About the service:

Bosworth Care Home is a residential care home registered to provide care for up to 20 older people who require personal care. Some of the people at the home were living with dementia. The home does not provide nursing care. At the time of the inspection there were 14 people living in the home.

Rating at last inspection:

At our last inspection we rated the home Requires Improvement (published 05 April 2018) as we found shortfalls in the medicines management, infection control, cleanliness of the home and ensuring the equipment and premises were safe. In addition, the systems to assess and manage the safety and quality of the service had not identified these shortfalls. At the last inspection we found three breaches of the Health and Social Care Act 2008 and associated Regulations. This service has been rated Requires Improvement at the last two inspections.

At this inspection we found the shortfalls had been addressed and the rating had improved.

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People told us they felt safe and happy living at Bosworth Care Home. The staff demonstrated a good understanding of how to meet people’s individual needs and wishes. People’s desired outcomes were known, and staff worked with people to help achieve these. People were supported and encouraged to retain their independence and live their lives as fully as possible.

People were supported to maintain contact with those important to them including friends, family and other people living at the home. Staff understood the importance of these contacts for people’s health and well-being. Staff and people were observed enjoying warm and mutually beneficial interactions. Staff knew people well and what made them individuals.

The management of the home were well respected and promoted an open and transparent approach. Staff had a good understanding of their roles and responsibilities and were supported to reflect on their practice and pursue learning opportunities. The staff team worked and got on well together demonstrating team work and flexibility.

Quality and safety checks helped ensure people were safe and protected from harm. This also ensured that practice standards were maintained and improved. Audits helped identify areas for improvement and this learning was shared with staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Bosworth 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.

This unannounced comprehensive inspection took place on 23 and 26 January 2018.

Bosworth Care Home is in Weymouth and can accommodate up to twenty older people. At the time of the inspection fourteen people were living at the home.

The home had 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.’

At our last inspection in December 2016 the home was rated as requires improvement. We identified areas for improvement in relation to the safe storage of medicines, the recording of people’s Mental Capacity Assessments and subsequent best interests decisions, the activities provided and the governance systems.

At this inspection we found three breaches of the regulations.

People received their medicines as prescribed but some people did not have ‘as needed’ PRN medicine plans in place and there were some recording shortfalls.

On the first day of the inspection the home was not clean, some areas of the building and equipment were not safe and there were infection control risks to people.

There were not enough staff on duty. This had impacted on the safety and quality of the service people received and the environment.

There were governance systems in place to assess and improve the quality and safety of the service. However, the systems in place were not fully effective as they had not identified the shortfalls and breaches of regulation found at this inspection.

The registered manager and provider took action to address the majority of risks to people’s safety and staffing levels between the first and second day of inspection three days later.

People felt they were safe and there were systems in place to safeguard people. Staff had completed training in safeguarding people and spoke knowledgeable about how to raise concerns if they suspected people were being abused.

People told us they liked living at Bosworth Care Home and said the staff treated them with kindness and warmth. Relatives were very happy with the care and service provided by the home. Staff knew people well and cared for them in the way they preferred. Staff spoke to people in ways which showed they valued and cared about them.

Staff were recruited safely and they were trained and had they opportunity for development. Staff told us they were supported by managers at the home and felt invested in.

People’s needs were assessed and planned for. People had good access to healthcare and staff referred people appropriately to health care professionals.

People and relatives told us they knew how to make a complaint and said staff listened to them and took action if they needed to raise concerns or queries.

People were provided with a choice of healthy home cooked food and drink that ensured their nutritional needs were met.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 19, 21 and 23 December 2016.

Bosworth Care Home is registered to provide accommodation and personal care for up to 20 people in a residential area of Weymouth. At the time of our inspection there were 17 older people living in the home.

There was a registered manager in post at the time of 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.

Care plans did not reflect that care was being delivered within the framework of the Mental Capacity Act 2005 when people did not have clear capacity to make decisions for themselves. However, staff showed they understood the importance of enabling people to make their own decisions wherever possible. They also understood the need to provide care that is in a person’s best interests when people could not make decisions for themselves. The registered manager started work to rectify this omission during our inspection. Deprivation of Liberty Safeguards had been applied for where a person who needed to live in the home to be cared for safely did not have the mental capacity to consent to this.

People told us they didn’t have enough to do and we found that they did not have access to meaningful activity as described by Bosworth’s Statement of Purpose. We spoke to the registered manager who assured us they would resume active recruitment for an activities coordinator after the festive period. We have made a recommendation about ensuring people have access to meaningful activity.

We identified that issues identified during our inspection were not covered by the quality assurance processes and discussed this with the Registered Manager. They made immediate changes to their auditing process to ensure these areas were checked regularly. Other quality assurance had led to improvements being made and people, relatives and staff were invited to contribute their views to this process. Where improvements were identified as necessary following feedback action had been taken. Staff, relatives and people spoke positively about the management and staff team as a whole.

People felt safe. They were protected from harm because staff understood the risks people faced and how to reduce these risks. They also knew how to identify and respond to abuse. People also told us they saw health care professionals when necessary and were supported to maintain their health by staff. People’s needs related to on going healthcare and health emergencies were met and recorded. Staff did not keep accurate records related to the creams people were prescribed and this meant it was not possible to know if the creams had been administered. People received their other medicines as they were prescribed.

People received support and care from staff who had been safely recruited. The staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet those needs. They told us they felt supported in their roles and had undertaken training that provided them with the necessary knowledge and skills. There was a plan in place to ensure staff received the training they needed to stay up to date with the care needs of people living in the home.

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