This was an unannounced inspection, which took place on 13 and 14 September 2018. Bassett House 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.

Bassett House provides accommodation with nursing and personal care for up to 63 people, some of whom have dementia. Accommodation is provided in one adapted building. The building has three floors accessed by a lift or stairs. There are communal lounges, dining areas and small satellite kitchens. At the time of the inspection, 54 people were living at the service. Five of the rooms were for people to stay for a short period of ‘intermediate care’. This gave people the opportunity to regain their independence after leaving hospital before returning home, for example after an injury or planned surgery.

At our last inspection in June 2017 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. We issued the service with five requirement notices.

At this inspection the service had made all of the required improvements and we rated the service Good.

The home 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. Statutory notifications had been submitted to us to inform us of incidents as required.

The registered manager was supported by a deputy manager and both were visible. People, their relatives, healthcare professionals and staff all told us they thought the registered manager was open and approachable.

People’s medicines were managed safely. Registered nurses administered medicines as prescribed and we observed their practice to be safe. Staff had additional guidance (protocols) for medicines prescribed to be taken ‘as required’ (PRN) and they explained when medicines could be given.

Care plans were detailed and contained guidance for staff to make sure people were supported safely. Risks had been identified and there were risk management plans in place. These had been reviewed regularly. End of life care had been provided with support from the relevant healthcare professionals. People had been given the opportunity to record their end of life wishes.

We have made a recommendation about the provision of care plans for people who required 1-1 support.

There were quality monitoring systems in place for all areas. Where actions and improvement was required this was completed and ‘signed off’ by the registered manager. All quality monitoring was shared with the provider so they could also have oversight of the service.

People were protected from potential abuse by staff that were trained and understood how to safeguard them. 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.

Recruitment practices were safe. Pre-employment checks had been completed to make sure suitable staff were employed. There were sufficient numbers of staff deployed to make sure people’s needs were met. The registered manager monitored people’s dependency levels with a tool so that additional staff could be deployed if needed.

Staff were trained and supported. Without exception people and their relatives told us staff were kind and caring. People appreciated the staff approach to their care which they all found to be positive. People had access to health professionals and other specialists if they needed them in a timely

Bassett House is registered to provide accommodation which includes nursing and personal care for up to 63 older people, some of who are living with dementia. At the time of our visit 57 people were using the service. Bedrooms are situated over three floors. There were communal lounges and dining areas with satellite kitchens on each floor with a central kitchen and laundry.

The service also provided five intermediate care beds. This service provides support to older people to help them avoid going into hospital unnecessarily and to help them to be as independent as possible after discharge from hospital before returning home.

We undertook a full comprehensive inspection on the 21 and 22 June 2017. The first day of the inspection was unannounced. During our last inspection at Bassett House in July 2016 we found the provider did not meet some of the legal requirements in the areas we looked at. After the previous inspection the provider wrote to us with an action plan of improvements that would be made to meet the legal requirements in relation to the law. We found on this inspection the provider had taken some steps to make the necessary improvements.

A registered manager was employed by the service and was present throughout our 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.

There were arrangements in place for the safe storage and administering of medicines as prescribed. However, where people were administered medicines covertly appropriate processes had not been followed and there was no evidence that decisions were undertaken in the person’s best interest. Protocols for “as required” medicines were not of a consistent good quality.

The service did not always act in line with current legislation and guidance where people lacked the mental capacity to make certain decisions about their support needs. Mental capacity assessments had not been undertaken and there was no evidence that discussions had taken place to make decisions in the person’s best interest. We saw that people were supported with making decisions around their care. Staff sought people’s consent before providing them with care and support.

During our last inspection some care plans did not contain up to date assessments. Whilst improvements had been made some sections of care plans still lacked person centred information and guidance for staff.

Staff were aware of their responsibilities to keep people safe. They had the knowledge and confidence to identify safeguarding concerns and knew what actions to take should they suspect abuse was taking place. Whilst risks to people’s personal safety had been assessed and plans were in place to minimise these risks they did not always provide enough guidance for staff on how to reduce the risks.

Whilst the provider had systems in place to monitor the quality of service to ensure improvements were identified these had not picked up the areas needing improvement we had noted.

Staff spoke passionately about wanting to provide people with a high standard of care. People were supported by staff that had gotten to know them well. People were treated with kindness and compassion in their day-to-day care. People and their relatives spoke highly of the staff and the care and support they provided.

There were sufficient numbers of suitably trained staff to keep people safe and meet their individual care and support needs. People were supported by staff who received on-going training and support to enable them to deliver effective care and support. Safe recruitment practices were followed before new staff were employed to work with people. Checks were undertaken to ensure staff were of good character and suitable for

Bassett House provides accommodation which includes nursing and personal care for up to 63 older people, some of who are living with dementia. At the time of our visit 56 people were using the service. Rooms are arranged over three floors .There were communal lounges and dining areas with satellite kitchens on each floor with a central kitchen and laundry. The home is situated in a residential area on the outskirts of Wootton Bassett.

