About the service:

Bindon Residential Home provides accommodation for up to 42 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. At the time of our visit 33 people were living at the service.

People’s experience of using this service:

• Systems and processes to monitor the service were not effective, did not drive improvement and the provider had poor oversight and had not identified this. As a result, the quality of care provided to people had deteriorated since the last inspection.

• People’s health, safety and welfare were put at risk because there were not always sufficient numbers of suitably qualified, skilled and experienced staff on duty.

• The provider had not ensured staff were suitably trained and sufficiently supervised. As a result, the staff team did not have the skills to support people effectively and people had been exposed to the risk of harm.

• The service was not safe because people were not always protected against the risks associated with medicines.

• People’s nutritional needs were not always identified and monitored. Nutritional care plans lacked detail or clear instructions for staff about how to support people in relation to eating and drinking, especially where they were at risk of weight loss. Records relating to people’s daily dietary and fluid intake were poor. This meant we could not tell in any detail what people had to eat each day

• People were at risk because accurate records were not consistently maintained. There were gaps in people’s repositioning and personal care records. We could not be assured people’s care needs were being met consistently.

• Care records did not always reflect the needs and preference of people using the service. They were contradictory in places. The lack of detailed and accurate care plans meant care and support may not be given effectively. Visiting healthcare professionals shared similar concerns.

• There was a lack of stimulation for people using the service. Several people said they would like to see improvements in this area. Very few activities were offered and those that were did not always take into account individual interests and preferences or consider individual’s abilities.

• Some equipment and aspects of the premises were not clean. Poor infection control standards were found throughout the service.

• Some environmental risk had not been identified.

• We saw positive interactions during the inspection, with staff being kind, friendly and patient when assisting people.

• People enjoyed the meals provided.

Rating at last inspection:

At the last inspection the service was rated as requires improvement (February 2018). The service had been rated as requires improvement for a third consecutive time. At this inspection we found the service had deteriorated and is rated as inadequate overall.

Following the last inspection, asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. We also met with the provider to confirm they were following their action plan to ensure improvements were made.

Why we inspected:

We brought this comprehensive inspection forward as we had received concerns from a variety of sources that included community health and social care professionals, anonymous whistle blowers and family members. Concerns included poor staffing levels, poor standards of personal care, poor management of risks, unsafe staff recruitment practices, poor standards of cleanliness and a lack of stimulation and occupation for people. As a result of the mounting concerns, Devon County Council implemented a whole service safeguarding process in January 2019. There were also several individual safeguarding investigations in progress. Placements to the service have been suspended by Devon County Council because of the safeguarding conce

This unannounced comprehensive inspection took place on 19 and 22 February 2018.

We brought this comprehensive inspection forward as we had received concerns about staffing levels, continence care and the quality of food. Devon County Council investigated one of the concerns under the safeguarding process and found this concern was not substantiated. We reviewed staffing levels and continence care. While staffing levels had been impacted on occasion in previous months due to short notice sickness, staffing levels were satisfactory at the time of the inspection. No concerns were found in relation to continence care or the quality of food.

The service was previously inspected in February 2017. No breaches were found at that inspection however we made three recommendations. We recommended the deployment of staff be reviewed to ensure people’s needs are met and monitored in a timely way. We recommended the service followed the National Institute for Health and Care Excellence Guideline (NICE), Managing Medicines in Care Homes which would help the service to ensure they maintained accurate medicine records. We recommended that good practice advice in respect of setting and achieving improvement plans is reviewed and implemented. We also found Deprivation of Liberty Safeguards (DoLS) applications contained insufficient information or identical information and were not ‘person centred or specific’. The service was rated as Requires Improvement.

At this inspection we found some improvements had been made. For example, staff deployment had improved. Some communal areas had been reconfigured to enable staff to have a regular presence in communal areas in order to provide timely support to people. Deprivation of Liberty Safeguards (DoLS) applications submitted to the local authority contained relevant and specific information. However, we found a breach in regulation as the management of medicines was not entirely safe.

The service has been rated as requires improvement for a third consecutive time. The Care Quality Commission will be monitoring improvements within the service.

Bindon Residential Home provides accommodation for up to 42 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. These are accessed by separate front doors or via the garden at the rear of the properties. At the time of our visit 34 people were living at the service, 22 of whom were living in Bindon and 12 of whom were living in Elmcroft.

Bindon is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

There was 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.

