We inspected Bafford House on the 29 March and 3 April 2018. Bafford House is registered to provide accommodation and personal care to 19 older people and people living with dementia. The service is split over three floors with communal spaces on each floor, there were 16 people living at Bafford House at the time of our inspection. The service has a large garden which people could enjoy and close to a range of local amenities. This was an unannounced inspection.

We last inspected the home on 12 and 13 April 2017 and rated the service as “Requires Improvement”, with the question ‘Is the service well led?’’ being rated as “Inadequate.”

We found that there were not always effective management systems in place to maintain and improve the quality of the service. Staff did not always maintain an accurate record of people’s care and wellbeing needs. Care staff did not always receive effective training and supervision and the provider did not always ensure care staff were of good character. Following the inspection in April 2017 we imposed a condition on the registration of the provider. The provider was required to send us bimonthly information on the actions they were taking to improve the quality of service people received.

At this inspection we identified significant improvements had been made however some of these systems required more time to be embedded to ensure they were sustainable. For this reason we have rated Bafford House as ‘Requires Improvement.’

There was a manager registered with CQC at the service and the registered provider worked in the home on a daily basis. The provider had recruited a manager as the registered manager had reduced their presence within the home, however was still involved in providing management support. 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 living at Bafford House. There were enough staff deployed to ensure people’s needs were being met. The provider had recruited more care staff which meant the service was less reliant on the support of agency staff. People received the support they required to meet their health and wellbeing needs. People enjoyed engaging and interacting with care staff.

Care staff treated people with dignity and ensured they had their nutritional needs met and received their medicines as prescribed. Care staff were aware of and met people’s individual dietary needs. Staff spoke positively about the support and communication they received. All care staff felt the provider and manager were approachable and that they had access to the skills and support they required to carry out their role.

People and their relatives felt their concerns and views were listened to and acted upon. Relatives told us the management team was responsive and approachable. The provider and care staff worked alongside healthcare professionals to ensure people’s ongoing needs were met. The provider ensured lessons were learnt from any concerns and complaints to improve the quality of the service.

The manager and provider had implemented systems to monitor and improve the quality of service people received at Bafford House, including a detailed electronic care planning system. While a range of improvements had been made, improvements regarding people’s care records, incident and accidents, medicine management and the monitoring of quality required further time to be embedded.

We inspected Bafford House on the 12 and 13 April 2017. Bafford House is a residential home for up to 19 older people. Many of these people were living with dementia. 19 people were living at the home at the time of our inspection. This was an unannounced inspection.

At our inspection on 12 and 13 April 2017 there was a registered manager in post who was also the provider of the service. 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.

We last inspected in September 2016 and found that the provider was not meeting a number of the regulations. We found that people were not always protected from the risks associated with their care and people’s legal rights were not always protected. Additionally people could not always ensure a safe environment was maintained. The provider did not have effective systems to monitor the quality of the service. Additionally people did not always receive care which was personalised to their needs and an accurate record of their care was not maintained. Following our inspection in September 2016, we issued the provider with two warning notices in relation to safe care and treatments and good governance. The provider sent as an action plan of the actions they would take to meet the legal requirements. We found some improvements had been made however some regulations were not being met.

People and their relatives were generally positive about the home. They felt safe and well looked after. People enjoyed the food they received in the home and had access to food and drink. People felt there were enough activities; however activities care staff provided were not always documented.

The provider and registered manager had implemented systems to monitor and improve the quality of service people received, however these systems were not always effective and were not consistently applied. There was no current system to seek people and their relative’s views on the care people received. The provider and registered manager had not identified concerns we had identified during the course of this inspection.

People were now being protected from the risks associated with their care; however people’s care and risk assessments were not always reflective of their needs.

Staff were deployed effectively to ensure people’s basic needs were met and kept safe. However people could not be assured new staff were of good character as all recruitment checks had not been maintained. Care staff had not received all the training they needed to meet people’s needs. The provider and registered manager did not have an overview on staff training needs and competencies.

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

We inspected Bafford House on the 29 and 30 September 2016. Bafford House is a residential and nursing home for up to 19 older people. Many of these people were living with dementia. 17 people were living at the home at the time of our inspection. This was an unannounced inspection.

