This inspection took place on 14 January 2019 and was unannounced. Borovere is registered to provide accommodation and support to up to 30 people older people some of whom are living with dementia. At the time of the inspection there were 24 people living there.

Rating at last inspection

At our last inspection on 9 January 2017 we rated the service Good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Rating at this inspection

At this inspection we found the service remained Good overall, but the key area of safe has deteriorated to Requires Improvement.

Why the service is rated Good

People were safeguarded from the risk of abuse. Risks to people had been assessed and managed for their safety. Incidents were investigated, and any required changes made. Medicines were safely managed and administered by trained staff. The service was clean and well maintained to reduce the risk of people acquiring an infection. There were sufficient staff to meet people’s care needs in a timely manner.

Monthly nutrition and tissue viability charts for two people were not up to date, although people had received the care they required. The registered manager took swift action to rectify this, but further time is required to demonstrate their monthly completion has been sustained.

Relevant pre-employment checks had been completed. However, the registered manager had not followed the provider’s policy which required all staff to complete an annual declaration in relation to their disclosure and barring service check, to ensure no changes had occurred. They took immediate action to address this for people, but it will take time for them to be able to demonstrate this check has been sustained.

People’s needs were assessed prior to the offer of a service. Their care was delivered by staff who had the required skills, knowledge and experience. Staff ensured people received enough to eat and drink for their needs. Staff worked effectively together and across agencies to ensure people received the care and support they required and that their health care needs were met. People’s needs were met by the design of the premises. 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 were treated with kindness, respect and compassion by staff. People were supported to express their views and to be involved in decisions about their care and treatment. People’s privacy, dignity and independence were both respected and promoted by staff.

People received personalised care that was responsive to their needs and were provided with opportunities for social interaction and stimulation. People were provided with information about how to make a complaint if they needed to. People were appropriately supported by staff at the end of their life.

There was a positive person-centred culture. Staff understood their roles and responsibilities. People and staff were engaged and involved with the service. Processes were in place to monitor and improve the quality of the service provided.

Further information is in the detailed findings below

The inspection took place on 9 January 2017 and was unannounced. Borovere is registered to provide accommodation and support to 30 people older people some of whom are living with dementia. At the time of the inspection there were 22 people living there.

This was a comprehensive inspection to check on the provider's progress in meeting the requirements required following our inspection of 8 and 9 February 2016. During that inspection breaches of legal requirements were found in relation to medicines, premises and clinical governance. Following the inspection the provider sent us an action plan detailing how and by when they would meet regulatory requirements. At this inspection we found legal requirements had been met.

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.

People told us they felt safe and well supported. Staff had undergone safeguarding training and understood their role in relation to safeguarding and the actions they should take to keep people safe from the risk of abuse.

People told us there were always staff available when needed. Records showed sufficient numbers of competent staff were available with the right mix of skills to meet people’s needs. People were kept safe because the provider had robust recruitment policies and procedures.

The provider had ensured that the premises were secure and suitable for people. Plans were in place to ensure people were safe in an emergency. People’s records demonstrated that risks to them as individuals in relation to their care had been assessed and managed safely.

All of the people we spoke to said they received their medication on time and the provider ensured people received their medicine only from trained, competent staff. Processes were in place to ensure the safe management of medicines. People received their medicines safely.

People told us the staff appeared to be well trained, knew what they were doing and supported them in the way they liked. New staff underwent a relevant induction to prepare them for their role. Staff received regular supervision to support them in their role. Staff were required to undertake a range of training identified by the provider as necessary in order to meet people’s needs. Staff were also supported to undertake professional qualifications in social care.

People said the staff always sought their consent. Staff were able to demonstrate how the Mental Capacity Act (MCA) applied to their day to day work with people. Arrangements had been made to ensure staff were able to complete or refresh their MCA training. Whilst awaiting this training or training update the MCA had been discussed at a staff meeting and MCA pocket reminders of their legal obligations had been provided to staff. Where people were subject to the Deprivation of Liberty Safeguards (DoLS) legal requirements had been met.

People said the food provided was of a good standard. They were offered a choice of nutritious and appetising meals. People had nutrition care plans which provided staff with guidance about their nutritional needs. Risks to people associated with their eating and drinking had been assessed and relevant measures taken to manage these effectively.

People were supported to access a range of healthcare services to ensure they could maintain good health.

