Archived: Bentley Care Home

The building is converted from three large Victorian houses divided into two units. These are known as 'the house' and 'the unit'. People have their own bedroom and share bathroom and shower facilities. Each unit has sitting and dining facilities for people to share.

This was an unannounced inspection carried out on 15 September 2016. We carried out this inspection at this time as the home was in special measures and had been rated inadequate and we needed to check that improvements had been made to the quality and safety of the service.

We had carried out a comprehensive inspection of this home in September 2015 as a result of which the home was rated inadequate and was placed into special measures. A second comprehensive inspection of the home in March 2016 again rated the home as inadequate and they remained in special measures. In July 2016 we carried out a focused inspection of the home and found that improvements had been made in some areas.

At this inspection we found that improvements had been made in all areas but further improvements were needed to meet regulations in regard to ensuring the care and treatment of service users met their needs and reflected their preferences and that risks to the health and safety of service users are been adequately assessed and action taken to mitigate and identified risks.

In response to the improvements that had been made we have taken the home out of special measures.

People’s legal rights were not always protected. Assessments of people’s capacity to make important decisions had not always been undertaken to establish whether they needed the protection of a Deprivation of Liberty Safeguard.

Up to date care plans and risk assessments were not in place for everyone living at the home. This meant staff did not always have up to date guidance to support people safely and well. A new care plan format had commenced and provided detailed information about people which helped staff provided a more person centred approach to care. However not everybody had these care plans in place.

No organised activities took place at the home and people told us that they were often bored. An activities co-ordinator was due to commence working at the home shortly.

Staff did not always recognise when people needed support and provide it in a timely manner. At times staff congregated in communal areas rather than spending time interacting with people living at the home.

People told us that they felt safe living at the home. Potential safeguarding concerns had been recognised and addressed. Staff had an understanding of safeguarding adult’s procedures and their role in protecting people.

There were sufficient staff working at the home to support people. People living at the Bentley told us they liked the staff who worked there and we saw some warm interactions between staff and people they supported.

Staff had received support and supervision and felt listened to by the senior management team. Training had been delivered to staff to enable them to understand and carry out their role effectively and more specialist training was being planned. Robust procedures had been followed to recruit staff who were suitable to work with people who may be vulnerable.

Systems were being introduced for gaining the views of people living at the home and their relatives. People told us they felt listened to and we saw that action was taken in response to people’s comments. Similarly complaints were listened to, investigated and appropriate action taken on the findings.

People received the support they needed with their healthcare and with their medication.

A choice of meals was always available including meals that met dietary, cultural or religious preferences. People told us that they liked the meals provided.

The building was a safe place for people to live and work. Although parts of the building remain shabby and in need of decoration improvements to the overall appearance and décor of the building had commenced with further work planned. People living at the home were pleased with the improvements made and those areas decorated looked welcoming and pleasant.

People living at the home and staff liked the manager and provider’s representative. They said they were a visible presence in the home and were improving the service people received.

The building is converted from three large Victorian houses and is divided into two units. People have their own bedroom and share bathroom and shower facilities. Each unit has sitting and dining facilities for people to share. Externally there is a small car park and gardens people can sit in.

We carried out an unannounced comprehensive inspection of the home in September and October 2015 and found breaches of legal requirements. As a result the home was rated inadequate and placed into special measures. We carried out a second unannounced comprehensive inspection of this service on 15 and 23 March 2016. At that inspection continuing breaches of legal requirements were found. This led to the home remaining in special measures. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bentley Care Home on our website at www.cqc.org.uk.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months of the date of the comprehensive inspection we carried out in March 2016.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

The home had not had a manager who was registered with CQC since October 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Suitable systems were not in place to enable people in their bedrooms to summon help if needed. Clear care plans were not in place to support people who behaved in a way which could affect their safety or the safety of others. This left them open to potential abuse.

Some staff training had taken place however records of staff training were incomplete and inaccurate. No overall training plan was in place and we found that staff had not received the training, support and supervision needed to enable them to support people safely.

The care and treatment people received did not always reflect their needs and preferences. People’s legal rights were not always protected.

Improvements had been made to the safety of the environment. This included ensuring doors that should be locked remained locked and that people did not smoke within the home. Some changes had been made to the environment to address the overall appearance. However the overall appearance of the home remained shabby and the environment did not meet good practice guidance for supporting people living with dementia.

