About the service: The Borrins Care Home is a 25 bedded residential care home for older people and people with physical disabilities. At the time of our inspection there were 19 people using the service.

People’s experience of using this service:

At our last inspection in August 2017 the service was ‘good’ in all of the key questions and ‘good’ overall. Since then the service had been taken over by a new provider HC-One Oval Limited who were trying to sell the home.

At this inspection we found the service had deteriorated to ‘requires improvement’ in four of the key questions and ‘requires improvement’ overall.

There were not enough staff to keep to people safe and meet their care needs. Staff were not always available to provide the necessary supervision to people who were at risk, for example, of choking or falling. The lack of staff also impacted on the activities programme as the activities co-ordinator was frequently providing personal care.

Staff training was not up to date and staff did not feel supported and told us staff morale was poor. Staff supervisions and appraisals were not up to date.

Staff were recruited safely. People using the service and relatives spoke well of the care staff and told us there was a nice friendly atmosphere in the home.

Some improvements need to be made to ensure medicines were managed safely and available to people as prescribed.

People who used the service were very complimentary about the meals. The chef was very aware of people’s individual preferances and catered for these.

Care plans for people using the service were in the process of being up dated. Some information did not reflect people’s current needs and the support they required from staff. Risk assessments were in place but action had not always been taken to reduce or eliminate identified risks.

Appropriate referrals were being made to the safeguarding team when this had been necessary.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

Audits and checks were carried out, however, these were not always effective in identyfing areas which needed to be improved.

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.

More information is in the full report.

Rating at last inspection:

Good (report published 25 August 2017).

Why we inspected:

This inspection was brought forward due to information of concern. We had received eleven notifications since the last inspection regarding people developing pressure ulcers. We had also received concerns there were not enough staff on duty to make sure people’s needs were met.

Enforcement:

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around staff training and support and governance. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

As the service has been rated ‘requires improvement, we will request an action plan from the registered provider about how they plan to improve the rating to Good. In addition, 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.

This inspection took place on 1 August 2017 and was unannounced.

The Borrins Care Home has a total of 25 beds and is part of BUPA Care Homes Limited. It provides accommodation and personal care services for older people. The home had been and was still in the process of extensive redecoration and refurbishment. This was providing people who used the service with a clean, comfortable and homely environment. On the ground floor there were two lounges and a dining room and plans were underway to provide a ‘coffee shop’ and hairdressing salon. The bedrooms were on ground and first floor level and there was a passenger lift available for people to use. All of the bedrooms were single occupancy and 13 had en-suite facilities. There was a car park to the front of the building and large gardens which had benefitted from new, substantial garden furniture. On the day of inspection there were 23 people living at the home.

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.

We found since the last inspection of the service in August 2016 improvements had been made regarding medicines and care records were being kept up to date.

We saw staff was kind and caring and there were enough of them to keep people safe and to meet their care needs. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where they could discuss their on-going development needs.

Care plans were up to date and detailed exactly what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. We saw appropriate referrals were being made to the safeguarding team when this had been necessary.

People’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a choice of meals and said the food was good. We also saw there were plenty of drinks and snacks available for people in between meals.

We found the service was working within the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards and that staff had a good understanding of how these principals applied to their role and the care they provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Activities were on offer to keep people occupied both on a group and individual basis.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The registered manager provided staff with leadership and direction and was described as being very approachable.

There was a quality assurance monitoring system in place that was designed to continually monitor and identify any shortfalls in service provision.

People who used the service and relatives were asked for their opinions about the way the service was managed through meetings and surveys.