The service was not consistently following safe practice in relation to medicines management. This meant people were at risk of not receiving their medicines as prescribed. Current quality assurance arrangements had not consistently identified shortfalls within the service.

People who used the service felt safe and we found staff knew how to recognise and report concerns about people’s safety and wellbeing. Guidance was in place to ensure risks were minimised without restricting people’s independence.

Sufficient staff were available to meet people’s needs. Necessary checks were carried out to ensure staff were recruited safely and were suitable to work with people at the service.

People were treated with kindness and respect. Staff were attentive an

This inspection took place on 23 and 28 February 2017. The inspection was unannounced.

Bindon Residential Home provides accommodation for up to 42 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. These are accessed by separate front doors or via the garden at the rear of the properties. At the time of our visit 36 people were living at the service, 22 of whom were living in Bindon and 14 of whom were living in Elmcroft.

We undertook a focussed inspection on 28 October 2016 in response to concerns about staffing levels and the possible impact this had on people’s care. We did not find evidence to support these concerns.

The service had a comprehensive inspection in November 2015 when it was rated as ‘requires Improvement’. At that inspection we found a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the recruitment procedures. At the focussed inspection in October 2016 we found recruitment procedures had improved and the service was fully compliant in relation to recruitment. A number of other improvements were identified during the November 2015 inspection. For example, there were times when there were delays in assisting people or monitoring the impact of people’s behaviour on others. Some areas of risk management needed to be improved to ensure risks were managed safely and consistently. There was a complaints process but written information was not readily available about the process and the timescales. People’s care needs were reviewed but not in a meaningful way which resulted in care plans not reflecting their current needs and the risks to their well-being. Improvements were needed to meet people’s social needs. Quality monitoring systems were in place but some audits had not identified areas for improvement. At this inspection we found improvements had been in some areas, but not in all.

A registered manager was 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.

The provider had quality assurance systems in place, including various audits. However the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process.

Most aspects of the environment were safe and the registered provider was taking steps to ensure the environment was safe in relation to hot water temperatures. The registered manager was working to ensure additional information was included in personal evacuation plans to make them informative and effective should a planned evacuation be necessary. Medicines were generally safely managed; however, we have made a recommendation to ensure all medicine records are accurate.

There were sufficient staff to meet people’s care needs. However staff were not always deployed in a way that kept people safe. We have made a recommendation that the provider review staff deployment to ensure people’s needs are met and monitored in a timely way.

The provider was taking steps to fully meet the Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. Staff were not fully informed about DoLS protection. However, the provider was in the process of taking the required steps to gain the legal authority to subject people to continuous supervision and control, including preventing them from leaving the building.

Several improvements had been achieved since the last comprehensive inspection in November 2015. For example, care planning records and ri

This focussed inspection took place on 28 October 2016 and was unannounced. The inspection was carried out by one inspector. We undertook the inspection as concerns had been raised about staffing levels and the impact this had on people’s care. We did not find evidence to support these concerns.

Bindon Residential Home provides accommodation for up to 46 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. These are accessed by separate front doors or via the garden at the rear of the properties. At the time of our visit 33 people were living at the home, 20 of whom were living in Bindon and 13 of whom were living in Elmcroft.

The service was previously inspected in November 2015 when the service was rated as requiring improvement. At that inspection we found a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach related to the provider not fully effective recruitment procedures in place. At this inspection we found recruitment procedures were more robust. - There were systems to ensure checks were fully carried out before new staff were appointed to a post.

There was a registered manager in post who had worked at the home for a number of years in various roles. 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.

The registered manager monitored staffing to ensure it was sufficient to meet people’s needs. Staff were recruited safely with checks being carried out before they started working with people, to ensure they were suitable to work with vulnerable people.

Staffing levels at Bindon were generally found to meet people’s needs and expectations. However we were told about some occasions when people had to wait longer than they were comfortable with for personal care. The registered manager said they would monitor this and address any concerns.

During the inspection staff worked calmly and did not appear to rush people. However on some occasions, we observed staff being very task focussed and not always interacting with people in communal areas. Staff said they felt there were sufficient staff on duty to ensure they met people’s needs. Staff showed kindness and were caring to people when supporting them. People and visitors to the home said staff were very kind, however, they said described how on occasions, staff spoke in a foreign language to each other while providing care. The registered manager said this had been raised with staff in the past as it was not acceptable practice. They said they would ensure that staff were reminded about this again.

The provider had introduced a new computerised care record system which they said had improved the availability and access to care records. We saw evidence that staff used the system to check people’s care. Staff said they found the new system really helped them with more accurate and up-to-date records.