No systems were in place for formally communicating with people whose first language was not English. Action had commenced on findings representatives who could interpret for these people.

Care plans were generic and contained incomplete information about the care and support people required. Senior staff acknowledged this and said they had plans to make care plans more person centred.

A process had been recently introduced to investigate and record any concerns or complaints that people raised regarding the home.

A system for quality assurance had been introduced within the home. Although this had led to improvements to the safety of the environment, it was not yet robust enough to identify and implement improvements to the quality of the service people received. No formal system had been introduced to obtain the views of people living at the home.

The choice and quality of meals had improved and action was being taken to ensure meals met people’s cultural and religious requirements.

People living at the home had been provided with a written guide to how the home operated.

Improvements had been made to the way people’s medication was managed and it was now managed in a safe way.

The building is converted from three large Victorian houses divided into two units. These are known as 'the house' and 'the unit'. People have their own bedroom and share bathroom and shower facilities. Each unit has sitting and dining facilities for people to share.

Bentley appointed a manager in October 2015. At the time of this inspection the manager had registered with the Care Quality Commission to become the registered manager of the home.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected Bentley Care Home in September and October 2015. At that time we found a number of breaches of regulations relating to person centred care, dignity and respect, safe care and treatment, receiving and acting on complaints, good governance and staffing.

At this inspection we found that significant improvements had not been made. We found that continuing breaches remained in areas relating to person centred care, dignity and respect, safe care and treatment, safety, receiving and acting on complaints, good governance and staffing.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

People living at the home had varied experiences of the care and support provided to them. Some people felt safe living there, others did not. The home had taken no action to formally communicate with or obtain the views of people whose first language was not English. This left people feeling isolated and unable to make their concerns heard or to contribute to discussions regarding their care.

Staff had not received training in safeguarding adults for some time and did not always recognise and therefore taken action on potential incidents of abuse.

Action had not been taken to ensure the building was always safe for people living there. This included leaving doors unlocked that led to dangerous areas of the home. Robust action had not been taken to prevent people who were unsafe smoking within the building from doing so. This increased the risk of fire within the home.

People’s medication was not managed safely and effectively. Guidance for staff was not clear and could lead to mistakes with medication occurring.

The environment did not meet good practice guidance for supporting people living with dementia.

Staff had not received the training, support and supervision needed to enable them to support people safely.

The care and treatment people received did not always reflect their needs and preferences. No system was in place for obtaining people’s views of their care and treatment.

People’s legal rights were not always protected. People were not supported to make important decisions or to ensure important decisions were made in their best interests.

People generally received support with their health care. However care plans were generic and did not provide clear advice for staff to follow to support people safely and well.

People living at the home had concerns and complaints but these had not been recorded or acted upon.

No effective system was in place for monitoring and planning improvements to the service provided.

We observed during our inspection that the people who used the service appeared happy and content living there. We found people were treated respectfully and given support to have their say, when possible, in how they wanted to be helped and were supported to do the things they wanted to do.

People were treated with care and consideration. We observed that staff were focussed on completing tasks for people, but always acknowledged and engaged them.

The people who lived at Bentley Care Home were cared for by staff who were appropriately recruited, well trained and experienced at supporting them. We found that staff were happy working at the home and that they had received relevant training for their role.

We saw that there were appropriate systems in place to monitor the quality of care that people received at the home and we were told that the manager was approachable and responded to comments and suggestions made by people, their relatives and members of staff.

Some people were unable to communicate with us. However, we observed staff interacting with them with respect and warmth. We observed that staff engaged positively with people. They took the time to listen to people. Their approach to care and support was person centred. They had a good rapport with the people living there and the atmosphere was calm and relaxed. People were involved in providing feedback about their views of the service through quarterly questionnaires and at residents' meetings.

The home had systems in place for gaining consent from people. The manager informed us that people or their representative signed a form to say whether they wished to participate in their care planning. The home had systems in place to support nutrition and healthy eating and we saw that staff recorded people's weight on a weekly or monthly basis as needed. We observed staff assist people with feeding; people were given time to eat and care staff were attentive. The home had a variety of policies and procedures used to assess and monitor the quality of the service.