Archived: Blenheim House Specialist Care Centre

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.

At the time of our inspection, 47 people were living at Blenheim House. The home was last inspected in June 2015 and was found to be requiring improvement in the effective and responsive domains. Subsequently the provider submitted an action plan to address these shortfalls and during this inspection we check to see that these improvements had been made and sustained.

This inspection took place on 22 June 2016 and was unannounced. We returned on 23 June 2016 to complete the inspection.

At the time of the inspection, a registered manager was not in post, however following the inspection we were notified by the nominated individual that a successive candidate had been offered and accepted the post. The new manager had since started the process with CQC to become the registered manager. 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.

The provider had made the necessary improvements since the inspection in June 2015 in ensuring that the Mental Capacity Act 2004 was being adhered to and all staff had a good grasp of verbal and written English.

People who use the service and their relatives were positive about the care they received and praised the staff and management. People told us they felt safe living in Blenheim House and were involved in planning and reviewing their care.

Systems were in place to protect people from abuse and harm and staff knew how to use them.

People received their medicines on time. A new electronic medicine recording system was in place. At this time, not all of the required information was on the system and the provider continued to monitor and make improvements to the system. A pharmacy audit had identified improvements around medicines management and the provider was working to address this.

During our inspection we found there were times when staff were not visible or available to people.

Staff understood the needs of the people they were providing care for. People's needs were set out in care plans they had been involved in developing. Staff followed these plans, which helped to ensure people received care in the way they preferred.

Staff were appropriately trained and had the right skills to provide the care people needed. Staff had a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people's needs and wishes. People's views about their care and support was listened to and acted upon. There was an effective complaints procedure in place.

The provider regularly assessed and monitored the quality of care provided at Blenheim House.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This inspection was carried out to assess what the provider had done in response to the action we had told them to take following our last inspection. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found the service was safe because people were protected against the risks associated with medicines. We found that there have been improvements made to the way medicines were handled and managed in the service since our previous inspection.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One relative said 'the care is very good'. Another relative said 'they are very patient and spend lots of time'.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff received appropriate support to enable them to provide care and support to people living at the home. One staff member said 'all staff attend training'.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

The home had several measures in place to ensure that a hygienic environment was maintained and infections prevented where possible.

Attention was paid by staff to ensure that meals were prepared that met the nutritional needs of people who used the service. Where people had difficulties eating assistance was given and people were encouraged to eat to maintain their health and wellbeing.

Staff in the home had completed safeguarding adults training and know how to identify abuse and make an appropriated alert. People who live in the home said that they felt safe and knew who to complain to if they were concerned about bad practice.

There are sufficient numbers of suitably qualified staff in the home, who demonstrated through their practice that they understood the needs of people using the service and how to meet them.

A quality assurance system was in place within the home. Clinical audits and a range of safety checks were carried out. A recent quality survey of all stakeholders confirmed a high level of satisfaction with the home.