About the service:

Bletchley House is residential care home that was providing residential and nursing care for 37 older people including people living with dementia.

People’s experience of using this service:

The manager had completed audits to support quality checks, however for some areas, these had not identified where improvements needed to be made. This was linked to inconsistent recording in many areas of care planning.

People told us they felt cared for.

Staff morale had improved and everyone was committed to ensuring people received good care and support.

Medicines were managed safely and people were encouraged to be as independent with medication as possible.

There was sufficient staff to support people.

People had health care support from professionals. When people were identified as unwell, staff had raised the concern and taken action with health professionals to address their health care needs, however, the action required was not always documented.

The manager worked in partnership with health and care professionals.

They had displayed the latest rating at the service and on the website.

When required notifications had been completed to inform CQC of events and incidents, this helped us to monitor the action the provider had taken.

The manager was open and committed to making improvements.

More information is in the detailed findings below.

Rating at last inspection:

GOOD (report published 01 September 2017)

Why we inspected:

This was a planned inspection based on our last rating and aimed to follow up on information of concern we received prior to the inspection. We explored the areas of concern as part of our inspection.

Enforcement:

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Follow up:

Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated requires improvement.

This inspection took place on 18 July 2017 and was unannounced.

Bletchley House Residential Care and Nursing home provides accommodation, nursing and personal care to older people.

At the time of our inspection the provider confirmed they were providing care to 25 people.

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 always safe. People were not always able to alert staff when they required assistance as they could not always access the call bell system. People who did use the call bell system told us that staff did not always come quickly enough to meet their needs.

Some people in the service received support with pressure wounds and were using pressure mattresses. We found one person had a deflated mattress and staff were not aware of this. Checking systems were in place for mattresses, but these were not effective enough to make sure every person was supported safely and to have the right inflated mattress.

People told us they generally felt safe within the service. Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. People had risk assessments in place to enable them to be as independent as possible .

Effective recruitment processes were in place and followed by the service. This meant that only people that were suitable to be working with vulnerable adults were employed. During our inspection we saw that there were sufficient numbers of staff on shift that day to meet people's care and support needs. Rotas showed that staffing was consistent.

Medicines were stored and administered safely. The people we spoke with told us that they were happy with the support they received to take their medicines.

All staff went through an induction process before working within the service. Staff told us that the process was thorough, and that along with the ongoing training they received, they felt well trained and confident within their roles.

Staff received supervision from management. All the staff we spoke with said that they received supervision and felt that it was a valuable process. We saw that supervisions had been recorded, and that on-going supervisions had been booked in for the coming months.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met.

People had a choice of freshly prepared food and drink. People told us they were happy with what was on offer. We saw that food and fluid intake was being accurately monitored and recorded for people when required.

Staff supported people in a caring manner. They knew the people they were supporting well and understood their requirements for care. We observed positive interactions between staff and people.

People's privacy and dignity was maintained. People told us they felt their privacy was respected, and staff we spoke with explained the importance of maintaining people’s privacy and dignity.

The service had a complaints procedure in place and people knew how to use it. We saw that any complaints made had been responded to promptly.

Quality monitoring systems and processes were used to drive future improvement and identify where action was needed.