We carried out this inspection over two days on the 13 and 14 July 2016. The first day of the inspection was unannounced. Two inspectors and a pharmacist inspector attended the inspection on the 13 July 2016. The same two inspectors and an expert by experience attended the inspection on the 14 July 2016. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. During our last inspection in May 2015 we found the provider did not meet some of the legal requirements in the areas that we looked at.

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.

Medicines were not always managed safely. Records pertaining to the safe administration of medicines were not always completed correctly. Medicine administration records did not always contain all relevant protocols and advice for administration, including detailed ‘as necessary’ (PRN) protocols.

Staffing rotas reflected the staffing levels identified by the dependency tool. However, some staff members, people and relatives said there were on occasions not enough staff present and this concerned them.

Whilst people were supported to eat and drink food and fluid charts were not always completed which meant it was not always possible to determine whether people had received sufficient fluids and food.

Staff showed concern for people’s wellbeing in a caring and meaningful way and they responded to people’s needs when required. People were treated with kindness and compassion in the day to day care. People and their relatives were mostly positive regarding the care and support provided by staff.

People and their relatives were involved in developing their care, support and treatment plans. Care plans were personalised and detailed daily routines specific to each person. However some care plans did not contain up to date assessments. This meant people’s care plans were not always in line with their needs.

The staff had received appropriate training and supervision to develop the skills and knowledge needed to provide people with the necessary care and support. Staff received regular refresher training and attended a range of training which included training specific to the needs of people using the service, for example dementia awareness. Safe recruitment practices were followed before new staff were employed to with people.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Senior management and staff had a good understanding of supporting people to make decisions and choices.

There were systems in place to monitor the quality and safety of the service provided. Where required actions to improve the service had been identified and acted upon. People, relatives and staff were encouraged to share their views on the quality of the service they received.

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

This inspection was a follow up to our last inspection in May 2014. The provider sent us an action plan on 29 June 2014 and told us they were going to employ a variety of methods to ensure medicines were administered safely. These included further training for staff, providing more qualified staff and using more robust methods of auditing medicines. The provider stated that they would be compliant by 15 August 2014.

This inspection was carried out by a pharmacist inspector to assess what the provider had done in response to the action we had told them to take with regards to the safe management of medicines.

Is the service safe?

We found the service was safe because people were protected against the risks associated with medicines.

Two inspectors, one of which was a pharmacy inspector, visited the home and answered our five questions, Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. Additionally we used the Short Observational Framework for Inspection (SOFI) tool for a forty minute period.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care plans instructed staff how to meet people’s needs in a way which minimised risk for the individual. People's diversity, values and human rights were respected. People were treated with respect and dignity by the staff.

Mental Capacity Act 2005 assessments were included, as appropriate in all plans of care. Staff understood mental capacity, consent, choice and deprivation of liberties safeguards (DoLS).

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home liaised effectively with the local authority DoLS team and had made applications as appropriate. The home had not made any DoLS referrals in 2013 or 2014.

We found that medication was not administered and recorded in a way which kept people as safe as possible. We have asked the home to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the unsafe use and management of medicines.

The home had robust recruitment procedures and checked, as far as possible, that candidates were safe and suitable to work with vulnerable people. People told us they had never experienced any poor treatment and felt very safe in the home.

Systems were in place to make sure that the manager and staff continually monitored the quality of care offered to people. We received no negative comments about the care the home offered to the people who lived there.

Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People told us they were: ‘‘treated very well’’. One person told us that they were: ‘‘very glad’’ they had chosen the home. They said: ‘‘I really couldn’t have done better’’.

People’s health and care needs were assessed with them, and/or their relatives, as appropriate. Care plans were detailed and clearly identified people’s needs and how they should be met. They were reviewed regularly and changes were made to meet people’s changing needs.

Is the service caring?

People were supported by kind, caring and patient staff. We saw that care staff responded quickly and sensitively if people asked for or indicated that they needed help. People told us that they were treated with respect and dignity at all times and said: ‘‘staff always make me feel comfortable and never cause any embarrassment’’. They described staff as: ‘‘excellent, caring and patient’’.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

People told us that their relatives and friends were always made welcome in the home and as a result liked to visit. This resulted in people visiting them more often.

Is the service responsive?

The home had made changes and improvements as a result of ideas and discussions with people who live in the home and their relatives.

People knew how to make a complaint if they were unhappy. The home had received a number of complaints in 2013 and 2014. These were dealt with appropriately and actions taken, as necessary. People told us: ‘‘we are very confident that staff would listen to us and do what they needed to’’. Staff told us they were ‘‘absolutely confident that the manager listens to complaints and takes the proper steps’’. Relatives described minor issues that were ‘‘put right immediately’’.

