Archived: Blenheim Care Centre

Blenheim Care Centre is a residential care home providing personal and nursing care for up to 64 people. At the time of the inspection 54 people were living at the service. The provider offers a service to younger adults with disabilities and older people, some of whom were living with the experience of dementia. The home is divided into three units. The ground floor provides accommodation to the younger adults and some older people. The first floor is for people who do not have nursing needs but have dementia and the second floor is for people with dementia and nursing needs.

The service was owned and managed by MMCG (2) Limited, part of the Maria Mallaband Care Group, a private organisation providing care services in England.

People’s experience of using this service and what we found

People were not always safe at the service. Risks to their safety and wellbeing had not always been assessed or planned for. Some of the information about people's needs was inaccurate and staff did not always follow the guidance from healthcare professionals. This placed people at risk of harm. There were also potential risks within the environment which had not been assessed or mitigated.

Medicines were not always being managed safely.

The provider did not always investigate or respond adequately to concerns about people’s safety and wellbeing to rule out the risk of possible abuse. Where investigations had taken place, there was not always learning from these to make sure improvements were made.

People's needs were not always planned for or met in a personalised way. Care plans contained generic information which did not always specify people's needs or preferences. The care being provided was often task based and this meant people did not have the opportunity to engage with staff or make choices about their care. Some of the staff treated people disrespectfully.

The provider's systems for monitoring and improving the service had not always been operated effectively, because they had failed to identify or take action where regulations were not being met.

People using the service and their visitors told us they were happy with the service and the staff, they felt able to raise concerns and speak with the registered manager. However, they felt that improvements regarding the food and social activities were needed.

The staff told us they felt well supported and enjoyed their work. However, we found that the staff were not always knowledgeable about their work or the needs of people who they were supporting. Records of meetings with the staff did not address areas of concern about practice or adverse events at the service. Furthermore, where staff had raised concerns during individual meetings with their line manager, there was no record to show how these had been addressed.

There had been some improvements at the service, in particular there was now a more permanent staff team. There had also been improvements to the environment, and more were planned. People using the service, visitors and staff found the registered manager supportive and responsive.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 20 December 2018) and we identified breaches of regulations relating to person-centred care and good governance. The service had also been rated requires improvement for the previous two inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection, we found not enough improvement had been made and the provider was still in breach of these regulations. We also identified breaches of three other regulations relating to dignity and respect, safe care and treatment and safeguarding people from abuse and improper treatment.

Why we inspected

The inspection was prompted in part due to concerns received from the local authority regarding the leadership of the service and the provider's failure to identify and respond to safeguarding alerts. A decision was made for us to inspect and examine these areas as well as looking at whether they had made improvements since the last inspection in all areas.

We have found evidence that the provider needed to make improvements. The overall rating for the service has changed from requires improvement to inadequate.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blenheim Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person-centred care, treating people with dignity and respect, safe care and treatment, safeguarding people from abuse and good governance.

You can see what action we have asked the provider to take within our table of actions.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The last inspection of the service was on 22 May 2018, when we rated the service requires improvement. We asked the provider to complete an action plan to show us the improvements they were going to make.

Blenheim Care Centre is care home with nursing for up to 64 people. 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. The provider offers a service to younger adults with disabilities and nursing needs and older people, some of whom were living with the experience of dementia. The home is divided into three units. The ground floor provides accommodation to the younger adults and some older people. The first floor is for people who do not have nursing needs but have dementia and the second floor is for people with dementia and nursing needs. At the time of our inspection 54 people were living at the service.

The service was owned and managed by MMCG (2) Limited, part of the Maria Mallaband Care Group, a private organisation providing care services in England. MMCG (2) Limited took over the management and ownership of the service on 4 August 2017.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At this inspection we found there had been improvements to all aspects of the service. However, further improvements were needed.

Care plans, risk assessments and medicines profiles did not always contain enough detail or information was contradictory. This meant that staff who were not familiar with people's needs may have provided inappropriate care.

The provider ensured people were asked to consent to care and treatment. However, records relating to their mental capacity were not always clear. Therefore, people were at risk of receiving care which was inappropriate or did not meet their needs.

