Archived: Benedict House Nursing Home

This unannounced inspection was carried out on 20, 22 and 23 June 2016. At this inspection we found several breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014 in relation to safe care and treatment and person centred care and good governance. We found that action had not always been taken to support people where risks to them had been identified and that the provider's systems for monitoring the quality of the service were not operating effectively as we found some issues with care plans and risk assessments that the provider had not identified. We took action to impose urgent conditions on the provider. These required the provider to carry out a thorough and comprehensive review of all people using the services care plans and risk assessments to ensure they fully reflected people’s current needs and to undertake monthly audits of care plans and risk assessments and send the Care Quality Commission a report of any actions taken as a result of these audits each month.

We also found that staff were not always aware of people's care needs. Staff were not always following the guidance as recorded in some people's care files. Staff did not assess risks to people using the service in a timely way following falls. Some staff had not received the appropriate training to enable them to carry out their duties. Leadership within the home was inconsistent. There was a high turnover of managers and nursing staff at the home. You can see what action we told the provider to take at the back of the full version of the report.

The home did not have 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 2008 and associated Regulations about how the service is run. A new home manager started work at the home in April 2016. They had begun the process of applying to the CQC to become the registered manager for the home.

At our last inspection of the service we found breaches of legal requirements relating to regulations 9 and 18 of the Health and Social care Act 2008 (Regulated Activities) Regulation 2014. These related to staff supervision and appraisals and a lack of activities for people using the service. At this inspection we found that the provider had addressed these breaches.

There were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People’s medicines were managed appropriately and people received their medicines as prescribed by health care professionals. There were arrangements in place to deal with foreseeable emergencies. People had individual emergency evacuation plans which highlighted the level of support they would need to evacuate the building safely. Appropriate recruitment checks took place before staff started work.

Recruitment for nursing staff was on-going. The provider had yet to establish a full complement of qualified nursing staff to support people using the service with their health care needs. The provider had limited the numbers of people they would support at the home until the home had established a fully functional nursing team that would meet people’s health care needs.

Staff had completed an induction when they started work. The manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. People were receiving the food and fluids as recorded in their care plans. People had access to a GP and health and social care professionals when they needed them.

Staff spoke to and treated people in a respectful and dignified manner and people’s privacy was respected. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. There was a range of activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

Staff said they enjoyed working at the home and received good support from the new manager. The provider took into account the views of people using the service and their relatives about the quality of care provided through relatives meetings and surveys. The manager used the feedback from the meetings to make improvements at the home. The manager carried out unannounced visits to the home to make sure people were receiving appropriate care and support.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 may 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.

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.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they were comfortable and felt safe and secure in the home. The provider had safeguarding policies and procedures and staff we spoke with knew of their responsibility to safeguard vulnerable adults. They told us the procedures they would follow to ensure that people were safe, if abuse was witnessed.

We saw that the home was clean and well maintained. All the people we spoke to told us that this was always the case. Equipment was well maintained and regularly serviced and all health and safety records we looked at were up to date. This showed that people who used the service were not placed at unnecessary risk.

The staffing arrangement in place and the number of staff on duty on the day of our inspection were sufficient to meet people's needs. People received a consistent and safe level of support. There were various staff with different qualifications, skills and experienced to meet people's needs.

Procedures for dealing with emergencies were in place and staff we spoke with knew the actions to take in the event of an emergency.

Is the service effective?

All the people who used the service had a care plan set out to meet their individual needs. All the care plans we looked at had been reviewed monthly to ensure that an individual's current needs were met. Staff told us that care plans were discussed with people and their relatives, and some people we spoke with confirmed they were involved in the care planning process. Some other people said they were not sure if they had been involved or not. All the care plans we looked at did not demonstrate that people were involved in the care planning process or not.

The care plans we reviewed included people's health and social care needs, and provided staff with information they required to meet people's needs. However, information about people's social preferences and life history which would help staff understand more about them was limited.

Decisions about care and treatment were made by the appropriate staff at the appropriate level. People had access to a range of health care professionals some of which visited the home on regular basis including a general practitioner (GP). The service provides palliative care for people at the end of their lives. We saw that people's end of life care had been discussed with them where appropriate, and their wishes taken into consideration when planning and delivering their care.