We had received concerns about what activities were available for people at Bindon. We found that there had been some improvements following a recent appointment to the role of activity coordinator. This meant people were being offered individual and group activities which included trips out, games and music sessions in the home as well as individual pampering. We saw evidence that this was the case.

A concern about malodourous smells in communal areas which had been raised prior to the inspection was not found to be evident. However, the provider was installing air fresheners in communal areas to reduce the risks of stuffiness and stale air.

The inspection was unannounced and lasted over eight hours. Two inspectors and an expert by experience visited the service. There were 27 people living at the home. The home consisted of two areas of care called Bindon and Elmcroft. We spoke with 11 people living at the home, two relatives, six staff and the management team. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care.

We looked at a selection of care and medication records and staff communication records, as well as records relating to staffing levels, training and quality assurance. Prior to the inspection, we had also met with health and social care professionals who had recently visited the home as part of the safeguarding process. Since the inspection, the safeguarding process has been closed due to significant improvement in the standard of care.

Is the service safe?

We saw risks to people's health and well-being were monitored and regularly assessed. Systems were in place to make sure that people’s care and welfare was monitored. This reduced the risks to people and helped the service to continually improve. The management team recognised their responsibility to ensure staff received appropriate training to promote people’s safety. We saw staff moving people using equipment in a safe and caring manner. Staffing levels meant people were cared for in a safe environment where the atmosphere was calm.

Is the service effective?

Visitors told us they were happy with the care at the home and we saw people looked relaxed with staff and at ease in their surroundings. Some people were also able to confirm they were happy with their care. People's health and care needs were assessed, and staff knew when to seek external advice when people’s care needs changed. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by friendly and caring staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw that staff were attentive to people’s needs. For example, one person asked for a blanket and this was immediately given to them. The person said “You are very kind, you all smile and that’s good, thank you, I’m very cosy”.

Is the service responsive?

We looked at people's care plans and we saw the management team contacted health and social professionals appropriately when people's needs changed. When people raised concerns the management team responded promptly. Additional staff had been trained to provide extra support at busy times, such as providing support at mealtimes. The manager guided staff to change their practice to respond to people’s individual need, such as how a person was supported with their meal when they chose to walk around while their ate.

Is the service well-led?

The service was developing a quality assurance system to ensure identified shortfalls were addressed promptly. Since our inspection in February 2014, we have seen significant improvement in the quality of the service both on this inspection and on our inspection in April 2014. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and their role in promoting good practice and reporting concerns. This helped to ensure that people received a good quality service.

In this report the name of a registered manager for personal care and accommodation (Bindon Care Limited) appears. However, they were not managing the regulatory activity at this location at the time of the inspection. Their name appears in the report because they were still a registered manager on our register at the time of the inspection.

On 28 February 2014, we carried out a responsive inspection, which was triggered by a safeguarding alert made by a health professional visiting the home. Following this inspection we took enforcement action in connection with two outcomes relating to privacy and dignity, and care and welfare. We also made compliance actions to improve staffing levels and the way staff were supported. At the same time, there was a whole home safeguarding process, which meant other health and social care professionals were involved in assessing and monitoring the care provided by the service.

After the inspection in February 2014, the providers provided us with an action plan to demonstrate the improvements they had made. We met with the providers in April 2014 to discuss the action plan and the changes to the management team. We also discussed with them an anonymous concern relating to staff attitude, people’s dignity and the management of risk. The providers have investigated these concerns and have not upheld them. We also included these concerns as part of our inspection.

The focus of this unannounced inspection on 30 April 2014 was to follow up on our enforcement action. Based on our discussions with people living at the home, staff and relatives, as well as on our observations and looking at care records we judged the quality of care had improved. We judged there had been improvements regarding ensuring people were treated with dignity and respect, and choice was promoted. We also judged that the management of people’s care and welfare had improved. We saw staff caring for people in a calm and gentle way.

There were 30 people living at the home. The home consists of two areas of care called Bindon and Elmcroft. We spoke with 21 people, two relatives, six staff and the management team. We also spent time with people in communal areas of the home so we could make a judgement about how well people were cared for as some people were not able to comment directly on their care. We looked at a selection of care records and staff communication records, and focussed on privacy and dignity, and care and welfare. Prior to the inspection, we had also met with health and social care professionals who had recently visited the home as part of the safeguarding process.

