The inspection took place on 14 and 15 January 2019 and was unannounced.

Badbury Care Home 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.

Badbury Care Home is registered to accommodate 33 older people. The home was split over two floors with the first floor having access via stairs or a lift. On the ground floor there are various lounges, smaller seating areas and a dining room. There was level access to the outside patio and garden areas. There were 24 people living at the service at time of inspection.

At our last inspection in November 2017 we rated the service ‘requires improvement’. At this inspection we found that improvements have been sustained and further positive developments have been made.

People were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and who to report this to if abuse was suspected.

Staffing levels were adequate to provide safe care and recruitment checks had ensured staff were suitable to work with vulnerable adults. Staff had received an induction and continual learning that enabled them to carry out their role effectively.

Staff received regular supervision and felt supported and confident in their work.

When people were at risk staff had access to assessments and understood the actions needed to minimise avoidable harm.

Medicines were administered and managed safely by trained and competent staff. Medication stock checks took place together with daily and monthly audits to ensure safety with medicines.

People and their relatives had been involved in assessments of care needs and had their choices and wishes respected including access to healthcare when required. The service worked well with professionals such as doctors, occupational therapists and social workers.

People had their eating and drinking needs understood and were being met. People had mixed views about the quality, variety and quantity of the food.

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.

The registered manager actively sought to work in partnership with other organisations to improve outcomes for people using the service.

People, their relatives and professionals described the staff as caring, kind and approachable. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they could communicate their needs. Their life histories were detailed and relatives had been consulted.

The home had an effective complaints process and people were aware of it and knew how to make a complaint. The service actively encouraged feedback from people, their relatives and professionals.

People’s end of life needs were assessed. The records showed that people and their relatives had been involved in these plans. Feedback received by the service showed that end of life care provided was of a good standard.

Activities were provided and these included staff, people and their relatives. Individual activities were provided for those that preferred them.

Relatives and professionals had confidence in the service. The home had an open and positive culture that encouraged the involvement of everyone.

Leadership was visible within the home. Staff spoke positively about the management team and felt supported.

There were effective quality assurance and auditing processes in place and they contributed to service improvements. Action plans were carried out and lessons learnt.

The service understood their legal responsibilities for reporting and sharing information with other services.

The inspection took place on 14 15 December 2017 and was unannounced.

Badbury Care Home 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.

The care home accommodates up to 33 people across two floors, each of which has separate adapted facilities. At the time of our inspection there were 23 people living at the service.

At our last inspection on 13, 14, and 17 July and 22 August 2017 we found there was a lack of consistent, effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. People's identified risks in relation to skin damage had not been consistently managed or actions taken in order to minimise the risks.

Systems were not in place to ensure people received their medicines safely. Stocks were not always available to ensure people received their medicines when required. People were at risk of malnutrition because food and drink records were vague and did not reflect how much people had actually eaten or drank. Service users were not always treated with dignity and respect. Service users did not always receive personalised care that responded to their individual needs and reflected their preferences. Care records were not always completed accurately or consistently. Care plans and grab sheets did not reflect people’s DNAR preferences. Systems and processes in place to assess, monitor and improve the service were ineffective. The provider had not notified us of all notifiable events.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well led. We found that during this inspection the action plan had been followed but although improvements had been made, some improvements were still required.

Fire procedures for visitors and signage was not clearly displayed in the home. The provider acknowledged this and told us they would address this as a priority. Following the inspection evidence was shown which identified measures had been taken to ensure signage was clear.

People, staff and relatives described that the home had been through a challenging period. They were all confident that the provider had secured change and stability.

Although improvement had been made to ensure medicines were managed safely, there remained a risk that people may not receive their medicines when required as stock levels were not maintained. This meant people could be at risk of not receiving their medicines when required. Medicines were, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines.

People were happy with their care and they shared appreciation and confidence in the registered manager and staff team. Professionals confirmed that improvements had been made. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

People felt safe. They were protected from harm because staff understood the risks people faced and how to reduce these risks. Measures to reduce risk reflected the person’s preferences. Staff knew how to identify and respond to abuse.

People described the food as good and there were systems in place to ensure people had enough to eat and

We undertook an unannounced inspection of Badbury Care and Nursing Home on 13, 14 and 17July 2017.

The home is registered to provide accommodation and residential care for up to 33 people. At the time of our inspection there were 24 people living at the home, some of whom were living with a diagnosis of dementia. The home is set out over two floors. Access to the first floor is by stairs or passenger lift. The ground floor provides access to a secure garden area.

When the service was last inspected in October 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. Regulation 12 Safe care and treatment. People's identified risks in relation to skin damage and malnutrition had not been consistently managed or actions taken in order to minimise the risks. Regulation 17. Good governance. Auditing systems had not recognised areas that required improvements to ensure safe care of people. As a result of our findings of the inspection in October 2016 we imposed conditions on the provider’s registration in that we required the provider to report to the Care Quality Commission (CQC) about the safety of people's care Although people and relatives said they felt safe, the risks people faced were not consistently managed. We found examples where people were at risk.

This inspection was brought forward because concerns had been raised by the local authority safeguarding team, health care professionals and a number of safeguarding alerts received by the Care Quality Commission. Regular action plan progress updates had been sent to the Care Quality Commission following the last inspection. Information we received did not reflect the concerns and risks found during this inspection. At this inspection we found concerns about the safe care and treatment for people living at the home, consistent with concerns raised prior to the inspection taking place.

We found there was a lack of consistent and effective management and leadership which coupled with ineffective quality assurance systems meant issues were not identified or resolved. This was evidenced by the continued breaches we found at this inspection. We identified five breaches in regulations, staffing, safe care and treatment, safeguarding, person centred care, and good governance. Two of these were repeat breaches over the previous two inspections.

