Archived: Bexhill Care Centre Limited

Bexhill Care Centre is registered to provide personal and nursing care for up to 41 older people who are living with dementia and/or have physical disabilities. There were 34 people living at the home during the inspection

People’s experience of this service

The provider did not have an effective quality assurance and monitoring system to assess the services provided and ensure people had appropriate care and support. The provider did not have oversight of the service, which meant they had failed to identify areas where improvements were needed, and placed people at risk of harm.

People’s health, safety and well-being were not always protected, because pre-admission assessments had not identified people’s specific needs before they moved into Bexhill Care Centre. The care plans and risk assessments based on the pre-admission assessments therefore had not always reflected people’s needs or provided clear guidance for staff.

There was some guidance for staff to follow to protect people, such as, those at risk of falls. However, from our observations and records staff did not always follow this guidance and people were at risk of falls. Where accidents and incidents had occurred the registered manager or staff had not made referrals to the local authority under current safeguarding procedures. They had not kept CQC informed of these incidents and lessons had not been learnt to prevent re-occurrence.

Medicines were not managed safely. The ordering, checking and storage of medicines had not followed relevant guidelines and people had not consistently received their medicines as prescribed.

There were not enough staff working in the home with the right skills and knowledge to provide personalised care to people, based on their needs, preferences and choices. There was an over-reliance on agency staff, nurses and care staff, and there was no clear process to assess the competence or suitability of agency staff before they worked at the home.

There was ongoing maintenance at the home. However, some immediate action was needed to make safe the environment to protect people and this had not been done, which meant people were at risk of harm.

Recruitment procedures were thorough to ensure staff were suitable to work in the care setting.

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

Rating at last inspection

The service was last rated Requires Improvement. (Published 22 February 2019).

Why we inspected

We received concerns in relation to the management of medicines, people’s nursing care needs, staffing and overall management of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection. Areas where improvements were needed have been consistently found during inspection since this service started in 2015. Where some improvements have been made they have not been sustained and people continue to be at risk of harm.

Enforcement

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

Following the inspection we took action to ensure the provider improved the safety in the service. We informed the local authority and clinical commissioning group (CCG) of our concerns.

The overall rating for this registered provider 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 and there is still a rating of inadequate for any key question or overall, 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.

We inspected this service in July 2017 and found the provider was in breach of the Health and Social Care Act2008 (Regulated Activities) Regulations 2014 and Registration Regulations 2009. The provider had not ensured people received safe care and treatment; records were not up to date and people had not received personalised care and support and the quality assurance system had not been effective as it had not identified areas where improvements were needed. The overall rating was inadequate and the service was put in ‘special measures’.

At the last inspection in February 2018 we found improvements had been made and the provider had met the legal requirements. However, some areas needed further improvement and time to ensure they were part of everyday practise at the home. The overall rating for the service was Requires Improvement.

At this inspection we found the improvements had not been sustained and there were breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The quality assurance system had not been effective as it has not identified areas where improvements were needed. For example, medicines were not managed safely and people had not consistently received their medicines as prescribed by medical practitioners. Care plans had not reflected people’s individual assessed needs and there was no clear guidance for staff to follow to provide personalised care and support.

Risk had been identified and systems were in place to reduce these, but the provider had not ensured these were followed and risk was reduced as much as possible. Accident and incidents had been recorded. However, the provider had not investigated the causes or implemented changes, which meant lessons had not been learnt and plans had not been put in place to prevent a re-occurrence.

This is the fourth comprehensive inspection where improvements were needed under the key questions safe, responsive and well led and the overall rating remains Requires Improvement.

Bexhill Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to provide nursing and personal care and accommodation for up to 41 older people. At the time of the inspection there were 24 people living in the home. 22 people in Poppy unit and two people in Lavender unit. Some people were living with dementia and needed support with personal care and others had more complex needs, which required nursing care.