The provider's systems for monitoring and improving the service had been effective in making improvements. However, further improvements were needed to ensure that the risks to people's wellbeing were always mitigated.

The provider did not have specific guidance, training or support for staff to promote an LGBT+ (Lesbian, Gay, Bisexual and Transgender) inclusive environment. We discussed this with the registered manager and they agreed to look at how they could develop this area.

People living at the service had a variety of different cultural and religious needs. There were visitors from religious communities who supported people to celebrate their faith. Care plans included information about specific wishes or needs relating to faith and culture.

People living at the service and their relatives were happy there. They liked the staff and felt they treated them with kindness and respect. Although, we witnessed a few interactions which indicated some staff focussed on the tasks they were performing rather than the person they were caring for. We also witnessed positive interactions where the staff were kind, attentive and caring. The staff knew their individual needs and personalities and met these needs. People felt safe at the service. They said there were enough staff and that they felt secure and well looked after.

The staff were happy working at the service. There were procedures to ensure they were suitable to work there. They had effective inductions and training, so they knew how to provide care which met people's needs. There were good systems for the staff to communicate with one another and learn from incidents.

People had access to healthcare professionals when they needed them. The staff monitored their health and wellbeing and made sure they had enough to eat and drink. They received their medicines in a safe way and as prescribed.

People knew how to make a complaint and felt confident these would be responded to. The provider had systems for auditing the service and for involving people who used the service and other stakeholders, so they could incorporate their views when developing the service. People liked the registered manager and said that they were visible and responsive.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to Person Centre Care and Good Governance. You can see what action we have asked the provider to take within our table of actions.

The inspection took place on 22 May 2018 and was unannounced.

The last inspection of the service was on 27 September 2017 when we rated the service Requires Improvement for all key questions and overall. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service to at least ‘Good’.

At this inspection on 22 May 2018 we found that there had been some improvements. However, the service remains Requires Improvement in all key questions and overall.

Blenheim Care Centre is a care home. 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. The service is registered to accommodate up to 64 adults. At the time of our inspection 53 people were living at the service. Accommodation was provided on three floors. Eight younger (under 65 years of age) and ten older adults with physical disabilities and nursing needs lived on the ground floor, 17 older people living with the experience of dementia lived on the first floor and 17 older people with nursing needs were living on the second floor.

The service was owned and managed by MMCG (2) Limited, part of the Maria Mallaband Care Group, a private organisation providing care services in England. MMCG (2) Limited took over the management and ownership of the service on 4 August 2017.

The manager had been in post for two weeks at the time of our inspection. They had started the process of applying to be registered with the Care Quality Commission, by applying for their enhanced check with the Disclosure and Barring Service. The previous registered manager left the service in September 2017. There had been two other interim managers since this time. Neither had applied to be registered. 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 and associated Regulations about how the service is run.

The risks to people's safety and wellbeing had not always been identified, assessed and mitigated. This meant they were at risk of receiving care and treatment which was not appropriate or safe and did not meet their needs.

Medicines were not always managed safely at the home.

The staff supporting people did not always receive the supervision, guidance, support and appraisal they needed to effectively care for people. Their competencies at meeting people's needs were not always being assessed so people were at risk of receiving inappropriate care and support.

People were not always treated with dignity and respect or in a personalised way.

People's care was not always designed in a way to meet their needs and reflect their preferences. Furthermore, they did not always receive care which met their individual needs. For example, people did not always have enough to drink or the support they needed to wash and shower.

People told us that they were lonely and did not have the care and support they needed to meet their social and emotional needs.

The provider's systems for monitoring and improving the quality of the service were not always effective.

There were not enough permanent, regular staff deployed to provide consistent and effective care which met people's individual needs.

We found six breaches of Regulations during the inspection. These were in respect of person centred care, dignity and respect, safe care and treatment, nutrition and hydration, good governance and staffing.

We are taking action against the provider for failing to meet Regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We received some positive feedback from people using the service, with one person telling us, ''It is all grand here.'' Likewise, some visitors told us they were happy with the service. One of their comments included, ''I think [the provider] has some good ideas about the future of this service. Everything is good here and it is improving.''

