This inspection took place on 8, 9 and 12 March 2018 and was unannounced. Badgeworth Court Care Centre provides accommodation for 65 people who require nursing and personal care. 53 people were living in the home at the time of our inspection. Badgeworth Court Care Centre is set over two floors. The home has three units which support people with different needs. Each unit has a lounge and dining room with an adjacent kitchen. People have access to a garden, coffee area as well as a hair salon.

Following our previous inspection a new registered manager had been recruited. 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. Two regional directors were also supporting the registered manager to make the required improvements we identified at our previous inspection.

When we previously inspected this service in August 2017, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not always receive personalised care, records did not always reflect the care people received and required and the provider’s quality monitoring did not always address all the risks in the service. We rated the service ‘Requires Improvement’ overall. The provider had sent a report to CQC detailing the improvements they would be making to address the shortfalls we found.

At this inspection we found some improvement had been made however, there had been some delay in addressing all the concerns due to another management and several staff changes. Although the provider has started the process to rectify these issues since the inspection, they have yet to complete the works to ensure people's safety. We have again rated the service ‘Requires Improvement’ overall.

The provider had employed a new clinical lead to support with monitoring people's nursing care. We found an increased scrutiny of people’s nursing care was taking place following our previous inspection. The clinical lead had a good understanding of people’s needs and regular nurses meetings were being held to track and evaluate people’s treatment. A range of checks and audits upon the quality and safety of the service were being completed on a daily, weekly and monthly basis. Some were effective and others required further work to embed them and to make them fully effective.

Action was being taken to improve people’s care records. However, we found time was needed before these improvements would be completed in all people’s care plans and daily records across the service.

The provider had not ensured that the required pre-employment information was available for all staff recruited to demonstrate their suitability for their role with people.

People received their medicines from nurses and senior carers as prescribed. However, improvements to medicine practices were needed to ensure medicine were managed safely in accordance with current best practice guidelines.

We found following our previous inspection improvements had been made to the activities and social opportunities available to people. The service was making progress in ensuring people's end of life wishes were promptly documented in accordance with the provider’s end of life procedures Throughout our inspection we saw examples of staff responding promptly to people’s needs. However, more time was needed to ensure people would always receive staff support when needed, without delay, especially during meal times.

Staff told us they felt increasingly supported. Following our previous inspection staff had received additional training, team meetings took place and plans were in place for supervision to be completed.

Improvements had been made to the meal options and people and their relatives to

This inspection took place on 20, 21 and 22 August 2017 and was unannounced. Badgeworth Court Care Centre provides accommodation for 65 people who require nursing and personal care. 56 people were living in the home at the time of our inspection. Badgeworth Court Care Centre is set over two floors. The home has three units which support people with different needs. Each unit has a lounge and dining room with an adjacent kitchen. People have access to a garden, coffee area as well as a hair salon.

There was no registered manager in place as required by the provider’s conditions of registration. 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. However an interim manager was in place who was planning to submit an application to CQC to become the home’s registered manager until a permanent manager was recruited to ensure the provider would meet their registration requirements.

We inspected the home as we had received concerns about the quality of service being delivered to people who lived at Badgeworth Court Care Centre. These included concerns about the cleanliness of the home, the quality of food available, the support people received to eat as well as the number of staff available. This inspection was also prompted in part by the provider’s notification to CQC of a significant event. The information shared with CQC about the incident indicated potential concerns with the end of life care people received. This inspection examined those concerns and reported on the findings in the caring and well-led questions. This incident is subject to a separate coroner’s inquest and as a result this inspection did not examine the circumstances of the incident.

Our previous comprehensive inspection of the home was completed on 5 February 2016 and the home was rated ‘Good’ overall. At this inspection we found improvements were needed across all five domains and the provider had not maintained their previously awarded ‘Good’ rating. This is the first time the service has been rated Requires Improvement overall.

The provider had identified shortfalls in the service people received prior to our inspection.

A new interim manager had been allocated to the home by the provider to assess the care being provided and drive improvements across the home. They were being supported by specialist advisors from the provider as well as the regional manager. People, relatives and staff told us they were not always confident the improvements would be made, sustained and embedded in the home.

We found the interim manager and provider representatives understood the improvements that needed to be made to the service. They had started putting arrangements in place to reduce the impact the service shortfalls would have on people whilst the provider was completing their improvement plan. However we found these arrangements were not always effective and people did not always receive quality care whilst the provider’s monitoring systems were being embedded and improvements were being made.

We found that people who were at the final stages of their life could not always be assured that they would receive personalised end of life care. Delays in planning people’s end of life care meant people were not promptly given support to make decisions about their care preferences. Staff might therefore miss the opportunity to tailor people’s care at the end of their lives to their wishes.

People were supported to access health care services when their medical needs had changed and received their medicines as prescribed. We received mixed comments about the quality of food people received. We found that people’s dietary needs were catered for however people who lived with dementia were

We carried out an unannounced focused inspection of this service because we had received some information of concern. We have only looked at the areas of ‘Is the service safe?’ and ‘Is this service effective?’ as the concerns sat within these domains.

This inspection took place on 28 February 2017. Badgeworth Court Care Centre provides accommodation for 65 people who require nursing and personal care. 53 people were living in the home at the time of our inspection.

Badgeworth Court Care Centre is set over two floors. The home has three units which support people with different needs. Each unit has a lounge and dining room with an adjacent kitchen. People have access to a secure garden, coffee area as well as a hair salon.