We last inspected in August 2015 and found that the provider was not meeting a number of the regulations. We found that people did not consistently receive safe care and treatment, because an assessment of their care needs had not always been written or maintained. Additionally staff did not always have access to the training and support which they required. The registered manager did not have effective systems to monitor and improve the quality of service people received and did not always notify us of notifiable events within the service. Staff did not always ensure people were protected from harm or identify if they had capacity to consent to their care. People did not always receive the support they needed to meet their nutritional needs. Following our inspection in August 2015, the provider provided us with a plan of their actions to meet the fundamental standards. However, during this inspection we found while some improvements had been made the service was not meeting a number of the fundamental standards.

At our inspection on 29 and 30 September 2016, 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 provider did not have effective systems to monitor the quality of service people received. Audits were not consistently carried out and did not address shortfalls in the quality of the service to drive improvements. There was no evidence that people and their relative’s views had been sought or acted on.

There were enough staff deployed to meet people’s day to day needs. However, there was a high level of agency staff working at the service who did not always know people’s needs when they started working at the home, There was a consistent management team in place who were managing the staffing levels, by recruiting staff.

People mostly received their medicines as prescribed at times. Where people could receive their medicines covertly, there was no clear guidance for staff to follow on how to ensure people received these prescribed medicines.

People were at risk of unsafe care and treatment as assessments of their needs had not always been completed. People’s care plans did not always reflect their needs or provide care staff with clear guidance to follow. People did not always receive care which was personalised to their individual needs.

People we spoke with were positive about the home. They felt safe and looked after. People enjoyed the food they received in the home and had access to food and drink. People did not always benefit from meaningful engagement from staff. Records did not always show if people had been involved or enjoyed activities and external entertainment.

We found four breaches 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.

We were unable to speak to people who used the service about the many improvements we had found as they had a diagnosis of dementia and were unable to enter in to conversation about this. People we met during the inspection looked relaxed and were treated kindly and respectfully by the staff.

Arrangements for assessing people's needs and planning their care had improved, as had the arrangements for managing people's risks. There was evidence to show that although many people had been unable to engage in this process, their representatives had been given opportunities to speak on their behalf. We found staff had clear guidance on how to meet people's needs and people's care had been delivered in line with their care plans. Improvements had been made to the arrangements for protecting people from abuse and inappropriate use of physical intervention. This meant, where minimal physical intervention might be required, guidance on what this entailed and how it was to be used in each person's case, was clear.

The new arrangements for staff training and staff support had started and we found staff had already begun to update their knowledge. Management staff were more engaged with the systems designed to help them assess and monitor the service. Some improvement to how staff recorded the care they gave was needed.

These improvements were in their infancy and will need to be sustained in order to fully provide people with the on-going protection they require.

Many people who used the service were unable to tell us about their experiences due to their mental frailness. Three people were able to tell us they liked where they were and that the people who helped to look after them were kind.

Managers were aware of the legal requirements under the Mental Capacity Act and were putting processes into place to ensure people who could not give consent were protected. Care was not always planned and delivered in a person centred way, with set routines and task orientated ways of working being evident. Arrangements, designed to safeguard people, were not always in place or not being followed. The arrangements for medicines were not robust enough to protect people from possible related risks.

At times there were not enough staff on duty to safely supervise people. Staff had not been supported well enough, either through training or example to always be able to demonstrate best practice. The service could not demonstrate that people's complaints and concerns were being managed . Record keeping was, in places, not accurate and sometimes absent. The home's policies and procedures were not always being followed. The processes we were told were in place, to monitor the service and staff practices, were ineffective and ultimately not benefitting or protecting the people who used the service.

This inspection was carried out in response to information received by us. Concerns had been raised about the safety of some aspects of the environment and food storage. Before carrying out this inspection we contacted an environmental health officer who told us that previous inspections had been carried out by their department but they had no current concerns. This inspection was an un-announced inspection. We found the service to be fully compliant with the regulation it was assessed against which was Regulation 15 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2010.

We also evidenced that the service had been inspected by the Food Standards Agency in April 2012 and awarded a rating of 5 (the highest rating awardable to this kind of premises).

The service had also been inspected by the Fire Safety Officer on 17 October 2012 and found to be compliant with the Regulatory Reform (Fire Safety) Order 2005 and other legislation.