People's needs were assessed when they first moved to the service. There was evidence that the staff worked closely with other healthcare professionals to make sure people's healthcare needs were being met. The staff made referrals in a timely manner when people's needs changed and followed the advice and guidance of other professionals.

The provider had suitable procedures for the recruitment and training of staff. These included making checks on their suitability and providing training in line with the requirements of this type of service.

There were suitable systems for identifying and responding to safeguarding alerts, incidents and complaints. These included working with other agencies to protect people from the risk of further harm and learning from when things had gone wrong.

The provider was in the process of improving the environment and had plans to make the design and decoration more attractive and reflective of good practice guidance for services for people living with dementia. The building was appropriately maintained and the provider ensured that checks were carried out on the environment and equipment, regarding safety and cleanliness.

People liked the manager and felt that they had started to make improvements. They expressed concerns about the changes in management and felt that this had impacted negatively on the service, however, they told us they were able to speak with the new manager and that they had responded appropriately. The provider and manager had started to make arrangements to improve the service. These included recruiting a large number of permanent staff and reviewing and updating records.

Blenheim Care Centre provides accommodation for a maximum of 64 people. The service has three floors and accommodates people in single rooms each with en suite facilities. to the ground floor was designed to accommodate up to 12 older people and 8 people with physical disabilities. The first floor was designed to accommodate up to 22 older people with dementia care needs and the second floor for up to 22 older people with dementia care needs. Each floor has communal dining, sitting rooms and bathing facilities. Nursing staff were employed to provide care on the ground and second floors. At the time of the inspection 51 people were living at the service.

MMCG (2) is part of the Maria Mallaband Care Group, a privately owned organisation providing care homes, day care and domiciliary care across the UK, Northern Ireland and Channel Islands.

The registered manager left the organisation in August 2017. There was a temporary manager in post. The provider was in the process of recruiting a permanent 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 and associated Regulations about how the service is run.

The staff did not always care for people in a respectful way and sometimes focussed on the tasks they were providing rather than the needs and wishes of the people who they were supporting.

There was not enough information about how to meet some people's care needs within their care plans and this meant there was a risk they would receive care which was inappropriate or unsafe.

People's social and leisure needs were not always being met.

Care records were not always clearly maintained.

The provider had systems for monitoring the quality of the service and making improvements. However, these improvements were not always sufficient to address any identified shortfalls.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to person centred care, dignity and respect, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.

The environment had not been suitably designed and equipped to meet the needs of people living with the experience of dementia. We have made a recommendation in respect of this.

The staff took part in training in relation to their role but did not always demonstrate the skills and knowledge from this training. The staff were not always supported and supervised to make sure they met people's needs and understood their roles and responsibilities. However, the provider had started to address this and provide better training, support, supervision and information.

Some people felt there were not enough staff to meet people's needs and keep them safe. The provider had assessed staffing levels and felt that these were sufficient. We observed that the staff did not spend time engaging with people or supporting them for longer than physical care tasks. It was unclear whether this was due to staffing levels, the deployment of staff or custom and practice of the staff team. There were times of the day when there were not enough staff to support everyone at the same time, for example, during mealtimes. There were some instances where staff worked consecutive days without sufficient time off and this practice could put people at risk.

People were safely cared for at the service. Risks to their wellbeing were assessed and managed. People received their medicines in a safe way and as prescribed. The provider had procedures for safeguarding people from abuse and these were followed.

The provider acted within the principles of the Mental Capacity Act 2005 by assessing people's capacity to consent and making decisions in their best interests where they lacked capacity. They had made application for authorisations under the Deprivation of Liberty Safeguards where applicable. However, they had not always recorded that people had consented to their planned care when they did have capacity.

People's healthcare needs were being monitored and met. The staff worked closely with other healthcare professionals.

People were able to make choices about the food they ate and their nutritional needs were being met. Although some people did not feel they had enough choice of food. The kitchen staff did not always have the written information they needed about people's different nutritional needs, so there was a risk that they would not meet these needs.

The majority of people felt that the staff were kind and caring. They had good relationships with them and they were happy living at the service.

The provider had introduced a number of regular audits and checks in order to monitor the service. There was evidence they had taken action where they had identified areas of concern.