People told us the staff were caring and supported them in the way they liked. People experienced positive relationships from staff who received guidance about people’s communication needs and how to engage with them effectively. Staff provided people with relevant information to help them make informed decisions. People were observed to make decisions about their care acros

The inspection took place on 8 and 9 February 2016 and was unannounced. Borovere is registered to provide accommodation and support for up to 30 people. The location has two bedrooms out of commission in a part of the building known as the ‘Coach House’ and is using the two double bedrooms to accommodate people singularly; therefore they can only accommodate 26 people. At the time of the inspection there were 25 people living there.

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.

People and staff gave mixed views about the adequacy of staffing levels. Assessments of people’s level of care needs were completed and this information was used to determine the level of people’s fees but not the staffing needs of the service. Staffing levels for the service were fixed. There was no budgetary allowance for agency staff and management had to cover shortfalls where possible. There was not always a professionally qualified member of care staff on duty, on-site, to ensure suitable staff were deployed within the service at night. On-call senior care staff were available to be called upon if required. There had not always been a qualified first aider on-site at night as required. The registered manager made arrangements to ensure people’s safety whilst night staff underwent first aid training immediately following the inspection. Although no harm to people resulted from this, there was a risk of harm the longer this situation continued.

There were not robust arrangements in place to ensure staff were qualified and competent to administer people’s medicines. The registered manager took immediate action following the inspection to make sure night staff undertook medicines awareness training to ensure people’s safety. Records in relation to people’s medicines were not always complete. Processes to ensure medicines were stored at the correct temperature were not robust. Staff had failed to ensure people’s liquid medicines were always in date. Processes to monitor the quantity of medicines were not robust. Staff did not always administer people’s medicines safely.

Risks to people from the environment had not been adequately assessed and managed. There was the potential that people could leave the building without staff’s knowledge or be placed at harm through staff not securing unsafe areas of the service, such as the sluice. The garden was not safe and the perimeter was not secure. The registered manager was taking action in relation to the safety of the garden and took action during the inspection to ensure people could not access high risk areas of the service to ensure their safety.

The provider’s quality monitoring systems were not robust or effective. Some issues had not been identified or where issues had been identified they had either not been rectified or had not been addressed promptly. There was the potential that people might experience harm and opportunities to improve the service were not used effectively.

The management of records within the service was not robust. People’s personal care records were not stored totally securely to prevent any potential access by unauthorised people. Other records including people’s daily care records had not been completed at the time the care or support was provided, or there were gaps. People’s medicine records were not always secured when staff administered medicines to people.

People’s records demonstrated that risks to them as individuals in relation to different aspects of their care had been assessed and managed. Staff had access to written guidance about risks to people and had taken appropriate action to mitigate them.

People and relatives told us they felt

When we visited we spoke with the registered manager, seven members of staff, five residents, one relative and a visiting health professional. We observed how people were looked after and reviewed records relating to people’s care, the staff and the organisation of the home.

We found that people gave consent to care and staff understood how to gain people’s consent before offering support. The provider all considered the Mental Capacity Act and acted appropriately and in people’s best interests. People said they were given choices and could refuse care if they wished. For example, one person said, “You are quite free to do what you like. [This is] your home.”

People experienced safe and appropriate care, based on an assessment of their needs and preferences. We saw that the provider planned people’s care and took appropriate action when people’s health or wellbeing changed.

People were positive about the food. We heard comments such as,“[It’s] good food, plenty of choice and plenty of vegetables.” People’s specific dietary needs were understood and catered for and the provider supported people with their nutritional intake.

Staff recruitment was robust and the provider had systems in place to monitor the quality of the service and identify and manage risks.

When we visited we spoke with five residents, observed care and carried out a 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 talk with us.

People said that they felt at home and three people commented that they felt part of a community at Borovere. This was important to them as it meant they felt involved and respected. One person said, “they treat you as adults here”. Everyone we spoke with said that they were treated with respect.

Most people were aware that there were care plans summarising their care needs, but not all could recall involvement in reviewing them. However, some were not interested in having a formal care plan review process. People said that staff provided appropriate care, and that the home was well run. One person said, “staff attend to people who need help and are always pleasant”. Everyone said the activities provision was good and that they enjoyed most of the activities offered.

We were told that the staff were professional and caring, and one person said, “staff here are excellent and have the right attitude”. People said they felt safe and if they had any concerns they would be confident in talking to staff about them.

From observing care and using SOFI, we found that staff generally interacted positively with people. Lunchtime was busy, but staff were supportive, and discrete in the way they offered assistance.

People told us that they liked living at the home because the staff were friendly and caring, and this helped to create a homely environment. They said they felt safe, and that their privacy and dignity were respected. People said their health needs were attended to and that they could access a range of activities if that was their choice.