Archived: Bearnett House

Updated 29 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection visit took place on 2 and 9 October 2018 and was unannounced. The inspection visits were carried out by two inspectors, an inspection manager and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We checked the information we held about the service and the provider. This included notifications that the provider had sent to us about incidents at the service and information that we had received from the public. A notification is information about events that by law the registered persons should tell us about. We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. Since our last inspection we have continued to receive information of concern about the home from member of the public and other professionals. We used this information to formulate our inspection plan

We spent time observing care and support in the communal areas. We observed how staff interacted with people who used the service. We spoke with two people who used the service, three relatives or visitors, and five members of care staff. We also spoke with the manager, two of the partners and two of the partners representatives. We did this to gain people's views about the care and to check that standards of care were being met.

We looked at the care records for six people. We checked that the care they received matched the information in their records. We also looked at records relating to the management of the service, including audits carried out within the home, staff recruitment procedures and actions plan that were in place.

Updated 29 December 2018

This comprehensive inspection visit took place on the 2 and 9 October 2018 and was unannounced.

Bearnett House is a care home. People in care homes receive accommodation and 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. Bearnett House is registered to accommodate 25 people in one adapted building. The home accommodates people in one building and support is provided on two floors. There is a communal lounge, a dining area, a library and conservatory and a garden that people can access. Some of the people living at Bearnett House are living with dementia.

At the time of our inspection on 2 October 2018, 12 people were using the service. There were 10 people using the service on the 9 October 2018.

We have previously taken enforcement action against this home and there are currently conditions on their registration in place and people cannot be admitted into the home without the written permission of the CQC. After our visits on both 2 and 9 October 2018 we wrote to the provider to seek reassurances about peoples’ safety. We did not receive the reassurances we requested.

There is not a registered manager in place and has not been since January 2017. 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.

At this inspection people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Risks to people are not managed in a safe way and when needed action was not always taken to ensure people were safe. When falls occurred action was not taken to reduce the risk of reoccurrence and this resulted in a repetition of falls for people.

Staff demonstrated an understanding of safeguarding however we could not be assured all incidents had been fully considered or investigated to ensure people were protected from potential harm. There were not always suitably trained staff available who could administer medicines for people. People did not always receive support to eat or drink and were at risk of dehydration. When people had lost weight, action had not always been taken. People were not referred to health professionals for support when concerns were noted.

There were no systems in place so that lessons could be learnt when things went wrong. The audits completed did not drive improvement within the home. The provider had not made or sustained the necessary improvements since previous inspections.

Staff were kind in their approach however interactions were often task focused. People's cultural or dementia needs were not always fully considered. Staff received training however we could not be assured their knowledge in these areas was checked.

People's privacy was considered. People and relatives were happy with the staff and were free to visit anytime. The home was clean and decorated to consider people's preferences however was unsuitable for people living with dementia. The provider was displaying their rating as required.

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 will 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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.