The service did not have a registered manager. A manager had been appointed six weeks prior to this inspection and they said they were completing their application to register with CQC as the registered manager. 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 we rated the service ‘Requires Improvement’. We found improvements were needed to ensure there was an adequate process for assessing and monitoring the quality of the services provided and to ensure that records were accurate and complete. The provider has been rated ‘Requires Improvement’ four times and we have determined they are not meeting the regulation in relation to Governance because of this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff knew people well and were kind and caring as they assisted people to move around the home safely. They respected people’s preferences and encouraged them to make decisions about their day to day lives and be as independent as possible.

Staff had completed training, including safeguarding and moving and handling, and were supported to develop their practise through regular supervision. People and relatives said staff provided the support and care they needed and comfortable in their care.

People said the food was very good; they were offered choices for each meal and staff provided assistance when required. Relatives and visitors were made to feel very welcome and people were supported to keep in touch with them.

You can see what action we told the provider to take at the back of the full version of the report.

We previously carried out an inspection of this service in December 2015 when we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Health and Social Care Act (Registration Regulations 2009). We found the provider had not safeguarded people from abuse, safe care and treatment was not provided, there were not enough staff employed in the home, people’s personal records were not complete and up to date and the quality assurance and monitoring systems were not effective. The provider had also failed to inform CQC about incidents that affect the provision of services, such as insufficient staff. We received information of concern about staffing levels and carried out a focused inspection in February 2016. We found improvements had not been made and we took enforcement action.

The inspection in December 2016 found improvements had been made and the provider had met the regulations.

At the last inspection on 17, 19 and 21July 2017 the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Registration Regulations 2009. We found the service was not consistently safe because there were not enough staff with the skills and expertise to provide safe care and treatment. Risk had not been assessed appropriately, which put people at risk of harm or injury. Medicines were not managed safely. Emergency systems were not effective and safeguarding procedures had not been followed, which put people at risk of improper treatment. Personal records were not up to date and personalised care was not consistently provided. The quality assurance system was not effective and had not identified areas for improvement and CQC had not been informed of these concerns. The overall rating was inadequate and the service was put in ‘special measures’.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and confirm that the service now met legal requirements. We found improvements had been made and the provider had met the legal requirements. However, we identified some areas needed further improvement and others needed time to be embedded into day to day practice.

Bexhill Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide nursing, personal care and accommodation for up to 41people. There were 21 people living at Bexhill Care Centre at the time of the inspection. Some people had complex needs and required nursing care and support. Others were living with dementia or had physical disabilities and needed assistance with personal care and moving around the home safely.

The registered manager was present during the inspection. 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.

Since the last inspection there had been significant changes. The provider has taken a more active role in overviewing the service and had become the nominated individual. A nominated individual (NI) is the responsible person within the organisation. A registered manager had been appointed and an external consultant provided guidance. The NI, registered manager and consultant worked together to review the provision of services at the home. The quality assurance system had been reviewed and a plan introduced to ensure all areas of the service were audited regularly by senior staff responsible for that area of the service. Monitoring had identified areas for improvement, including the care planning process. Staff had been appointed to review and update the care plans to ensure the contained appropriate information about each person’s needs. We found additional work was needed to ensure the care plans identified people’s individual needs with clear guidance for staff to follow.

From August 2016 all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand so that they can communicate effectively. At this inspection we have made a recommendation that the provider seeks advice and guidance from a reputable source, about Accessible Information Standards (AIS) to ensure staff are aware of their responsibilities.

The NI, registered manager and consultant had looked at the staffing levels and what improvements could be made to ensure people received the care and support that met their specific needs. Lavender unit was closed with the agreement of people living there and their relatives. People had been moved to Poppy unit and the staff transferred with them. This meant the provider no longer relied on agency staff to make up staffing levels and there were sufficient permanent staff to provide appropriate care. Appropriate recruitment procedures were in place to ensure only suitable staff worked at the home.

