Archived: Blenheim House Specialist Care Centre

Updated 27 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 11 and 12 September 2018 and was unannounced on the first day.

The inspection was undertaken by two adult social care inspectors. Before the inspection we reviewed other information, we held about the service including notifications sent to us by the provider. Notifications are information about specific important events the service is legally required to send to us. We also looked at information in the Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with five people and six relatives. We spoke with six staff, a registered nurse, nursing assistant, activities coordinator and chef. The deputy manager, manager, acting regional manager and nominated individual were involved in the inspection. We reviewed five people's care plans in detail. We looked at specific areas of a further five care plans. We reviewed the staff matrix provided, staff duty rosters, policies and procedures and quality monitoring documents. We looked around the premises and observed care practices for part of the day.

Updated 27 November 2018

Blenheim House Specialist Care Centre is a care home and can accommodate up to 85 people across four separate units, each with separate shared space. One of the units specialises in providing care to people living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This inspection took place on the 11 and 12 September 2018 and was unannounced on the 11 September 2018.

A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The current manager will be applying to register as manager with CQC.

There were a range of quality audits undertaken and the manager told us there was an action plan on driving improvements. We found that audits were not in place for all areas of service delivery. For example, care planning. A comprehensive action plan was not in place from outcomes of all the audits. While patterns of accidents were analysed, action plans were not in place to prevent the same type of accident from reoccurring. This meant the monitoring of service delivery was made more difficult because action plans were not in place for all shortfalls identified or on how they were to be met.

There was an online care planning system which relatives and staff told us they preferred from the old paper system. Relatives said the previous system took time from their relative for report writing. However, there were inconsistencies within the system. This meant information about an area of need was not consistently recorded in the same section of the online care plan. The manager told us some icons were unlinked to reduce the sections where information could be repeated.

Care plans were not always person centred or reviewed monthly when people’s needs changed. Where there was input from health care professional their guidance was not used to develop care plans. For people that at times became anxious and frustrated care plans were not in place on how situations were to be managed by staff.

Risk management systems were used to assess people’s individual level of risk. Action plans were devised were risks were identified. While risk assessments gave staff guidance on how to minimise the risk, for some people the information was not up to date. Monitoring charts were used to ensure the risk level was minimised. For example, repositioning, food and fluid intake. However, monitoring checks were not consistently completed. This meant staff could not be certain the level of risk was minimised and if people’s health was deteriorating.

The training matrix showed that staff had completed multiple courses on the same day which may not be effective to embed good practice. Staff gave positive feedback about the training offered.. One to one meetings known as mentorship meetings took place with a line manager to discuss shortfalls in training. For example, moving and handling.

The home was clean well decorated and free from unpleasant smells. We saw housekeeping staff on duty within the home. While there were some areas of the environment that were adapted for people living with dementia, signage was needed to improve people’s orientation. For example names on doors and signs for toilets. For some people personal items were not included in the memory boxes on their bedroom doors. Without names on doors and memory boxes people living with dementia were not helped to find their bedrooms independently.

Medicine systems were managed safely. There was an electronic system for medicine administration and audits of medicine systems showed outcomes were met.

The staff we spoke with knew the types of abuse and how to report their concerns. They said they had attended safeguarding adults training to help them recognise the signs of abuse and about reporting concerns. People said they felt safe living at the home.

We saw adequate number of staff available to support people. People told us the staff responded to their request for support and assistance.

Where possible people made decisions about their day to day care and relatives said they were consulted. Deprivation of Liberty Safeguards (DoLS) were appropriately applied for. Staff were knowledgeable about the principles of Mental Capacity Act (2005) and there was guidance available to staff for reference.

People dietary requirements were catered for. However, people told us the menus were not varied.

People had access to healthcare services as required. Relatives told us they were kept informed about GP visits and about important events.

People we spoke with and relatives praised the staff for their caring manner. We saw some good interactions between people and staff.

Structured activities from two activities coordinators were spread across all units. Activities for people in the dementia unit were not as regular.

The complaints procedure was on display. Complaints policy in place with timescales on when to respond. There was a detailed response, investigated and action taken.

We found breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.