People's identified risks in relation to skin damage had not been consistently managed or actions taken in order to minimise the risks. Some people needed to be supported by staff to change position regularly in order to relieve pressure on their skin. Clear instructions were recorded in care plans. However these instructions were not always being followed.

People were at risk of malnutrition. Food and fluid records were kept in people’s rooms. They were vague and did not reflect how much people had actually eaten or drank, yet there were clear instruction in records for staff to ensure people ate and drank well.

Systems were not in place to ensure people received their medicines safely. Stocks were not always available to ensure people received their medicines when required.

The requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were not being met as we found conditions which had been applied to DoLS authorisations had not been complied with. Quality monitoring and audits had failed to identify that areas of service provision were not meeting the requirements of the law.

When other health care professionals had given the provider specific instructions on how to care and support people these were not consistently followed putting people at risk of unsafe or inappropriate care.

People and their relatives knew how to raise a concern or make a complaint. There were systems in place for people, staff and visiting professionals to give their feedback on the service. Staff felt able to approach their managers and raise any concerns.

We found breach

The inspection took place on the 27 and 28 October 2016 and was unannounced.

The service is registered to provide accommodation and residential or nursing care for up to 33 people. The service does not providing nursing care. At the time of our inspection the service was providing residential care to 27 older people some of whom were living with a dementia. The home is over two floors and bedrooms have en-suites. People have access to a number of sitting areas including a TV room and a music room. Access to the first floor is by stairs or passenger lift. The ground floor provides access to a secure garden area.

The service has 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’s identified risks in relation to skin damage and malnutrition had not been consistently managed or actions taken in order to minimise the risks. Assessments had not been reviewed regularly and when referrals had been made to health practicioners these had not been followed up. Food and drink charts were being completed but the information was not being reviewed to establish people’s risk of malnutrition. Equipment was in place to support people at risk of skin damage but this was not being used correctly. Staff did not always have up to date information about changes to people’s risks.

Auditing systems were in place but they had not always recognised areas that needed improvement. When areas had been identified actions had been taken to improve outcomes for people.

People, their relatives and visiting professionals told us there were not always enough staff to support people in a timely way particularly at weekends. Staffing hours had been assessed using a dependency tool and were higher than the tool calculated. However this was not reflective of people’s experiences. We have made a recommendation about staffing levels.

People were supported by staff that had been recruited safely and had been trained to recognise any unsafe practice or potential abuse and understood their role in reporting this. Staff received an induction and on-going training that enabled them to carry out their roles effectively. Staff felt supported in their roles and had regular supervision. Opportunities were available for staff’s personal development.

People’s medicines were ordered, stored and administered safely by competent staff that had completed medicine administration training. Peoples prescribed creams were being administered but not always recorded correctly. People had access to healthcare when it was needed.

Staff supported people’s ability and choices about their day to day care and obtained consent in line with the principles of the mental capacity act. People and their families knew how to make a complaint and felt they would be listened to and any actions needed would be taken.

Peoples eating and drinking needs were understood by care staff and the catering team and included specialist diets and allergies. The menu offered a variety of main meals and snacks and catered for individual likes and dislikes.

Care staff were kind, patient and friendly and respected people’s privacy and dignity. They had a good understanding of peoples communication needs and used different techniques to ensure that people were involved in decisions. Staff had a good understanding of people’s interests, likes and dislikes. This meant that staff could have conversations with people about things that were important and of interest to them.

People had care and support plans that detailed how they wanted to be supported. People and their families were involved in decisions related to their care and advocacy services were available if needed. R

This was the first inspection of Bradbury Care Home since it became registered on 12 January 2015.

When we visited there no registered manager in post but the provider was in the later stages of applying to register a manager at the home. The previous manager resigned their position in August 2015. 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.

Bradbury Care Home provides care and support for up to 33 older people. At the time of the inspection there were 18 people living at the home.

The recording and storage of medicines was not safe and put people at risk of harm. We found that medicines were not always stored in safe and clean environment. We also found that when staff hand wrote people’s names on medication mistakes had been made. We also noted that peoples care records did not consistently illustrate the medicines they had been prescribed. This put people at risk of receiving medicines inappropriately.

The risks people faced around mealtime were not consistently known to staff. Whilst care records illustrated foods that were harmful to people when we asked care and catering staff about this issue they were unaware of the professional guidance that had been obtained. This put people at risk of harm through choking.

Staffing levels at the home were not consistently sufficient to meet people’s needs and aspirations. Staff told us they would like to do more to give people a more fulfilled life but at times this was not possible. The staff were not organised in such a way as to meet peoples social needs and were mainly organised around the support tasks they had to carry out.

People told us that the staff were “Very kind and caring, they try” and “the staff are very patient and kind”. However one person told us they felt as they were more able, they received less attention than those with memory problems. They also said that “staff made them feel at home and treated them ok”.

The provider had not ensured there were activities to meet most people’s social and emotional needs on individual basis. For those that could entertain themselves equipment such as a computer or jigsaws were available, but for those who require more motivation and staff encouragement activities and stimulation had not been provided in a planned manner.

The provider had systems in place to ensure the quality of the service was regularly reviewed and improvements were made but this had not been kept up to date. This meant that some areas of the care and support people received were not regularly audited and areas for improvement not recognised. Whilst the staff knew people’s needs well, the records relating to people’s care and support were not always up to date.

The provider was meeting the requirements of the Mental Capacity Act 2005 and assessments of people’s capacity had consistently been made. The staff at the home understood some of the concepts of the Act, such as allowing people to make decisions for themselves.

People and their relatives were given information about the running of the home and how they could comment on areas for improvement.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.