Bentley House Care Centre

Bentley House Care Centre is registered to provide nursing and residential care for up to 50 people. The home is divided over two floors and provides care to people of all ages, including people living with dementia and physical disabilities. There were 46 people living at the home at the time of our inspection.

People's experience of the service and what we found

The provider assessed risks to ensure people were safe. Risk management plans were regularly reviewed to ensure they reflected any changes in people’s needs. Staff understood their responsibility to report any concerns that people were unsafe or at risk of abuse. Accidents and incidents were recorded by staff and analysed to identify any emerging trends or patterns so appropriate action could be taken to minimise identified risks.

There were enough staff to provide safe and effective care that met people's needs. Recruitment procedures ensured staff were qualified and safe to work with people who lived in the home. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, relatives and staff were very positive about the culture at Bentley House Care Centre. Relatives told us they worked in partnership with managers and staff which ensured the well-being of their family members was the focus of staff actions. Staff felt supported by good communication, teamwork and the leadership of the management team.

There were effective systems to monitor and improve the quality of service. The provider had created a learning culture which improved the care people received. Relatives and staff felt encouraged to be involved in shaping the service and making suggestions for developing the quality of care provided.

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

Rating at last inspection

The last rating for this service was Good (published 23 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Bentley House Care Centre on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a newly appointed registered manager in post at the time of our inspection visit. A requirement of the service’s registration is that they have a 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 and the associated Regulations about how the service is run.

We last inspected this service on 19 April 2017, when we rated the service as ‘Good’ overall. However, at that inspection we found Safe was ‘Requires Improvement’ because improvements implemented in medicines management needed to be sustained and embedded into practice. At this inspection we found improvements had been sustained and have rated the service as ‘Good’ in Safe and ‘Good’ overall.

People received their medicines as prescribed to maintain their health and wellbeing. People were supported to access healthcare from a range of professionals inside and outside the home, and received support with their nutritional needs. This assisted them to maintain their health.

People told us there were enough staff to keep them safe and we saw there were enough staff during our inspection visit to ensure people were cared for safely.

All necessary checks had been completed before new staff started work at the home to make sure, as far as was possible, they were safe to work with the people who lived there. People were supported by a staff team that knew them well.

Staff received training and had their practice observed to ensure they had the necessary skills to support people. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence.

People had been consulted about their wishes at the end of their life. Plans included information about people’s wishes about who they wanted to be with them, and the medical interventions they had agreed to.

The provider, manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The manager had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements.

People were supported to take part in social activities and pursue their interests and hobbies. People made choices about who visited them at the home, which helped people maintain personal relationships with people who were important to them.

People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run; action was taken in response.

Quality monitoring procedures identified some areas where the service needed to make improvements. Where issues had been identified in checks and audits, the registered manager took action to address them to continuously improve the quality of care people received.

The provider and registered manager worked with other providers, their sister home, and external professionals to improve and develop the quality of care people received.

The home was divided into two units. One section of the home provided accommodation and support for people living with dementia. This area had a separate lounge/diner and conservatory area. People with nursing needs were provided with accommodation and support over the ground and first floors of the home. There was a large lounge, dining room, and conservatory on the ground floor of the home for all to use.

We previously carried out a comprehensive inspection of this service in January 2017, when we found a breach of the legal requirements. This was because medicines management required improvement to ensure people always received their prescribed medicines when they should. As a result of the breach and the impact this had on people who used the service, we rated the key questions of ‘Safe’ and ‘Well-led’ as ‘Requires Improvement’. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Bentley House Care Centre' on our website at www.cqc.org.uk.

On this inspection visit we found sufficient improvements had been made to medicines procedures for the provider to meet the regulations. However, further improvements needed to be made to ensure medicines management was sustained and improved, to ensure all medicines were ordered, disposed of, stored and administered safely.

There were sufficient staff to meet peoples’ needs and care for them safely. Staff were recruited safely, and people were protected against risks.

There was a consistent management team in place to support staff, and the manager had been registered with CQC since our inspection in January 2017.

The provider had invested in a refurbishment programme at the home, and was asking people for their feedback about the quality of care they received.

Quality assurance procedures had been developed since our previous inspection, to monitor the care people received and to review record keeping. The manager planned to introduce further quality monitoring systems to ensure care records were kept up to date.

Although the provider is now meeting the regulations, the service continues to be rated ‘requires improvement’ in the area of ‘Safe’. However, we have adjusted the rating in ‘Well-led’ to Good. This means the service is now rated as Good overall.

The home was divided into a number of units. One section of the home was named ‘The Lawns’ and provided accommodation and support for people living with dementia. This area had a separate lounge/diner and conservatory area. Another unit of the home provided accommodation and support for people receiving physiotherapy. This unit had a separate area for physiotherapy sessions. People with nursing needs were provided with accommodation and support over the ground and first floors of the home. There was a large lounge, dining room, and conservatory on the ground floor of the home for all to use.

