Archived: St Bennett's Care Home

St Bennett’s care Home provides accommodation and personal care in one adapted building for up to 27 older people, including people living with dementia and people with a learning disability and or autism. At the time of our inspection, there were 20 people living at the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: Opportunities of choice, control and independence were limited. Activities to pursue interests, hobbies and make future plans were not supported.

People were not supported to have maximum choice and control of their lives. However, staff provided care and support in the least restrictive way possible and in their best interests; the policies and systems in the service however were not consistently adhered to.

Right Care: Staff were kind, caring and provided dignified care. However, care plans were not fully reflective of people’s current care needs. Care was therefore not consistently personalised.

Right Culture: The management team were in the process of developing a new staff team and showed a commitment in wanting to make improvements at the service. This included developing a positive staff culture and empowering people by improving their care and support experience and opportunities.

Risks associated with people’s care and treatment had not been consistently assessed and planned for. Guidance for staff of how to manage and mitigate known risks was not always available, up to date or sufficient in detail. Environmental health and safety risks had also not been consistently assessed, planned for and monitored.

Medicines were not consistently managed safely or effectively, and best practice guidance was not always followed. Safeguarding procedures did not fully protect people. Where authorisations to deprive a person of their liberty had been granted with conditions, these had not been reviewed and monitored as required.

Staff deployment was not sufficient. The provider did not use a dependency tool to assess people’s care needs. Care staff were also required to complete domestic tasks, and this had a negative impact on their availability to meet people’s care needs.

The provider’s systems and processes to assess and monitor quality and safety were not robust. This impacted on the provider’s oversight and leadership. Care records and documentation was disorganised, not always up to date, insufficiently detailed or missing. The provider’s policies and procedures had not been regularly reviewed to ensure they met current legislation and best practice guidance.

People’s health conditions had not consistently been assessed and planned for. Whilst changes to people’s health were reported to external health professionals and recommendations implemented, record keeping reflecting actions were poor.

People received enough to eat and drink but guidance for staff about people’s individual food and hydration needs lacked detail.

Staff were recruited safely and received ongoing training and support.

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

The last rating for this service was good (published 28 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staff deployment, care planning, risk management and the provider’s systems and processes. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

The provider took some immediate actions to make improvements.

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to risk management, the provider’s systems and processes that monitored the service, medicines management, safeguarding procedures and staff deployment.

Please see the action we have told the provider to take at the end of this report.

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

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.

St Bennett’s accommodates up to 24 people in one adapted building. At the time of this inspection, 17 people were using the service.

At our last inspection in January 2016, we rated the service 'Good'. At this inspection, we found the evidence continued to support the rating of 'Good.'

This inspection report is written in shorter format because our overall rating of the service has not changed since our last inspection.

People and relatives felt safe with the staff providing their care and support. Staff were aware of their responsibilities for keeping people safe from abuse and avoidable harm.

The registered manager understood their responsibilities to keep people safe and was aware to notify the local safeguarding authority and Care Quality Commission (CQC) of safeguarding concerns and carry out investigations as required, although the safeguarding procedure was not clear that all suspicions of abuse needed to be reported.

People felt safe in the service.

Staffing arrangements met the individual dependency needs of people currently using the service.

Staff had the appropriate skills, competency and knowledge to meet people's individual needs. Health and safety training followed current relevant national guidance to prevention and control of infection.

On-going support and one to one supervision was provided for staff to reflect on their practice.

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People received their medicines safely and staff supported people to access support from healthcare professionals when required, to ensure people continued to receive coordinated care and support.

The registered manager and staff understood the Mental Capacity Act, 2005 (MCA) legislation and followed this in practice.

The environment was clean, and repairs and refurbishment works had been and were taking place to the building. Routine safety checks were carried out on the fire, water, gas and electrical systems.

Risk assessments to manage assessed risk to people’s safety were not always comprehensively in place.

Staff recruitment procedures were in place to ensure that appropriate pre-employment checks were carried out to assure staff were suitable to work at the service, although these needed to be strengthened to ensure all known risks were fully explored.

People were involved in planning their on-going care. People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way. People and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and covered their health and social care needs. Activities were organised to provide stimulation for people and they had opportunities to take part in activities in the community if they chose.

People and their relatives told us they would tell staff if they had any concerns and were confident these would be followed up.

People, staff and representatives were satisfied with how the home was run by the registered manager. Management carried out audits and checks to ensure the home was running properly to meet people's needs, though not all essential issues had been comprehensively audited.

We found the provider had policies and procedures in place relating to people who did not have the capacity to consent. However, it was not clear if these had been followed.

We found people experienced care and support that met their needs and protected their rights. One person told us 'the staff look after me well and do a good job. The food is nice.' Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines. The number of controlled drugs in the controlled drugs cupboard did not match with the number recorded in the controlled drugs register.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found the provider had a complaints policy in place. However, the service did not keep an accurate log of complaints received. We found it was difficult to assess if complaints had been dealt with appropriately.