CQC report explained · a residential care home
What the CQC found at Boston House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicines were not always managed safely. Fridge temperatures were sometimes outside the required range, medicine administration times were not always recorded, and staff did not always follow the home’s medicines policies.
- Effective?
- Good
- This key question was not inspected during this focused inspection. Its rating was carried over from the previous comprehensive inspection.
- Caring?
- Good
- This key question was not inspected during this focused inspection. Its rating was carried over from the previous comprehensive inspection.
- Responsive?
- Good
- This key question was not inspected during this focused inspection. Its rating was carried over from the previous comprehensive inspection.
- Well-led?
- Requires improvement
- Management and auditing systems had improved, but they had not identified or resolved all the medicines problems found by inspectors.
What inspectors found, February 2023
Rated Requires Improvement; inspectors found unsafe medicines management despite kind care, adequate staffing and some improvements in leadership.
This was an unannounced focused inspection on 22 and 23 November and 13 December 2022. Inspectors checked whether earlier problems with medicines and quality monitoring had been fixed. They spoke with people, relatives and staff, observed care, and reviewed care, medicines, recruitment and management records.
The home had enough staff, safe recruitment checks and suitable training. People and relatives said staff were kind, respectful and responsive. Risks were assessed, infection controls were in place, and staff worked with other professionals to support people.
Medicines were still not always managed safely. Staff did not always follow the home’s medicines policies, medicine administration times were not always recorded, and fridge temperatures were outside the safe range on numerous occasions. Inspectors found no evidence that anyone had been harmed, but said people were placed at risk.
The overall rating remained Requires Improvement. Safe and Well-led were both rated Requires Improvement. The home had been rated Requires Improvement at the previous two inspections as well, making three consecutive inspections with that rating.
Enough staff
Inspectors found enough staff with the right training and skills to meet people’s assessed needs. Staff were recruited with appropriate safety checks.
“There were enough staff employed with the right training and skills to meet people's assessed needs.” from the report
Kind and respectful care
People and relatives spoke positively about the staff. People said their privacy, dignity, views and equality were respected.
“People told us they were well treated and their equality and diversity respected.” from the report
Supportive communication
Relatives said staff kept them informed and were easy to contact. The home also responded to complaints and concerns.
“There is open communication all the time; staff carry a mobile so you can get hold of them.” from the report
Working with professionals
The home made appropriate referrals and worked with health and social care organisations to meet people’s needs.
“The provider worked well with other organisations to ensure people's needs were met; this included liaison with statutory health and social care bodies.” from the report
Medicines were not always safe
seriousStaff did not always follow the home’s medicines policies for medicines people took on leave. Administration times were not always recorded, creating a risk that doses could be given too soon.
“Staff were not always following the homes medicines and medicines related policies for providing 'leave' medicines.” from the report
Medicine fridge temperatures
seriousMedicine fridges were outside their required temperature range on numerous occasions. Inspectors could not be assured that medicines needing refrigeration were safe to use.
“We were not assured medicines that required storage in a fridge were safe to use.” from the report
Checks had not found all problems
needs fixingAlthough auditing and governance had improved, the home’s systems had not identified or resolved the medicines problems found during this inspection.
“The majority of the issues we identified at our last inspection in relation to medicines management had been addressed, however other medicines issues were identified during this inspection which auditing and governance systems had not identified or resolved.” from the report
- 01What changes have been completed in response to the medicines action plan?
- 02How do you record the actual time each medicine is given when doses need a specific interval?
- 03How are medicine fridge temperatures checked, recorded and acted on when they are outside the safe range?
- 04How do you check that staff follow the policy for medicines people take on leave?
- 05What evidence can you show that your audits now identify and resolve medicines problems promptly?
This was a focused inspection of Safe and Well-led, mainly to check earlier medicines and governance concerns; the other key question ratings and the overall rating were carried over from the previous comprehensive inspection. This explanation was written from the published report of 10 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, September 2021
Rated Requires Improvement; inspectors found kind, personalised care, but medicines were not managed safely and leadership oversight was not strong enough.
