Archived: Blenheim Care Centres

Updated 6 July 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 checked 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 home, and to provide a rating for the home under the Care Act 2014.

This inspection took place on 14 March 2018 and was unannounced. The inspection team consisted of two inspectors and a specialist advisor. The specialist advisor was a pharmacist. An inspection manager was also part of the inspection team for a short time during the morning. The service had been rated as inadequate at the last two inspections and was in special measures. We undertook this inspection as the provider had indicated to us that they had made improvements in the care provided. We visited early in the morning as we had concerns that there were not enough staff working at night.

Before the inspection we reviewed the information we held about the home. This included any incidents the provider was required to tell us about by law and concerns that had been raised with us by the public or health professionals who visited the home. The provider completed a Provider Information Return (PIR) in July 2017. They had not been asked to update this form prior to the inspection. The PIR is a form that asks the provider to give some key information about the home, what the home does well and improvements they plan to make.

During the inspection we spoke with the registered manager, the regional manager and the provider. We also spoke with the nurse on duty and two members of care staff. We spent time observing the care people received. We spoke with one person living at the home.

We looked at six care plans and other records which recorded the care people received. In addition, we examined records relating to how the home was run. These included two staff records and records relating to training and supervision of staff. We looked at the competency records for seven members of staff. We looked at the staffing tool used to calculate the numbers of staff needed to keep people safe. We also looked at the audits in place to monitor the quality of care provided and a consultant’s report of the quality of the care and environment dated 4 January 2018. Following the inspection the provider sent us further information on the staffing tool, the employers liability insurance certificate, the minutes of the latest resident’s minutes and a copy of the regional manager’s report from their visit on 12 March 2018.

Updated 6 July 2018

The inspection took place on 14 March 2018 and was unannounced.

Blenheim Care Centres is a nursing and residential care home for up to 80 people located near to

Gainsborough, West Lincolnshire. The home is in two buildings, Blenheim House and Blenheim Lodge. Blenheim Lodge was closed on the day of our inspection. Blenheim house consists of 35 bedrooms and some flats.

The home caters for people of ages 18 years and older, and who have physical disabilities and/or neurological conditions. On the day of our inspection 19 people were living at the home, 10 of these people received nursing care.

An unannounced comprehensive inspection was carried out on 9 August 2016 during which we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to medicines arrangements, risk assessments, the environment, infection control and prevention, governance, staffing levels and capacity assessments. At two further inspections in September and November 2016 we found that although the registered provider had taken some actions, they had not made sufficient progress to become compliant with legal requirements and improvements had not been tested for sustainability. We completed a further comprehensive inspection on 21 February 2017 where we identified that there were still concerns related to medicines management, risk assessments, completeness of care plans, staffing levels and mental capacity assessments. The home was placed into special measures after this inspection. We inspected again on 4 September 2017 we found that the provider had failed to make the improvements needed and the overall rating for this home was Inadequate and the home remained in special measures.

At this inspection on 14 March 2018, we found that some improvements had been made. For example, the management of medicines had improved and people’s medicines were now ordered, stored and administered safely and accurate records were kept. However, other areas had not improved and the overall rating for this home remained Inadequate and the home remained in special measures.

Homes 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 home, 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 home. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This home 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 home. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care homes the maximum time for being in special measures will usually be no more than 12 months. If the home 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.”

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.

There was a registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The registered manager was not able to fully identify all the concerns in the home and lacked the ability to drive improvements in all areas so that people received the standard of care that they were entitled to. While staff received the training and support they needed they were not able to identify that the care provided was not meeting the latest guidance or evidence based practice. The registered manager had failed to see that the tool used to identify staffing levels was not working correctly. The turnover of staff did not support people to receive safe consistent care. Recruitment processes ensured that staff employed were safe to work with people living at the home. However, the registered manager facilitated the handyman starting before their DBS was received by asking them to work as self-employed until disclosure and barring service checks were completed.

Staff did not ensure that they accurately assessed the risks while providing care or ensure that they recorded clear guidance on how care should be delivered. Care plans contained conflicting information and would not support staff to provide safe care.

The environment did not support people’s dignity and was not maintained to an appropriate standard. Empty rooms were not maintained to a standard which would reduce the risk of infection. Plans in place to improve the quality of the environment were not effective.

The audits in place to monitor the quality and safety of care were not effective and did not result in improvements to the care that people received. Systems to ensure that care reflected the latest guidance and best practice were not successful.