This was a follow up inspection of the compliance actions issued by us following our inspection on 9 July 2012.

These related to a specific safety issue within the environment, the deployment of staff and arrangements for monitoring and improving the services provided.

During this inspection we found that all areas of required compliance had been met and that further improvements were work in progress.

We carried out a review of this service in response to information of concern received by us. In reviewing the service we also assessed other standards not included in the initial information. These are indicated throughout the report.

The provider informed us that they specialise in the care of people with dementia although the homes Statement of Purpose does not state this. Evidence supported the fact that the majority of staff have received appropriate training to do this, but that the environment is not conducive to supporting people with dementia and neither were the arrangements for staffing the home.

We only spoke to two people who were able to give a view on the care and support they were receiving. One person said the care was "absolutely marvelous". Another told us that they were supported to make choices and to be independent.

The home does not have a system for measuring and monitoring care provision and risks. The evidence would suggest that areas of non compliance have occurred because of this. Although there is evidence that people have been very happy with the care and support afforded to their relatives.

This unannounced inspection took place on 11, 12 and 13 August 2015.

Bafford House provides accommodation for up to 19 older people who require personal care. The service mainly cares for people living with dementia. The home is a detached house with accommodation on three floors. People have access to a communal lounge, two communal areas in the main hall and upper landing and a separate dining room. Some bedrooms have an en-suite facility and there is a bathroom on each floor. The gardens at the front and back were accessible for people. There were 13 people accommodated when we visited.

There was 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 relatives told us they thought the service was safe. Accident and incident records were not always completed and audited sufficiently to ensure people’s safety. People were not always supported by sufficient staff with the appropriate skills, experience and knowledge to meet their needs. A relative told us they were concerned about insufficient staff in the evenings.

Inadequate organisation of staff left people without supervision and support in the lounge and people were not repositioned in bed. We made a recommendation staffing levels are regularly assessed and monitored to meet people needs and protect them.

People’s medicines were not managed safely to ensure people received appropriate medicines. Medicines were stored safely but administration records were incomplete. Staffs medicine administration practice was monitored but the doctor’s instructions were not always followed correctly.

People were not protected by the Mental Capacity Act (MCA) when consent records were incorrect and capacity assessments had not been completed. There were some ’best interest’ decisions recorded for people without the capacity to make a decision but some decisions were incorrectly made by the staff.

The home was clean and free from offensive odours. Staff knew about infection control and the correct equipment to use to prevent cross infection. There was sufficient ancillary staff to maintain a clean environment and complete laundry tasks. The infection control policy required updating.

There was no choice of meals and people’s dietary requirements and food preferences were not fully met for their health and well-being. Food and fluid charts were not completed accurately to record people’s dietary needs were met. People told us they liked the meals and a relative told us that finger food was provided in the person’s bedroom when they were unwell. Special diets were catered for to include diabetic, vegetarian and fortified meals.

People had access to healthcare professionals to promote their health and wellbeing but there was a need to improve the information recorded for healthcare professionals to review progress. We made a recommendation robust records are maintained and are accessible for the appropriate period of time. A healthcare professional told us that recent end of life care for people was managed well by the service and referrals were made to them when necessary.

People looked well cared for. Most staff treated people as individuals and interacted with them positively giving them time to make choices. Relatives told us the staff were very caring and the care was good. We saw two staff did not always treat people with compassion, dignity and respect and required additional training to improve.

Relatives told us care plans had been reviewed with them but we were unable to access any records prior to July 2015 as they had been archived. The care plans we looked at were incomplete and had some blank records. The registered manager told us they were updating all the records. Some people had a ‘Journey through life’ record detailing their social history and a ‘This is me’ plan about their likes and dislikes but not all people had this information.

There were limited activities provided and staff told us they need more time to engage with people individually. We saw people playing a ball game with staff and relatives told us they completed puzzles, played skittles and sometimes sat in the garden.

The service was not consistently well managed and information required was unavailable. Quality assurance checks had not been regularly completed to ensure people were safe. People or their relatives had not been consulted about the quality of the service so that improvements were identified and made.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and (Registration Regulation) 2009 Regulations. You can see what action we told the provider to take at the back of the full version of the report.