CQC report explained · a residential care home
What the CQC found at Buckingham Lodge
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risks were generally identified and managed, and safeguarding, medicines and staffing systems had improved. However, infection control practices were not always effective, and there were some medicines and record-keeping shortfalls.
- Effective?
- Requires improvement
- This question was not inspected during this visit. Its rating carried over from the previous inspection.
- Caring?
- Requires improvement
- This question was not inspected during this visit. Its rating carried over from the previous inspection.
- Responsive?
- Requires improvement
- This question was not inspected during this visit. Its rating carried over from the previous inspection.
- Well-led?
- Requires improvement
- Management systems and audits had improved, and a new manager had been appointed. However, inspectors found that whistleblowing and negative feedback were discouraged, and some records were not reliably maintained.
What inspectors found, May 2022
Rated Requires Improvement; inspectors found important improvements since the previous inadequate rating, but infection control, openness and records still needed work.
This was an unannounced focused inspection on 27 and 28 April 2022. Inspectors checked whether the home had acted on its previous improvement plan, focusing on Safe and Well-led. They spoke with people, relatives and staff, observed care, and reviewed care, medicines, staffing and safety records.
People and relatives were generally happy with the care. Inspectors found improvements in safeguarding, risk management, staffing, training, care planning and management oversight. The home was no longer in breach of regulations found at the previous inspection.
However, infection control practices did not always reduce the risk of spreading infection. Records were not always accurate, and inspectors found that staff and relatives were not always encouraged to give negative feedback openly. The home was rated Requires Improvement for Safe, Well-led and overall.
The previous overall rating was Inadequate and the home had been in Special Measures since August 2021. It is no longer rated Inadequate and is no longer in Special Measures.
Kind care
People and relatives were generally positive about the care and described staff as kind and helpful.
“I am happy living here, the carers are all very nice and always very helpful,” from the report
Risk management
Care plans had improved and usually reflected people's needs and risks. Staff generally understood how to support people safely.
“Risks to people were identified and mitigated. People's care plans had been developed since the previous inspection and were person centred.” from the report
Improved staffing
Staffing levels were generally maintained and reliance on agency staff had reduced. Recruitment and staff training had also improved.
“The rotas and shift planners reviewed from 28 March till the 1 May 2022 showed staffing levels were generally maintained” from the report
Improved oversight
The home was using audits and an improvement plan to identify and address problems. Inspectors found better record management overall than at the previous inspection.
“Systems were in place to audit and monitor the service. A series of in-house audits took place” from the report
Infection control
needs fixingInspectors saw problems with handling laundry, protective equipment and COVID-19 testing during an outbreak. They also found dirt and staining in parts of the home.
“We were not assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Speaking up
needs fixingMeeting records suggested that staff were discouraged from whistleblowing and that relatives were directed to send negative feedback to the home rather than to the CQC.
“Team meeting minutes viewed did not promote an open culture. Whistleblowing was discouraged and staff were told to report positively to the Care Quality Commission and the local authority.” from the report
Inaccurate records
needs fixingSome care plans conflicted with each other, and rota and allocation records did not always clearly show who was working.
“The staff rota and allocation sheet were not always suitably maintained to ensure it was reflective of the staff on duty.” from the report
Medicine supply
needs fixingOne person's prescribed risperidone ran out and one dose was missed. The shortage was not investigated or escalated until inspectors raised it.
“A person's prescribed risperidone ran out of stock on the 15 April 2022, even though a month's supply had been provided.” from the report
Activities and consistency
minorPeople and relatives reported that activities were still limited at times, particularly when staffing was under pressure. Agency use and staff changes also affected consistency.
“Relatives told us staffing and activities had improved, although still not always sufficient with very little one to one activities provided.” from the report
- 01What specific changes have you made to prevent cross-infection during outbreaks, and how do you check that staff use protective equipment correctly?
- 02How can residents, relatives and staff raise negative feedback or whistleblowing concerns privately and directly?
- 03How do you ensure care plans, mental capacity decisions and staff rotas are complete, consistent and up to date?
- 04How do you prevent medicines running out, and what happens when a dose is missed?