Staff responsible for giving out medicines had updated their training and had taken responsibility for the management of medicines. However, we found the guidance for medicines prescribed on an ‘as required’ basis was not clear, which meant people may not have been given these when they needed them.

People and their relatives said people were safe and improvements had been made to facilitate this. Risk had been assessed and staff provided support to ensure people could move around the home safely. Staff had attended safeguarding training; they knew how to protect people from harm and what action they would take if they had any concerns. The home was clean and well maintained. Infection control policies were in place, there were regular health and safety checks of the environment and, emergency procedures were in place to support people if they had to leave the building.

Staff had received essential training as well as additional training specific to people’s needs, such as dementia awareness. Staff had a good understanding of the Mental Capacity Act 2004 and Deprivation of Liberty Safeguards. People were enabled to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible. Staff were supported to develop their professional practice, through supervision and yearly appraisals, and they were aware of their roles and responsibilities.

People were supported to eat a nutritious diet and drink sufficient fluids; meals were freshly cooked and snacks and drinks were available at any time. Staff understood people’s needs. They monitored people’s health and ensured people could access healthcare professionals and services, to maintain their health and well-being.

Staff provided personalised care for people that was based on their needs; through ongoing discussion and agreements with people and their relatives as required. People were enabled to maintain relationships with people important to them and, they were encouraged to raise concerns or put forward suggestions about the services provided. For example, through daily discussions, review meetings and satisfaction questionnaires.

The home has accommodation for up to 41 people with nursing and personal care needs. There were 25 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others were living with dementia and because of physical frailty or medical conditions needed assistance with person care and moving around the home safely.

This inspection took place on the 17, 19 and 21 July 2017 and was unannounced.

The service had not had a registered manager since November 2016. The provider told us the last manager had recently left the service and they were interviewing prospective managers at the time of the inspection. 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 our comprehensive inspection in December 2015 we found the provider was not meeting the regulations with regard to safeguarding people from abuse and improper treatment, safe care and treatment, staffing, personal records and assessing and monitoring of the services provided. We received information of concern about staffing levels and carried a focused inspection in February 2016. We found improvements had not been made and we took enforcement action.

At our last inspection in December 2016 we found improvements had been made and the provider had met the regulations. After that inspection we received new information of concern in relation to the management of the home and staffing, which may impact on people’s care and safety. As a result we carried out a comprehensive inspection on 17, 19 and 21 July 2017 and found the provider was not meeting the legal requirements with regard to safeguarding people from abuse, safe care and treatment, staffing, personalised care, personal records and assessing and monitoring the services. There were five repeated breaches of these regulations and one new breach and there were other areas where improvements were needed

The quality assurance and monitoring system had been reviewed and a number of audits had been completed. However, the system had not identified areas of concern that we found during this inspection and appropriate action had not been taken to ensure people’s safety.

Safeguarding referrals had not been made to the local authority when staff were aware of concerns about people’s safety. Although staff had attended training, they understood about abuse and explained what action they should take if they knew people were at risk of harm.

The management of medicines was not safe. Nurses employed at the home had not accepted responsibility for the ordering, receiving, checking and giving out medicines, which meant people were at risk of not receiving their prescribed medicine.

There were not enough permanent staff working in the home, staff allocation was not based on people’s needs and there was a risk that people would not receive the support and care they needed. Staff said they had completed relevant training. Although there were no records to verify this staff demonstrated an understanding of people’s needs and how they would meet them. One of the staff said they had had one to one supervision and, however this was not up to date and it was not clear how this would continue with the recent changes in management.

Assessments had been completed to identify areas where people may need specific care and support. However, these were not consistently effective, people were at risk of harm or injury and the service had not provided person centred care. Care plans did not contain sufficient information for nurses and staff to plan care to meet people’s needs.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected. Staff said DoLS application had been referred to the local authority and they were waiting for a response. However, mental capacity assessments had not been completed for two people living with dementia who had recently moved into the home.

