CQC report explained · a residential care home
What the CQC found at Buxton House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, September 2022
Rated Good overall, but inspectors found the home's leadership and quality checks still required improvement.
This was an unannounced focused inspection. Inspectors visited on 18 August 2022, spoke with people, relatives and staff, observed care, and checked care records and management records. They also checked infection prevention and control.
The home had improved since the previous inspection. Inspectors found safer risk management, better care records, safe medicines systems, enough staff and improved support with food and drinks. Staff were described as kind, supportive and familiar with people's needs.
The main remaining weakness was management oversight. New checks and an improvement plan were in place, but they had not been running long enough for inspectors to be sure that good practice would continue. The home was rated Good overall, with Safe and Effective rated Good, and Well-led rated Requires Improvement.
Safer risk management
Risk assessments and care plans were in place and staff followed them. The home had also improved its response to falls and other incidents.
“People's risk management plans were in place and were followed by staff.” from the report
Kind and familiar staff
There were enough staff, including regular agency staff, who knew people well. People and relatives spoke very positively about the staff team.
“There was a core of permanent staff employed at the home who were supported by regular pre booked agency staff.” from the report
Improved care planning
Care plans reflected people's needs and were updated when circumstances changed. Staff followed advice from health professionals.
“At this inspection, people's care plans had been updated and guidance was followed when their needs changed.” from the report
Better mealtime support
People were offered hot meals, drinks and snacks. Staff supported people to eat in a calm and relaxed way, with choices available.
“Staff supported people to eat and drink in a relaxed way.” from the report
Positive involvement
People, relatives and staff were asked for their views. The home acted on feedback, including bringing back a keyworker system.
“A keyworker system (where a staff member is allocated to build a relationship with each person) was reinstated following feedback from people and their relatives.” from the report
Management systems not yet established
needs fixingThe new quality checks and improvement work had not been in place long enough for inspectors to know whether they would continue to find and fix every problem. The home did not have a registered manager at the time.
“Not enough time had passed for the changes made by the provider and new management team to be fully embedded at the service.” from the report
Odour in one area
minorInspectors found a bad smell on the first floor. The manager said the area had been deep cleaned and would consider whether the carpet needed replacing.
“There was a malodour on the first floor.” from the report
Some medicines plans needed more detail
minorSome plans for medicines given when needed did not explain clearly enough how the person would appear when they needed the medicine. The deputy manager acted immediately.
“However, some needed further personalisation to include details of how the person presented when requiring PRN medicines.” from the report
- 01Who is currently responsible for managing the home while there is no registered manager, and when is a registered manager expected to be appointed?
- 02How are the new quality checks being reviewed to make sure they continue to identify and fix problems?
- 03How are as-needed medicines plans being checked to make sure they explain each person's signs and needs clearly?
- 04What action was taken about the odour on the first floor, and has the carpet been replaced or shown to be suitable?
- 05How are staffing levels and the use of regular agency staff reviewed to make sure staff continue to know residents well?
This was a focused inspection checking the previous warning notices for Regulations 12 and 17 and infection control; ratings for key questions not inspected were carried over from the last inspection. This explanation was written from the published report of 14 September 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, May 2022
Rated Requires Improvement, with an Inadequate well-led rating; inspectors found kind care but serious problems with risk management, records and oversight.
This was an unannounced follow-up inspection. Two inspectors and a medicines inspector visited on 6 April 2022, with inspection activity continuing until 19 April. They spoke with people, relatives and staff, observed care, and checked care plans, medicines and management records.
Inspectors found that people were generally treated kindly and felt safe with staff. There were enough staff at the time of the inspection, and a core team knew people well. Infection control was mostly managed, although some smaller problems remained.
However, some risks were not managed or recorded reliably. Care plans were not always updated or followed. There were problems with medicines records, consent decisions, meal support, oral care records and communication with relatives. The systems meant to check quality had not found all these problems.
The overall rating stayed at Requires Improvement. Safe and Effective were rated Requires Improvement, while Well-led fell from Requires Improvement to Inadequate. The home remained in breach of regulations from the previous inspection.
Kind relationships
People appeared relaxed with staff, and inspectors saw kind and caring interactions. Staff spoke positively and knowledgeably about the people they supported.
“Throughout the inspection we saw relaxed, kind and caring interactions between staff and people.” from the report
Staffing and familiarity
There were enough staff to meet people's needs at the time of inspection. A core group of staff had worked at the home for years and knew people well.
“There were enough staff to meet people's needs and there was a core staff team who knew people well.” from the report
Infection control
Inspectors were assured about most infection prevention arrangements, including visiting, PPE, testing and outbreak management. Some minor environmental and cleaning issues still needed attention.
“We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed.” from the report
Health referrals
Working with health professionals had improved. Feedback indicated that staff were making health referrals more promptly.
“One healthcare professional told us they had improved confidence in the staff making timely healthcare referrals.” from the report
Choice at mealtimes
The home had introduced large-print menus and offered people visual and verbal choices of meals. People were happy with the meals and snacks.
“Since the last inspection, people were being offered both visual and verbal choices of meals.” from the report
Risks and care records
seriousSome risk plans were inaccurate or not followed. Inspectors found examples involving repositioning, continence care and the thickness of drinks, which could have led to harm.
“Some people's risk management plans were not consistently followed or accurate. This placed them at potential risk of harm or injury.” from the report
Medicines safety
seriousMedicines were not always safely managed. One person using oxygen had no risk assessment or management plan, and some records did not identify the specific creams used.
“Medicines were not always safely managed.” from the report
Consent and best-interest decisions
seriousThe home did not always make clear that legal representatives were making health and welfare decisions. Some best-interest information had not been updated after medicines changed.
“Where people had appointed a legal representative to make decisions about their health and welfare, it was still not clear that these representatives had made decisions rather than be consulted.” from the report
Meal and oral care support
needs fixingSome people received inconsistent help with eating and drinking, and staff did not always consider whether food remained hot. Oral care records were not detailed enough to show what support had been given.
“However, some people had inconsistent support from staff and there was no consideration for whether meals were hot after long periods of time for those people staff supported with eating and drinking.” from the report
Weak oversight
seriousAudits and improvement plans did not reliably identify or resolve problems. Daily checks were not recorded, so it was unclear what action followed from them.
“The governance systems had not effectively mitigated the risks to people using the service.” from the report
Communication with relatives
needs fixingSome relatives were not kept informed about visiting restrictions or injuries. The report says communication was not consistently effective.
“There were mixed views as to whether people and relatives felt the communication systems were fully effective.” from the report
- 01What has been changed to make sure repositioning, continence care and modified-fluid plans are accurate and followed every time?
- 02How are medicines, oxygen use and topical creams now risk-assessed, recorded and audited?
- 03How do you make sure legal representatives make health and welfare decisions, and that best-interest decisions are updated when circumstances change?
- 04How are care records, daily checks, audits and improvement plans now reviewed by managers, and what evidence can you show that problems are being fixed?
- 05How will you keep relatives informed about visiting restrictions, outbreaks and any injuries or changes in care?
This was an unannounced follow-up inspection focused on the action required after the previous inspection, with infection prevention and control also checked; only Safe, Effective and Well-led were rated in this report. 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.
Every inspection of Buxton House
6 rated inspections over 7 years: the service has improved, from Requires improvement to Good.
- September 2022Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2022Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementWell-led: Inadequate
- November 2021Requires improvementdown from GoodSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- December 2017Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- August 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- February 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Requires improvement
- June 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- August 2011
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 23 November 2010.
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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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.
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