CQC report explained · a nursing home
What the CQC found at Buckingham House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, November 2019
Rated Good; inspectors found kind, safe care, but medicines, temporary staff checks and some care records needed improvement.
The inspection was unannounced and took place over two days. Inspectors spoke with people living at the home, relatives and staff. They observed care, medicines, meals and activities, and checked care plans, staff files, medicine records, complaints and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People and relatives described it as homely, welcoming and clean. Inspectors saw kind and respectful staff, enough staff to meet people's needs, good activities and appropriate support with health, food and communication.
There were some weaknesses. Medicine stock records were not always accurate, checks on temporary workers were not always up to date, and some care plans were not reviewed promptly. End of life wishes were also not consistently recorded. The provider was given recommendations to improve these areas.
The previous inspection, published in March 2017, also rated the home Good. The manager was applying to become registered with CQC, but the application was still being processed at this inspection.
Kind and respectful care
Inspectors saw staff treating people with kindness, compassion and respect. People and relatives also gave positive feedback about the care.
“People were cared for by staff who demonstrated kindness, compassion and respected individual's dignity.” from the report
Enough staff and safe care
Inspectors found enough staff to support people promptly. Risk assessments, equipment checks and safeguarding training helped protect people from harm.
“There were sufficient staff deployed around the building to meet people's needs.” from the report
Clean environment
The home was kept clean and hygienic. Inspectors saw good infection control, separate handling of soiled laundry and regular cleaning.
“Housekeeping staff maintained the premises in a clean and hygienic condition.” from the report
Activities and community links
People had varied activities, outings and opportunities to maintain relationships. The home also welcomed visitors, school children and links with local organisations.
“Activities and outings were arranged to provide stimulation and interest for people.” from the report
Positive management culture
People, relatives and staff were positive about the management team. The home used meetings, surveys and audits to gather views and plan improvements.
“Staff told us they had confidence in the management team, they felt valued and listened to.” from the report
Medicine records
needs fixingMedicine stock figures did not always match the medicines held, and audits did not always identify the errors. Guidance for some as-required medicines did not give enough information to staff unfamiliar with the person.
“We found there were discrepancies in the stock levels.” from the report
Temporary staff checks
seriousThe home had not checked that two temporary nurses still had current professional registration. One temporary care worker's agency profile could not be found at first.
“In the case of two nurses, we noted their registration with the Nursing and Midwifery Council (NMC) had expired” from the report
Care plan updates
needs fixingCare plans did not always contain people's life histories and were not always reviewed promptly when needs changed. One moving and repositioning risk assessment was not up to date.
“We recommend the service follows good practice in engaging with people, their families to ensure people received person-centred care and review circumstances to ensure records are kept to date with people's changing needs.” from the report
End of life wishes
needs fixingSome records for people receiving palliative care did not show whether end of life wishes had been discussed or recorded. This could mean people were not always given the opportunity to discuss their preferences.
“In some other files we looked at for people who received palliative care, end of life wishes had not been recorded.” from the report
- 01How do you now check medicine stock levels and the records for as-required medicines?
- 02How do you verify that temporary nurses have current professional registration and that temporary workers have suitable skills?
- 03How often are care plans and risk assessments reviewed when a person's needs change?
- 04How do you make sure each person's end of life wishes are discussed and recorded?
- 05What is the current position on the manager's application for CQC registration?
This was an unannounced comprehensive inspection covering the home and all five CQC questions; all five ratings were assessed and remained Good. This explanation was written from the published report of 5 November 2019 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, March 2017
Rated Good; inspectors found safe, kind and personalised care, with earlier record-keeping problems improved.
This was an unannounced comprehensive inspection on 9 and 10 February 2017. Inspectors spoke with people living in the home, relatives, staff and healthcare professionals. They reviewed care plans, staff recruitment records and medicines, and observed care and mealtimes.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found people protected from abuse, supported with medicines and cared for by trained staff. They also found kind relationships, good care plans, suitable activities and responsive healthcare support.
The previous inspection had found legal breaches involving inaccurate care records and failures to follow the Mental Capacity Act properly. The home had received a warning notice. At this inspection, inspectors found these problems had been addressed and the breaches had been met.
Improved care records
Inspectors found that risk assessments and care records were accurate, reviewed regularly and supported the care people needed. This addressed the main problem found at the previous inspection.
“In all the records we checked we found the assessments were completed correctly and evaluated on a regular basis.” from the report
Kind and respectful staff
People and relatives spoke positively about staff. Inspectors saw staff treating people with dignity, respecting privacy and taking time to build relationships.
“Throughout the course of the inspection we observed people being supported by staff who provided a kind, caring and thoughtful service.” from the report
Personalised activities
People were supported to take part in activities they enjoyed, both inside and outside the home. Staff also arranged individual activities and celebrations.
“In addition to the programmed activities people were encouraged to engage with staff through impromptu activities.” from the report
Better decision-making support
Mental capacity assessments were specific to the decision involved. Where people could not make a decision, best-interest decisions were recorded.
“We found assessments had been completed when required and were decision specific.” from the report
Diabetes kit checks not recorded
minorA nurse said the expiry dates of items in the diabetes emergency kit were checked regularly, but inspectors found no documentation to confirm these checks.
“We noted there was no documentation to support these checks.” from the report
Staff references
minorThe home had suitable recruitment checks, but inspectors asked it to make sure staff references were always dated.
“We have asked the provider to ensure references are always dated.” from the report
- 01How do you now check that care plans and risk assessments remain accurate when a person's needs change?
- 02How are expiry dates and other checks for the diabetes emergency kit recorded?
- 03How do you make sure all staff references are dated before staff start work?
- 04How do you decide staffing levels as the number and needs of people living here change?
- 05How are people and relatives involved in reviewing care plans and giving feedback?
This was an unannounced comprehensive inspection covering all five CQC questions and providing ratings for the whole service. This explanation was written from the published report of 9 March 2017 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 Buckingham House
5 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- November 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- September 2016Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2016Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- August 2014
Registered with the Care Quality Commission on 11 August 2014.
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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89 live-in carers within about an hour of Buckinghamshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,300 a week. 79 can care for a couple. 13 years' experience on average.
“We can all fully relax around Nyarai and she feels like part of our family, which is no mean feat!”
“She was v competent and confident and we felt our mum was safe in her care. She supported us through a difficult time.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.