- 05What staffing and activity arrangements are in place at weekends and when agency staff are used?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive carried over from the previous inspection. This explanation was written from the published report of 25 May 2022 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 Inadequate and placed in special measures; inspectors found unsafe care, staffing problems and weak management.
This was an unannounced, focused inspection on 15 and 16 June 2021. Inspectors spoke with people, relatives and staff, observed care, and checked care records, medicines, rotas, recruitment files and management records.
The home was rated Inadequate for Safe and Well-led. Inspectors found that risks were not always identified or managed, including risks linked to medical conditions, dehydration and infection control. Staffing levels were often below the home's stated requirements, and staff said they were working under pressure.
Management systems did not reliably identify or fix problems. Records were incomplete or difficult to access. People were not always protected from poor staff practice, and decision-specific mental capacity assessments were not routinely completed.
There were some safer systems. Medicines were generally managed properly, accident monitoring was in place, and health and safety checks were carried out. However, the overall rating fell from Requires Improvement at the previous inspection because enough improvement had not been made.
Medicines
Medicines were stored, recorded and administered safely during the inspection. Staff responsible for medicines had been trained and assessed as competent.
“The medicine administration records viewed showed medicines were given as prescribed with no gaps in administration.” from the report
Accident monitoring
The home recorded accidents and incidents and monitored people after falls.
“We saw the 72-hour post fall monitoring was completed for individuals, following a fall.” from the report
Building safety
Routine checks and servicing covered key equipment and fire safety arrangements.
“Health and safety checks took place and equipment such as the lift, fire equipment, gas, electricity and hoists were serviced.” from the report
Visiting arrangements
Visits had restarted and were being arranged in advance during the inspection.
“People and their relatives confirmed visiting had commenced and throughout the inspection we saw this was promoted with visits pre booked and facilitated.” from the report
Unmanaged risks
seriousSome medical, nutrition and dehydration risks were not fully assessed or managed. Inspectors found incomplete guidance and very low fluid intake recorded for some people.
“Risks to people were not always mitigated. This was a continued breach of regulation 12” from the report
Staffing levels
seriousThe rotas showed that the home's required staffing levels were not consistently provided. Staff and relatives described delays, pressure and people being left in bed longer than they wanted.
“Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not always provided to provide safe and consistent care to people.” from the report
Safeguarding and staff conduct
seriousPeople and relatives gave mixed accounts of staff behaviour and care. Inspectors found that people were not always protected from poor practice or improper treatment.
“People were not safeguarded from the risk of abuse. This was a breach of regulation 13” from the report
Weak management systems
seriousAudits failed to find important problems, and records were incomplete, inaccurate or not accessible to staff. Management changes also contributed to inconsistency.
“The service was not suitably audited, and records were not properly maintained to mitigate risks to people.” from the report
Mental capacity decisions
seriousDecision-specific mental capacity and best-interest records were not routinely completed for areas such as medicines, personal care and sensor mats.
“People were not consented with on their care. This is a breach of regulation 11” from the report
- 01What staffing levels are now provided on each floor during the day and night, and how do you cover agency cancellations or staff absence?
- 02How are risks such as dehydration, diabetes, seizures, nutrition and falls now assessed, recorded and checked?
- 03What changes have been made to infection control, including social distancing, PPE use, cleaning high-touch areas and visitor screening?
- 04How do you now complete and review mental capacity and best-interest decisions for medicines, personal care and sensor mats?
- 05What evidence can you show that audits, care records and action plans are now complete, accurate, accessible and acted on?
This was a focused inspection of Safe and Well-led only; the Effective, Caring and Responsive ratings carried over from previous comprehensive inspections. This explanation was written from the published report of 16 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 Buckingham Lodge
6 rated inspections over 6 years: the service has held its Requires improvement rating throughout.
- May 2022Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- September 2021Inadequatedown from Requires improvementSafe: InadequateWell-led: Inadequate
- July 2019Requires improvementdown from GoodSafe: Requires improvementWell-led: Requires improvement
- January 2018Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- May 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- April 2015
Registered with the Care Quality Commission on 5 April 2015.
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.
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