Archived: Benamy Care

The service was last inspected on 12 February 2016 at which time we found the registered provider had failed to implement the majority of an action plan they told us was intended to address a range of breaches of the Health and Social Care Act 2008, identified in a previous inspection of 19 and 20 August 2015. These breaches of legislation were:

• Regulation 9 – Person-centred care

• Regulation 11 – Consent

• Regulation 12 – Safe care and treatment

• Regulation 17 – Good governance

• Regulation 18 - Staffing

We took enforcement action following the inspection of 19 and 20 August 2015 and the service was put into ‘Special Measures’. This meant the service was kept under review and a return inspection planned within six months, with the expectation that significant improvements should have been made within this timeframe. At the inspection of 12 February 2016 we found the registered provider had failed to make any significant improvements and remained in breach of these regulations. The service therefore remained in ‘Special Measures.’

On this inspection of 13 September 2016 the inspection team were unable to undertake a full inspection of the service due to the obstruction of the registered providers and the registered manager (who is also one of the registered providers). The registered providers confirmed they had made no changes or improvements since the last inspection and did not intend to do so.

The obstruction of an inspection is a criminal offence under Section 63 (7) of the Health and Social Care Act 2008. CQC has considered the appropriate regulatory response to this obstructed inspection and has shared information regarding the conduct of the registered providers with local authority commissioning professionals.

The service therefore remains in Special Measures.

Benamy Care is a small residential care home in Seaham providing accommodation and personal care for up to five adults with learning disabilities. There were five people using the service when we attempted to inspect the service.

The home had a registered manager in place. 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.

Of the documentation we saw, as per the comments by the registered providers, we saw care files had not been reviewed since the last inspection and there was no evidence of quality assurance work being undertaken.

The registered providers confirmed they had put in place no action plan since the last inspection. The registered providers obstructed the inspection by way of refusing to answer further questions and requesting that we leave the premises and we were unable to complete a comprehensive inspection of the service at this time.

During our inspection we found no evidence to indicate that the previous breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 (as identified in previous inspections) had been addressed, or that any improvements had been made.

The service was last inspected on 19 and 20 August 2015 at which time we found the registered provider had failed to implement an action plan intended to address a range of breaches of the Health and Social Care Act 2008, identified in a previous inspection of 24 July 2014. Following the inspection of 19 and 20 August 2015 (published on 15 October 2015) the service was rated as ‘Inadequate’ and therefore in ‘Special Measures’. This meant the service was kept under review and a return inspection planned within six months, with the expectation that significant improvements should have been made within this timeframe.

On the inspection of 12 February 2016 whilst we found some improvements had been made, significant aspects of the latest action plan provided to CQC had not been completed and the service continued to be in breach of Regulations 9, 11, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This registered provider remains in special measures. This inspection found that there was not enough improvement to take the registered provider out of special measures.

CQC is now considering the appropriate regulatory response to the latest findings.

Benamy Care is a small residential care home in Seaham providing accommodation and personal care for up to five adults with learning disabilities. There were five people using the service when we inspected.

The home had a registered manager in place. 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 found that there were insufficient numbers of staff to adequately care for people using the service and to meet their range of needs.

Some aspects of the action plan submitted to CQC had been completed with regard to the safety of medicines management but we identified other areas where risk assessments were not sufficiently detailed neither were staff sufficiently knowledgeable of those risks. Emergency and evacuation plans had been reviewed and improved, meaning people were better supported should there be a need to evacuate the premises in an emergency. As there were no emergencies, we did not observe this in practice during the inspection.

Mental Capacity Act training had not been attended by the registered provider, who undertook caring responsibilities, at the time of the inspection. All four other staff had received this training although we found staff had a poor understanding of the Mental Capacity Act 2005 (MCA) and supporting people through best interests decision-making and Deprivation of Liberty Safeguards (DoLS). We found documentation reflected this lack of understanding, for example people without capacity had been asked to sign documents to give their consent to care and treatment despite other documents stating they did not have capacity to do so.

Whilst we saw that some basic staff training was in place, training generally was not planned in a coherent or effective manner. We found that safeguarding training had not been refreshed in line with the service’s policy, MCA awareness training had not been completed for all staff and that training specific to the needs of people who used the service had not been delivered. For example, we found staff had not been trained with regard to Diabetes awareness.

We found that people enjoyed meals and were involved in their own meal planning and preparation. We did not find evidence of poor nutrition; lunches and evening meals contained a range of vegetables. We found however the registered provider had failed to ensure menus benefitted from the opinion of a suitable professional, such as a dietitian. Relatives of people who used the service as well as external healthcare professionals told us people were well cared for and happy in the service.

We found that, as at the last inspection, independence within the community was not promoted and no efforts had been made to tailor care plans to a mode of communication people could understand.

We found that people were supported to access medical appointments to ensure their health needs were met. Relatives we spoke with expressed confidence in the levels of care provided.

We found the majority of care planning documentation had not been updated in line with the registered provider’s action plan. One person’s care plans had been completed whilst the rest were in draft format.

We found that some aspects of auditing had begun but other audits, as committed to in the action plan, had not been undertaken, such as a care plan audit and staff training audits.

We found that surveys had been distributed to people who used the service, relatives and external professionals regarding the service, and that these had been returned. The content of the returned surveys was uniformly positive.

We found that the action plan submitted to CQC had not been acted upon to a satisfactory standard.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014. We are currently taking enforcement action regarding these breaches and will publish this when the inspection process is complete.

We were able to observe the experiences of people who use the service. We saw that staff treated people with dignity and respect. For instance, people told us that they all had their own rooms, with a key, and that they would not go into anyone's room without the person's permission. We saw that the people using the service related well with the staff. We saw the staff communicated well and appropriately with people in a way that was easily understood. We saw that staff were attentive and interacted well with people. People told us that they liked to make their own choices. They told us that they liked to go on holiday and told us they had just been on a long weekend trip away to Blackpool. We observed how people demonstrated choice with meals. On the day of the visit we observed that some people using the service preferred a packed lunch when going out for the day.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service had their care and welfare needs met.

We found that there were good systems in place for the involvement of other health or social care professionals.

We found that staff were supported in their roles and had received training and guidance in supporting people. We found that people were safeguarded against abuse.

We found that there was an effective complaints system in place and people had been able to raise any concerns or issues effectively.

We looked closely at the condition of the home, how the provider maintained it and how unforeseen damage was dealt with. We found the building had been properly maintained and when unexpected damage occurred, immediate steps had been taken to ensure the safety of people who lived or worked there. We found the provider had also taken steps to ensure the safety of people who used the service by carrying out regular checks and making improvements based on their findings.

We saw people who used the service, their relatives and other professionals were welcomed to the home and their views were sought on the way the home was run. We found people's diversity was valued, respected and encouraged.