A registered manager was in place as required by their conditions of registration; however they were unavailable on the day of our inspection. The clinical lead therefore supported us during the inspection. 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 nutritional and dietary needs had been assessed and were catered for. People’s risks of choking or malnutrition had been assessed. Control measures had been put into place to eliminate any risks such as soft diets or fortified foods. Their care plans provided staff with the guidance they needed to support people with food and drinks. People were weighed regularly to ensure they maintained their weight. Where needed people’s food and fluid intake was monitored. People were referred to the relevant health care services if they experienced changes in their wellbeing and nourishment.

There were sufficient staff on duty to support and monitor people eating their meals. Staff were knowledgeable about people’s specialist diets and preferences. We observed people being offered a choice of meals and being provided with a meal to suit their dietary needs or preferences. The kitchen staff were aware of those people who required a specialised diets such as soft texture or diabetic diet. Most staff had been trained in food safety and supporting those people who were at risk of choking.

Whilst we found good practices in relation to people’s dietary needs, we have not changed the ratings of this service as we did not inspect all areas of the domain. Therefore this report only covers our findings in relation to these specific areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Badgeworth Court Care Centre’.

This inspection took place on 5 and 8 February 2016 and was unannounced. Badgeworth Court Care Centre provides accommodation for 65 people who require nursing and personal care. 58 people were living in the home at the time of our inspection. This service was last inspected in January 2014.

Badgeworth Court Care Centre is set over two floors. The home has three units which support people with different needs. Each unit has a lounge and dining room with an adjacent kitchen. People have access to a secure garden, coffee area as well as a hair salon.

A registered manager was in place as required by their conditions of registration. 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 had been in post since August 2015.

People told us they enjoyed living at the home and they felt safe. Their support needs and risks were mainly managed well. There were sufficient numbers of staff to meet people’s basic needs; although some people were not always effectively monitored. However the registered manager and provider took immediate action to increase the staffing levels and put formal systems in place to monitor people who were left unsupervised or who were at risk.

The employment and criminal history of most staff had been suitably checked and vetted, although there were gaps in recruitment procedures of two staff files. However, new staff were appropriately supported and mentored in their probation period to ensure they were suitable to care for people. Staff told us they felt supported and trained and supported to carry out their role. Staff had access to additional training if required.

Systems were in place to ensure people’s medicines were ordered, stored and administered as prescribed. However the home’s medicines policy did not reflect practices of people who required different support with the management of their medicines or those who may require medicines as required.

The home was undergoing a refurbishment programme. On-going plans were in place and being implemented to provide an environment and items which would help orientate and stimulate those people who lived with dementia. The home was regularly maintained and cleaned to ensure people were free from harm and the risk of the spread of infection. Staff were aware of their responsibilities and systems to ensure people were safe.

Both people and their relatives complimented the caring nature of staff. We received many positive comments about the home. Staff delivered compassionate care which was focused on people’s individual needs. They were knowledgeable about people’s wishes and preferred way to be supported. Staff respected people’s decisions and provided support when requested.

A wide range of activities were provided for people in and out of the home. Most people were encouraged to partake in activities, however some people felt socially isolated in their bedrooms

People told us they enjoyed the meals and food provided. Their dietary needs and preferences were catered for.

The registered manager and senior staff had a good understanding of their role and how to manage the quality of the care provided to people. Quality monitoring systems were in place to check and address any shortfalls in the service. People’s complaints and concerns were taken seriously. Where concerns had been raised by people and their relatives these had been investigated into and discussed with the complainant.

People told us they enjoyed taking part in the activities available at the home. One person said “I like doing bingo", and another told us they go to the library in Gloucester. Another told us how much they like to read but said “it’s a shame there is no longer a mobile library”. One person said “I like the art group and went to the hen party (for the Royal Wedding)” and another said “I go for a swim and enjoy this”. One person said “I spent yesterday sitting in my wheelchair all day because there were no activities” while another said “I like the gardens and my children and grandchildren visit often”. On the morning of our visit, several of the residents had been out strawberry picking locally and told us how much they had enjoyed this.

People told us that they were happy with the care they received at the home. People said “the staff are magnificent”, “staff work hard”, “the staff are very good”, “they are marvellous” “I have no gripes” and “the staff are fabulous”.

People told us they enjoyed the food provided at the home. We received comments such as “the food is great”, “there is too much of it, I need to lose weight”, “we have lots of choice and the puddings are delicious” and “the food is lovely”.

We used a number of different methods to help us understand the experiences of people using the service. This was because some people using the service had complex needs which meant they were not all able to tell us their experiences. We observed staff interacting with people and spoke with staff about people's needs and examined their care records. People made the following comments; "staff are always looking in on you”, “staff get to know you, they say you are not yourself today, is there anything we can do for you?" and "we are very close here, we are one big happy family". People told us they felt safe and well cared for. They also said they would tell a member of staff if they had any concerns about their treatment or other difficulties. One person said "I have no worries about anything here, anything that crops up here, I go to the boss and she sorts it that day or the next day".

We found people had detailed care plans and risk assessments in place for all assessed needs. These were kept under review and updated as required. People had access to external professionals, for example, GP's, social workers, dentists and chiropodists.

There were arrangements in place for monitoring the services provided.

Before people received any care or treatment they were asked for their consent and the service acted in accordance with their wishes. Where people did not have the capacity to consent, a system was in place to make sure any decision was made in their best interest.