The Care Quality Commission (CQC) inspector said of Banbury Heights Care Home, Old Parr Road, Banbury: “We had received concerns in relation to how people's nursing needs were monitored and met, staffing numbers and skills and the overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.”
The overall rating for the service has changed from good in 2019 to requires improvement, based on the findings of this inspection which identified breaches in relation to medicines management, reporting of events involving people (notifications) and the provider's quality monitoring system.
“We found evidence that the provider needs to make improvements. Action was taken by the provider during the inspection to mitigate risks to people,” the report said. “We will continue to monitor the service and will take further action if needed. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect,” the inspector said.
"At our last inspection we rated this key question (well led) requires improvement. At this inspection the rating has remained requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.
"The provider did not have effective systems in place to monitor the quality and safety of the service. The provider's checks and audits had not identified all the shortfalls found on inspection. These included those relating to the management of people's medicines and submission of notifications to CQC.
“Systems to monitor people's daily care delivery were not developed enough to support the manager to check whether people had received their personal care as agreed. Where monitoring had identified areas for improvement, such as through falls analyses or complaints investigations, we saw lessons learned had been shared with staff. However, there was a lack of information about what action had been taken to improve practice and how these improvements had been monitored to ensure they were sustained.
“The provider had failed to ensure there were effective governance and quality assurance measures in place. The provider failed to notify CQC of five safety incidents in accordance with legal requirements to ensure CQC could monitor the action they had taken to keep people safe.
"There was a clear vision in place to provide person centred care and to ensure people's equality and diversity needs were respected. However, we saw staffs' approach was often task-focused with fewer meaningful interactions taking place with people. The provider had a process in place for monitoring staff interactions, but told us they would review this to ensure it resulted in improvements in this area.”
Banbury Heights Nursing Home is a residential care home providing accommodation for predominantly adults over 65 years, although it can support younger adults.
The care home has an agreement in place with local health and adult social care commissioners to support up to 17 people, who require further care and treatment directly following discharge from hospital. These short-term admissions are referred to as 'hub' admissions. At the time of the inspection, hub admissions were not taking place.
The care home can provide support to a maximum of 59 people. At the time of the inspection on April 27 – 28, twenty eight people were receiving support.
The report said that during the inspection medicines were not always appropriately managed which meant people were not protected from unnecessary risks and harm related to their medicines. Action was taken during the inspection to reduce medicines risks, for example, some necessary guidance records were completed.
Processes designed to protect people from abuse had not always been followed. The provider acted during the inspection to improve their monitoring of notification submissions. Notifications must be submitted to the Care Quality Commission when incidents between people take place so that the actions taken to protect people can be followed up to ensure people are protected.
The provider's quality monitoring processes had not always identified the shortfalls the inspectors identified during this inspection. Once informed about the shortfalls, the provider took action to make improvements. These improvement actions need to be sustained, the CQC said.
People told inspectors they felt safe. There were processes in place to assess risks to people and reduce or mitigate these. This included risks from the environment, equipment used and emergency situations such as a fire.
Successful and safe staff recruitment had ensured there were enough staff available to meet people's needs. There were effective infection prevention and control arrangements in place and people lived in a clean environment. Situations which had not gone to plan were reflected on and learning taken from these to avoid recurrences.
Work had been done on team building and a predominantly new staff team was working well. Feedback had been sought from people, relatives and staff and once the results were fully collated, this would be used to help improve the service, the report said.
The provider worked with partner agencies to ensure people could access the services of the care home when required.
Staff received relevant training and there were arrangements in place to support them with their learning and development needs.
The full report can be seen here.
The last rating for this service was good (published in November 2019). The CQC published its new report on on June 10.