Inspectors visited on 16 June, 24 June and 14 July 2021. They spoke with people, relatives and staff, observed care, and checked care plans, medicine records, staff files and management records. The inspection was prompted partly by concerns about support for a person with complex needs.
The home provided caring and personalised support. People’s needs and risks were assessed, staff were trained, relatives were involved, and people were supported with healthcare, activities and communication. The ratings for Effective, Caring and Responsive were Good.
There were important safety and management problems. Medicine records were not always accurate, medicine supplies were not always secure, and the medicine audit had not found the problems inspectors identified. Some staff did not use PPE correctly, and some staff were not confident about what to do in a fire.
The overall rating was Requires Improvement. Safe and Well-led were both Requires Improvement. The home was still in breach of Regulation 12 from the previous inspection, and a warning notice was issued.
Kind and respectful care
Inspectors observed staff treating people with warmth, dignity and respect. Staff supported people to make choices about their care and daily activities.
“We observed interactions between people and staff and found that people were asked what they needed or how they wanted to be supported.” from the report
Personalised care planning
Care plans and risk assessments gave staff clear information about people’s needs, choices and preferences. Relatives were involved when people could not provide information themselves.
“People's views, choices and wishes were used to develop person centred care plans and records.” from the report
Staff training and support
Staff had a robust induction and relevant training. The management team had systems for supervision and support.
“The provider had effective systems in place to provide staff with robust training.” from the report
Family involvement and communication
Relatives said they were kept informed and involved in care planning. The home helped people maintain contact with family during the COVID-19 pandemic.
“Relatives told us they felt support was provided in a caring manner and had a positive impact on people's lives.” from the report
Medicines were not managed safely
seriousMedicine records contained inaccuracies, including administration instructions, identifying information, fridge temperatures and use of some medicines. Stock levels also showed that some people did not have a month’s supply, creating a risk they might not receive their medicines.
“Medicines were not managed safely. The provider had produced an action plan following the last inspection and there was evidence that actions had been taken to improve medicines management, including extensive staff medicines training.” from the report
Quality checks missed medicine problems
needs fixingThe medicine audit, including an independent audit, did not identify the same issues found by inspectors. The provider was asked to review its auditing and quality assurance systems.
“However, the medication audit, carried out by an independent auditor, hadn't identified the same issues we found at this inspection.” from the report
Fire safety confidence
needs fixingSome staff were not confident about what to do in a fire. The manager scheduled fire drills and said evacuation plans would be reviewed as a priority.
“However, staff did not always feel confident in what they would need to do in the event of a fire.” from the report
PPE was not always used correctly
needs fixingInspectors saw some staff wearing masks incorrectly despite training and guidance. The manager took immediate action after this was raised.
“Staff did not always use personal protective equipment appropriately, despite receiving training and guidance and we observed staff not wearing masks appropriately.” from the report
Staff vacancies and agency use
minorStaffing levels were sufficient at the inspection, but several staff had recently left and the home had used a large number of agency staff. Recruitment was under way.
“Staffing levels were sufficient to meet people's needs; however, a large number of agency staff had been used over recent months.” from the report
- 01What changes have you made to medicine records, stock checks and medicine incident reviews since this inspection?
- 02How do you now check that people always have enough of the correct medicines?
- 03When was the most recent fire drill, and how have each person’s evacuation arrangements been reviewed?
- 04How do you check that staff use PPE correctly during every shift?
- 05What evidence can you show that your audits now identify problems with medicines before CQC or others find them?
This inspection considered all five key questions, including infection prevention and control, but the nursing unit was closed and no one was receiving end of life care at the time. This explanation was written from the published report of 1 September 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Boston House
2 rated inspections over a year: the service has held its Requires improvement rating throughout.
- February 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- September 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- November 2020Inspected but not ratedSafe: Requires improvementWell-led: Requires improvement
- January 2020
Registered with the Care Quality Commission on 17 January 2020.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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