Is the service well-led?

Staff members told us that they were supported to do their job well and it was a very positive place to work. They said that they felt valued and their views were listened to. People who lived in the home and their relatives told us that staff and the manager were very approachable, as was the provider who visited regularly.

The service had a comprehensive quality assurance system. We saw records which showed that identified shortfalls and ideas people put forward were addressed. As a result the quality of the service was being maintained or improved.

People who lived in the home we spoke with told they were happy with the care and support they received. We were told that staff treated them with respect and that care and support was provided professionally.

We spoke with relatives of people who lived in the home. They told us the manager and staff communicated professionally with them and responded promptly to any issues they raised.

We found that staff were supported to undertake regular training.

We found that the home provided enough staff to meet peoples needs.

We found that the home had an effective complaints procedure in place. People living in the home and their relatives felt able to raise concerns or make a formal complaint if the need arose.

A full unannounced inspection of this home was completed in June 2012 when the service was found to be compliant with the outcomes which were inspected.

We undertook this subsequent inspection visit in response to concerns that had been raised and brought to our attention. These related primarily to the care and welfare of the people living in the home and the staffing levels that were provided. We found that the home was compliant in the areas inspected and was taking steps to improve the quality of service and address the concerns that had been raised.

People living in the home we spoke with told us they were satisfied with the care and support provided. People said they were treated well by the staff and generally had their needs attended to promptly.

We spoke to three relatives who were visiting the home. We were told that staff were always available when they visited and they were made to feel welcome in the home. We were told the staff communicated well with them and kept them informed of concerns or issues.

We observed that people appeared well cared for and interacted positively with the staff. The nursing staff organised and prioritised the care and support that was delivered. We saw that the staff worked well as team.

Changes and improvements were being made to the management structure of the home. An additional deputy manager had been recruited and one deputy now had the designated task of overseeing all clinical matters within the home.

People who lived in the home told us they were well treated by the staff and their dignity and privacy were respected.

People using the service told us that the home was always clean and tidy.

We were told the food was of good quality and that personal choice was catered for.

Staff said they worked well as team and were well supported by the management of the home. We were told that appropriate staffing levels were maintained.

This was the first inspection of Bassett House since it was registered with us in March 2011.

People and their visitors were satisfied with the care and support provided. We received lots of positive comments about members of staff.

Staffing levels were increasing as more people moved in.

Bassett House provides accommodation, nursing and personal care for up to 63 people. At the time of our inspection there were 51 people living there. The rooms are arranged over three floors. There is a communal lounge and dining area on each floor with a central kitchen and laundry. The home is situated in a residential area on the outskirts of Wootton Bassett.

The inspection took place on 21 and 22 May 2015. This was unannounced inspection. We carried out this inspection as we had received a number of concerns relating to the care being provided to people living in the home and low staffing levels. During the inspection we investigated the concerns that has been raised with us about care and support and found no evidence to substantiate these concerns. During our last inspection in May 2014 and a follow up visit in November 2014 we found the provider satisfied the legal requirements in the areas that we looked at.

At the time of our inspection the home did not have a registered manager. The management of the service was being overseen by the director of care and development and the deputy manager. A new manager had recently been recruited and was due to commence employment in June 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.

The director of care and development and staff had knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Deprivation of Liberty Safeguards is where a person can be deprived of their liberties where it is deemed to be in their best interests or for their own safety. Where necessary Deprivation of Liberty Safeguards applications had been, or were in the process of being submitted by the provider. However, the requirements of the Mental Capacity Act were not always followed when assessing people’s capacity to make decisions.

We looked at the care and support plans for eight people and found that guidance did not always reflect people’s current needs and identify how care and support should be provided. This meant people were at risk of inconsistent care and/or not receiving the care and support they needed.

Systems were in place to protect people from abuse. Staff knew how to identify if people were at risk of abuse and what actions they needed to take to ensure people were protected. People and/or their relatives told us they or their relative felt safe living at Bassett House.

People’s nursing and health care needs were met. Staff understood the needs of the people they were supporting. People were supported to maintain their physical health. Where necessary staff involved a range of other health and social care professionals to ensure people’s needs were met.

People were supported to have a balanced diet which promoted healthy eating. There were arrangements for people to access specialist diets where required. People told us they could choose what they wanted to eat each mealtime. If they did not like what was on the menu then they could ask for an alternative. There were snacks and drinks available throughout the day.

There were clear policies and procedures for the safe handling and administration of medicines. These were followed by nursing staff and this meant people using the service received the correct medicines at the right time of day.

Staff were appropriately trained and understood their roles and responsibilities. Staff had completed training to ensure that the care and support provided to people was safe and effective to meet their needs. Staff received a comprehensive induction and training to support them to carry out their roles correctly.

We found two 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 the report.