About the service:

Bedford Care Home provides personal and nursing care for up to 180 people. The home is divided into six different units, each with 30 beds. Astley and Lilford is for people who require personal care and support, Croft and Kenyon for people with mainly physical nursing needs and Pennington and Beech for people with dementia care nursing needs. The home also has designated beds on two of the units for intermediate care. At the time of the inspection there were 153 people living at Bedford Care Home.

The current provider took over responsibility for the home in February 2018, following our last inspection.

People’s experience of using this service:

We found improvements were still required in key areas including medicines management, staff supervision and support, record keeping, involving people, relatives and staff in the running of the home and the quality monitoring process. Internal and provider level audits had picked up on the majority of issues we noted during the inspection, however action taken had either not been maintained or been implemented timely.

People and their relatives were positive about the standard of care provided and spoke highly of the staff, who were described as ‘wonderful’, ‘caring’ and respected people’s right to privacy and dignity. Whilst people and the majority of staff we spoke with felt current staffing levels were enough to meet needs, relatives and some staff disagreed. We have recommended the provider considers how staffing levels are determined.

Staff had received training in safeguarding and knew how to identify and report any concerns. Accidents, incidents and falls had been recorded consistently with action taken to prevent reoccurrence. This helped keep people safe. We found the home to be clean, odour free with effective cleaning and infection control processes in place.

People received personalised care which met their needs. Care plans explained how people wanted to be cared for. These had been reviewed regularly to reflect people’s changing needs and wishes, although people or their legal representative’s involvement in this process had not been captured consistently.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People felt the staff were well trained and knew their likes, dislikes and interests. We saw lots of examples during the inspection which demonstrated this. People spoke positively about the choice and standard of meals provided and we found people requiring a modified diet received these in line with professional guidance.

People told us staff were kind, caring and treated them with dignity. People’s independence was encouraged and promoted. We saw people had developed positive relationships with the staff, who had taken the time to get to know them. Where people required support at the end of their life, this was carried out respectfully, compassionately and with professionalism.

The home had a clear management structure in place, albeit was still recruiting to some key roles. The management team across the home were actively engaged in addressing poor performance and promoting positive change. It was evident during the inspection, the transition from the previous provider to the current one had been challenging and further work was required, for which plans had been developed.

For more details please see the full report either below or on the CQC website at www.cqc.org.uk

Rating at last inspection:

At our last inspection the home was rated as requires improvement (published 20 March 2018). The home remains requires improvement. This is the second time the home has been requires improvement. We will maintain contact with the provider until the next inspection to monitor the action they are taking to improve the rating to at least good.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and qual

We carried out an unannounced inspection of Bedford Care Home on 17, 18 and 22 January 2018. This was the first inspection of Bedford Care Home since it had been re-registered with the Care Quality Commission in December 2017. The re-registration had taken place as part of a restructuring of the company. Bedford Care Home was one of 22 homes being sold to another provider and the registration changes were part of this process.

Bedford Care Home 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.

Bedford Care Home is a large care home with 180 beds operated by Bupa. The home is divided into six different units, each with 30 beds. Astley and Lilford cater for people who require personal care and support, Croft and Kenyon look after people with mainly physical nursing needs and Pennington and Beech care for people with dementia care nursing needs. The home is situated in a residential part of Leigh close to the town centre. At the time of the inspection there were 160 people living at Bedford Care Home.

During the inspection we identified seven breaches in five of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment; including the management of medicines, staffing, meeting nutritional and hydration needs, person centred care and good governance. You can see what actions we told the provider to take at the back of the full version of this report.

We have also made a recommendation about staffing levels and how these are determined, to ensure enough staff are deployed to safely meet people’s needs.

At the time of the inspection the home 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.

People we spoke with told us they felt safe. Relatives were also satisfied with the safety of their family members and were complimentary about the care provided. The home had detailed safeguarding policies and procedures in place, with clear instructions on how to report any safeguarding concerns to the local authority. Staff had received training in safeguarding and knew how to identify and report both safeguarding and whistleblowing concerns.

We noted issues with risk management, particularly in regards to the action taken by the home when specific risks had been identified either by professionals or internal assessments. Concerns were also identified with people’s access to and use of the nurse call system, should they need to request assistance when in their room. The home took steps to address this particular issue during the course of our inspection. We also found inconsistencies with the management of people’s weight and referrals to the dietetic service, as well as the adherence to dietetic guidelines.

We saw the home had systems in place for the safe storage and administration of medicines. Overall the completion of the medication administration record (MAR) was done consistently. Staff authorised to administer medicines had completed the necessary training and had their competency assessed. However our review of medicines management highlighted gaps in some documentation such as topical medicine charts. Self-administration documentation was not always clear and we found a lack of guidance in place for some medicines and medical devices.

On each day of inspection we found the home to be clean with appropriate infection control processes in place. We saw infection control audits were completed as per the policy and toilets and bathrooms contain