A further inspection will take place, which will be unannounced and scheduled. This means we will follow up on the two compliance actions made in February 2014 but we will also look at other outcomes, including the quality assurance system within the home. This will help us monitor that the improvements to people’s care have been maintained.

In this report the name of a registered manager for personal care and accommodation (Bindon Care Limited) appears. However, they were not managing the regulatory activities at this location at the time of the inspection. Their name appears in the report because they were still a registered manager on our register at the time.

Our inspection was unannounced and was completed on 28 February 2014 and lasted approximately ten hours. The inspection was responsive rather than scheduled. It was triggered by a safeguarding alert for one individual made by a health professional visiting the home. After a multi-disciplinary safeguarding meeting on 27 February 2014, CQC decided to carry out an inspection. The focus of the inspection was to check on the health and well-being of the people living at the home. According to the list of people given to us on the day by staff, there were 34 people living at the home.

The home is divided into two buildings called Elmcroft and Bindon. We spent the majority of our time on Elmcroft as people living in this building presented as having more complex care needs. During our inspection, we spoke with 15 people who lived at the home but most people were unable to comment directly on the care they received. We therefore spent time in communal areas observing people's experiences and how staff interacted with them. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not comment directly on their experience of care. We also visited people who spent most of their time in their bedroom.

We spoke with five staff members and the deputy manager. The registered manager was on annual leave but the providers made themselves available to us, as did the registered manager from another home run by the organisation. We spoke with one visiting health professional. We looked at a selection of care records, and focussed on people’s health and welfare. During our inspection, we saw evidence of people’s dignity not being respected and we found staffing levels were not sufficient to meet people's needs. Some staff did not have the skills to care for people safely and appropriately.

We spoke with six visitors during the inspection about their views on the quality of care provided at the home and their views were generally positive. However, these opinions did not reflect our judgements on the quality of care. Care provided by the home needed to be significantly improved to enhance the lives of people living at the home. Our findings showed people’s dignity, management of people’s personal care needs and the management of identified risks were not being met. Staff lacked skills to effectively communicate with people and the way they assisted people to move was not always safe.

These examples of poor management of care and poor practice were promptly shared under a safeguarding process. Clear feedback was given to the providers about areas for improvement. A multi-disciplinary plan was drawn up by health and social care professionals to protect people’s safety and well-being. This resulted in health professionals visiting the home as part of a safeguarding investigation and in a protection role.

Our inspection was unannounced and lasted approximately three hours. This was a follow-up inspection to check on the cleanliness of the home. When we last inspected on 24 May 2013, we had made a compliance action to improve on the standards of cleanliness and infection control. During this visit, we also inspected two further outcome areas relating to medication and care and welfare of people living at the home. This was because we had received information of concern from someone linked to these areas of care; all three outcomes were compliant.

There were 32 people living at the home, and one person on a short stay. We met people living at the home but on this occasion we did not ask them direct questions about the outcomes we were inspecting. Instead, we spot checked several bedrooms and communal areas, such as a lounge and toilets. We spoke with staff and the provider. We also looked at audit records, housekeeping records and care plans, as well accident records. We found that standards of hygiene and infection control had improved. People’s rights regarding medication were well managed. While people’s specific needs relating to moving and handling planning, and the management of diabetes were supported appropriately.

There were 33 people living at Bindon and Elmcroft during our unannounced visit. We spoke with the provider, the manager, deputy manager, activity co-ordinator, cook and six staff as well as a visiting health professional. We spoke with six people living at the home. Some people living at the service were not able to comment directly on their care so we observed the practice of staff throughout the visit also spending time observing care in the communal areas and during lunch service in Bindon and Elmcroft. We also looked at care support plans for people living at the home.

Three of the four outcomes areas we inspected were compliant. We saw that people's dignity and respect was maintained. Their health and wellbeing was assessed and care was provided in a way that suited people's individual needs. Although the maintenance of the environment and cleanliness was being maintained in Bindon there were areas in need of improvement in Elmcroft to manage the risk and spread of infection effectively. We also received information about areas of concern related to the environment and fire regulations and these were inspected after referral to the relevant agencies and found to be satisfactory with minor recommendations from those agencies.

We carried out a desk top review of medication looking at information provided by the service as requested and found that areas of non compliance noted at the previous inspection had been addressed.

We visited Bindon and Elmcroft unannounced on 7 September 2012. There were 17 people living at Bindon and 15 at Elmcroft. The majority of the people that use the service have dementia and therefore not everyone was able to tell us about their experiences. We spent most of the day observing what was going on within the home and how staff cared for people. Some people using the service were able to tell us about their experiences and we also spoke with a relative and a visiting health professional. We spent individual time with six people living at the home, spoke to one person who was able to tell us about their experience and had lunch with 11 people in Bindon.