Staff said people had access to health care professionals and there was evidence of the management of people's care between the staff and external professionals. Although one record stated a person had difficulty with swallowing, but this was not supported by records of visits from healthcare professionals. GPs visited the home as required and these were recorded in the care plans,

People said the food was good, choices were offered and staff assisted people with their meals. Any concerns with people’s diet were referred to the GP and people were weighed regularly to ensure they had sufficient to eat.

People were encouraged to keep in touch with people who were important to them and relatives and friends said they could visit at any time and were made to feel welcome.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

The home has accommodation for up to 41 people with nursing and personal care needs. There were 16 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others needed support with personal care and assistance moving around the home due to physical frailty or medical conditions, and some were living with dementia.

A registered manager had not been in place since October 2016. A manager had been appointed and was applying to register at the time of the inspection. 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.’

This inspection took place on the 21 and 29 December 2016 and was unannounced.

At our inspection on 17 and 21December 2015 we found the provider was not meeting the regulations with regard to safeguarding service users from abuse and improper treatment, safe care and treatment, staffing, personal records and quality assessment and monitoring of the services provided. At this inspection we found improvements had been made and the provider had met the regulations.

Because of additional concerns we carried out a focused inspection on 5 February 2016 and looked specifically at the safe question We found the provider was not meeting the legal requirements in relation to safe care and treatment. We took appropriate action. At this inspection we found improvements had been made and the provider had met the warning notice.

We found that additional work was needed to ensure the improvements were embedded into practice. For example, the quality assurance and monitoring system had been reviewed and a number of audits had been completed. However, the system had not identified areas of concern that we found during the inspection. Such as gaps in the care plans and risk assessments.

There were systems in place for the management of medicines and we observed staff completing records as they administered medicines but, the guidance for staff to give out some medicines, such as those prescribed ‘as required’, was not clear.

Staff had attended safeguarding training and they demonstrated an understanding of abuse and said they would talk to the management if they had any concerns. They knew that referrals were made to the local authority and how to make these. People said they were comfortable and relatives felt people were safe living at Bexhill Care Centre.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People had access to healthcare professionals, including the GP, optician and chiropodist. Choices were available for meals; people were supported to have a healthy diet and, they were consulted about the menu. Relative and friends could visit at any time and they were made to feel very welcome.

The atmosphere in the home was calm and relaxed. Conversations between people, visitors and staff were friendly and staff respected people’s choices and protected their dignity when providing personal care.

Complaints procedures were in place and any concerns had been addressed following the providers procedures. The provider and manager encouraged people, relatives and staff to be involved in decisions about how they service improved and, people and staff were very positive about the management of the home.

Satisfaction questionnaires were used to obtain feedback from people living in the home, their relatives and outside agencies. The responses expressed a high degree of satisfaction in staff attitudes and their willingness of staff to seek guidance and support where necessary and the quality of care provided.

The home has accommodation for up to 41 people with nursing and personal care needs. There were 16 people living at the home at the time of the inspection. Some people had complex needs and required continual nursing care and support, including end of life care. Others needed support with personal care and assistance moving around the home due to physical frailty or medical conditions, and some were living with dementia.

A registered manager had not been in place since September 2015. A manager had been appointed and had applied to register at the time of the inspection. 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.’

This inspection took place on the 5 February 2016 and was unannounced.

People were supported to make choices about the support and care they received and staff were kind and respectful. However, there were not enough staff with the appropriate experience and skills to meet people’s individual needs. This meant that people were not being helped by staff who knew how to assist them to move safely or protect them from harm.

The information in care plans was limited; risk had not been assessed for some people and, there was no clear guidance for staff to follow to support people.

Systems were not in place to monitor the support and care provided and, staff were not clear about their individual responsibilities or accountability for their actions.

The atmosphere in the home was relaxed and comfortable and a relative and visitor felt people were safe and well cared for.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.