managers had not always listened to what they had to say and some told us they did not feel they were respected. We have made a recommendation about motivating staff and team building.

The home had a registered manager in post. 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. They were also aware of the legal requirement to display their current CQC rating which we saw was displayed at the home.

People told us they felt safe living at the home. Training records confirmed that staff had received training on safeguarding and there was a whistle-blowing procedure available and staff said they would use it if they needed to. Staff were attentive to people’s needs. Action was taken to assess any risks to people and risk assessments and care plans included information for staff about action to be taken to minimise the chance of accidents occurring. Medicines were managed appropriately and people were receiving their medicines as prescribed by health care professionals. We found that the home was warm, clean and tidy and free from any unpleasant odours. People were protected from the risk of infections. People told us the home was comfortable and met their needs.

Staff had the knowledge and skills required to meet people’s needs. 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 told us they enjoyed the meals provided to them and they could choose what they wanted to eat. People were supported to maintain good health and they had access to healthcare professionals when they needed them.

People had been consulted about their care and support needs. These needs were assesse

This inspection took place on 25 and 27 July 2017 and was unannounced. Baugh House Care Centre is a home providing residential and nursing care for up to 60 older people some of who may be living with dementia in the London Borough of Bexley. At the time of our inspection there were 34 people living at the home.

This was the first comprehensive inspection of the service since it was registered under the provider, GCH (South) Ltd in May 2017. Prior to this the service had been inspected in April 2017 under the previous provider, GCH (Kent) Ltd, at which time it was rated ‘Inadequate’. CQC decided that we could only permit GCH (South) Ltd to operate this service subject to a number of conditions to address the concerns found during that inspection. GCH (South) Ltd agreed to accept those conditions on its registration and has complied with their requirements since that time.

There was no registered manager in post at the time of our inspection. The current manager was in the process of applying to become 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 identified breaches of regulations because records relating to people's medicines were not always properly completed to demonstrate they had received their medicines as prescribed, and because the provider had not always followed safe recruitment practices when employing new staff. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people had been assessed and action taken to manage identified risks safely. However, improvement was required to ensure records relating to the management of any wounds people had were kept up to date and accurate. Improvement was also required to ensure sufficient staff were consistently deployed on each unit at night time to meet people’s needs, and to ensure quality assurance systems consistently identified issues and drove improvements.

People were protected from the risk of abuse because staff were aware of the action to take if they suspected abuse had occurred. Staff were supported in their roles through training and supervision and told us they were well supported by the management team. People were able to access a range of healthcare services when needed and were supported to maintain a balanced diet.

Staff sought consent from people when offering them support and the provider worked within the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People told us their privacy was respected and that they were treated in a caring and dignified manner. Staff involved people in day to day decisions about the support they received.

People told us their care and support needs were met. They had care plans in place which had been developed based on an assessment of their needs and preferences, which were reviewed on a regular basis to ensure they remained up to date. The service offered a range of activities for people to take part in and plans were in place to increase the level of activities offered.

The provider had a complaints policy and procedure in place, and people told us they were aware of how to raise any issues they had. Most staff spoke positively about the management of the service, although one staff member highlighted that there had been a series of changes in the manager role and it was too early to have formed a proper view on the management arrangements.

The service had systems in place to seek feedback from people using the service and senior staff confirmed that any feedback they received would be acted on to drive improvements. We also saw action had been taken to address issues identified during checks and audits