Staff promoted people’s independence. When we arrived people were going about their day as they wished. Some people were relaxing in the lounge or in their rooms. Most of the people who were mobile liked to move about the home and were able to access the garden as they chose.

We spent time observing care delivery in the communal areas and looked at all areas of the home. We spoke to the provider, the manager, who was newly appointed to cover maternity leave, the manager who was going on leave and four staff members. We also looked at a wide range of records, including care files, risk assessments, audits, staff training and rota, menus and complaints.

People told us that it was “a very nice home, I feel like I am home” and 'the girls are so kind and patient”. All the people we spoke to living at the home were positive about their experience there and one relative also expressed positive views of the service.

We saw that the home focussed on people's choice about how they wanted to live their

lives in a person centred way. Staff were aware of people's likes and preferences and there was good communication between the staff and people living there. Staff were well trained and knowledgeable about people's needs and how to meet them. We saw that the three care records that we looked at were detailed and that staff were caring for people in a person centred way.

We looked at the environment throughout the home. The buildings were of an older style and were not purpose built for caring for people with dementia or those who need mobility aids. Therefore some areas such as skirting boards, wall edges and doors did need regular attention. We spoke to the provider and the managers and we could see that there was evidence of investment in the home and that there was an employed maintenance man and gardener who regularly worked at the home to ensure that a rolling maintenance plan was followed.

There were 34 people using services when we carried out an unannounced visit to Bindon and Elmcroft (15 people in Elmcroft).

People living at the home said that they enjoyed living there and we found that their needs were being met in a person centred way by staff who know what they are doing. One relative said that their loved one looked more like themselves now that they were at the home’.

We saw staff interacting with people using the service in a respectful way, spending time with people using the service and chatting. People using the service said that they were comfortable with the staff saying that ‘they are lovely’. Everyone we spoke to using the service had positive comments about their care and life at the home.

No-one spoken to had any problems with the meals or showed any negative signs when asked about food. Food was presented in an appetising and sociable way and there were condiments available. Attention is given to ensuring that people using the service are able to eat things that they like and as much or as little as they like in a sociable setting.

Staff said that they enjoyed working in the home. Staff receive satisfactory training that is relevant to their job and they are well supported. However, improvements are needed in relation to medication records and administration.

Staff and the manager were able to describe how they managed individual peoples' needs in good detail and that they understood how to promote a homely atmosphere. Staff know how to protect people and keep them safe. Records are good and staff showed that they knew people using the service well and people using the service said that their needs were well met.

We found the home to be generally clean and staff were following infection control procedures although due to a staff vacancy there are areas on Bindon that need improvement.

An unannounced inspection took place on 5 and 9 November 2015. It was carried out by two inspectors. Bindon Residential Home provides accommodation for up to 46 people and 36 people were living at the home during our visit. The service provides care for older people; most people are living with dementia. The building is separated into two different areas called Bindon and Elmcroft, which are accessed by two separate front doors or the via the garden.

A registered manager was 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.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, applications had been made to the local authority in relation to most people who lived at the service.

There were numerous positive interactions between staff and people living at the home; we saw staff treated people with kindness and compassion. It was evident staff were aware of people’s life histories and knew their preferences for how care and support was to be provided. Staff understood the need to respect people’s privacy and maintain their dignity. People looked confident as they moved around the home and people told us they felt safe. Staff knew to report poor or abusive practice. People had access to health services.

There were times when there were delays in assisting people or monitoring the impact of people’s behaviour on others. The provider is currently recruiting for staff to specifically provide activities; some people said they would like more to do. Staff were provided with a range of training and were able to translate theory into practice. The service was run by a registered manager, who staff described as approachable.

Risk assessments and care plans did not consistently reflect people’s current support and care needs and at times lacked guidance for staff. Staff were attentive and provided individualised care. Staff understood the importance of gaining consent. People benefited from a staff group that were trained and worked as a team.

Improvements were needed to the recruitment and some aspects of the quality assurance process to make them more effective and help keep people safe. Medicines were administered safely but changes were needed to improve the auditing of medicine management. Once the management team were aware of a complaint they took time to try to resolve the concern and work with people and their families. However, current information regarding making a complaint was not accessible or clear regarding the process and timescales.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.