Is the service caring?

People looked well cared for, clean and comfortable. They were appropriately dressed for the time of year. Those people being cared for in bed appeared comfortable and well hydrated. Pressure relieving equipment was in place where necessary.

People were supported by staff who were kind and attentive to their care needs. All the people we spoke with complimented the home and the staff who worked there. Some of the commented we received included 'the service is excellent,' 'I am happy here. I will like my mother who is 91 now to be here.' Two visiting friends we spoke with told us that their friend was happy and content in the home.

Staff were aware of people's care needs and were sensitive to their needs when providing care and treatment that met their needs. For example, people with dementia care needs.

Is the service responsive?

Residents and relatives meetings took place on a regular basis where they could express their views and opinions about the home. The provider also carried out an annual customer satisfaction survey about the services they provided in 2013. The survey results we looked at were mostly positive and people said they were satisfied with the service they or their relatives received. The home manager informed us that the results of the survey were discussed at the residents and relatives meeting and their feedback had been used to improve on the quality of service provided at the home. People we spoke with told us did not have any concerns and that if they had any concerns or were unhappy, they would speak with staff or the home manager.

The provider carried out staff satisfaction surveys to improve the quality of service provided. Where issues were identified for example with lack of communication, we saw that the provider had taken action to improve on how information was being communicated to staff. The provider carried out their own monitoring checks in areas such as health and safety, medication and care plan audits. We saw that following the audit, the provider addressed any identified issues.

Is the service well-led?

Since the new manager came into post in September 2013, there had been significant organisation changes to improve on the service provided. We were told that around 30 staff had been recruited to ensure enough skilled and experience staff were available to meet people's needs. We found that a previous embargo put on the provider by the local authority due to poor care had been lifted, in part; and the provider could currently accommodation up to 36 people.

Staff we spoke with told us that they felt well supported by the home manager and other management staff in the home. They said staff worked together as a team to ensure people's needs were met. All the staff we spoke with were confident that any concerns raised with the home manager would be taken seriously, investigated and an appropriate action taken to ensure the standard of care delivery was maintained. We found that the responsible individual was also available on ad-hoc basis to support staff in their role.

We spoke to some people who used the service and their relatives and the majority of people were complimentary of the service. One person's relative told us their family member "gets all the care they need" and that they had "no concerns" about any aspect of the service. One person told us they were happy living at the home and they told us staff came quickly if they needed assistance. Another person's relative told us staff were attentive to their family members needs but felt sometimes there were not enough activities. We found that the majority of people had their call bell in reach and had access to drinks when they needed it.

We found the provider had maintained the required standards in relation to assessing, planning and risk assessing people's care needs and we found the care people received was in accordance with their care plans. The provider had made some changes to the way in which medicines were managed and we found this was now completed to ensure people received their medicines safely. We found staffing levels were appropriate to meet the needs of people, and we saw staff we able to attend to people's needs quickly.

People we spoke to who used the service told us that generally they were happy living at the home. One person told us 'I am happy here' and that the staff were 'good, obliging and helpful, but sometimes they are too busy'. We saw that staff were quicker to respond to call bells since our previous inspection and people did not have to wait as long for their breakfast in the morning and they were supported to eat appropriately.

We found the provider had made efforts to make improvements to the care and welfare of people and the safety and suitability of equipment since our previous inspection. The provider had assessed people and reviewed their care plans to ensure they reflected people's current needs. Care plans had also been reorganised so they were in a format which was easier to understand. The provider had repaired or replaced faulty equipment and had implemented checks to ensure people's equipment was safe and suitable for them.

We found that although people's needs were assessed, often this was inadequate or inconsistent, including wound assessments, pain management and nutritional assessments. We found most people had care plans in place to meet their needs, however some had not been drawn up in areas where people required support, for example diabetes and pain management. We also found in some cases people's care had not been delivered in accordance with their care plan.

We found that people were not adequately protected from the use of unsuitable equipment. Some people were cared for using equipment that did not meet their needs, and we found some equipment was not being used correctly which posed a risk to people's health and wellbeing. We found staffing levels were not adequate to ensure people always received the care they needed in a timely manner.