A requirement of the service’s registration is that they have a 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 and associated Regulations about how the service is run. There was not a registered manager in post at the time of our inspection visit. However, a manager was running the home and had applied to be the registered manager. They had been in post since October 2016, and were employed at the service immediately following the previous manager’s departure.

At our previous inspection in January 2016 we found medicines management required improvement to ensure people received their prescribed medicines safely and that medicines were stored in accordance with manufacturer’s guidelines. At this inspection we found that the provider had made some improvements to the way medicines were managed, but improvements still needed to be made to ensure people received their prescribed medicines safely.

Staff received training in safeguarding adults and understood the correct procedure to follow if they had any concerns about people's safety. All necessary checks had been completed before new staff started work at the home to make sure, as far as possible, they were safe to work with the people who lived there.

There were enough staff employed at the service to care for people safely, although some people told us they waited longer than they would like to receive care during busy times. The manager was reviewing staffing levels to ensure staff were deployed effectively around the home.

Care records were not always kept up to date, however, people were supported by a staff team that knew them well. New staff completed an induction programme when they started work to ensure they had the skills they needed to support people effectively. Staff received refresher training and had their practice observed to check they had the necessary skills to support people. However, some staff practice required improvement around the administration of medicines.

People were supported with their health needs and had access to a range of healthcare professionals where a need had been identified. People were encouraged to eat a balanced diet that took account of their preferences and nutritional needs. This assisted people to maintain their health.

The manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The manager had made some applications to the local authority where people's freedom was restricted, in accordance with DoLS and the MCA.

People's care was planned with them and the support of their relatives and staff. This helped to ensure care matched people's individual needs, abilities and preferences. A new format of care records was being introduced which were personalised and reflected people's care and support needs. The manager was in the process of improving care records and was incorporating end of life care plans for people.

People had an opportunity to take part in interests that met their needs and their personal preferences. Care staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with people that were important to them.

People knew how to make a complaint if they needed to. However, no-one had a made a written complaint in the last twelve months. People who used the service and their relatives were not always given the opportunity to share their views about how the service was run. The manager was implementing feedback systems to encourage more involvement with stakeholders in the running of the service.

Quality assurance procedures were in place to identify where the service needed to make improvements, these included checks of people’s care records, medicines administration and staff’s practice. Accidents and incidents were also monitored and investigated, to see where actions needed to be taken to improve the service, and to minimise the risk of re-occurrence. However, quality assurance procedures did not always identify where improvements needed to be made. For example, the manager had not identified where medicines administration procedures needed to be changed.

We found there was a breach 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 the report.

Bentley House provides personal and nursing care for up to 50 older people, including people living with dementia. There were 45 people living at the home when we inspected the service. The home was divided into a number of units. One section of the home was called ‘The Lawns’ and provided accommodation for people living with dementia. This area had a separate lounge/diner and conservatory area. Another unit of the home provided accommodation for people receiving physiotherapy. This unit had a separate room for physiotherapy sessions. People with nursing needs were provided with accommodation over two separate floors at the home. There was a large lounge, dining room, and conservatory on the ground floor of the home for all to use.

A requirement of the service’s registration is that they have a 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 and associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection. We refer to the registered manager as the manager in the body of this report.

Medicines management required improvement to ensure people received their prescribed medicines safely and that medicines were stored in accordance with manufacturer’s guidelines. People were supported to access healthcare from a range of professionals inside and outside the home, and received support with their nutritional needs. This assisted people to maintain their health.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, staff did not always understand the principles of the MCA and DoLS. The manager had arranged training in this area to be delivered within a month of our inspection visit. This training would ensure staff had the knowledge to support people effectively and in accordance with the legislation. Where decisions needed to be made in people’s ‘best interests’, for example regarding the management of their finances, these decisions had not always been recorded in their care records. The manager was reviewing people’s care records to ensure, decisions made in people’s ‘best interests’ were always recorded in line with the principles of the MCA.

Care records were personalised and reflected people's care and support needs. However, not all the records we reviewed were up to date. Following a recent review, the manager was in the process of improving care records and was incorporating end of life care plans for people in the near future.

People were protected against the risk of abuse as the provider took steps to recruit staff of good character, and staff knew how to protect people from harm. Safeguarding concerns were investigated and responded to in a timely way to ensure people were supported safely.

People had an opportunity to take part in interests and that met their needs and their personal preferences. Care staff treated people with respect and dignity, and supported people to maintain their privacy and independence. People made choices about who visited them at the home. This helped people maintain personal relationships with people that were important to them.

People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so that the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run.

Quality assurance procedures were in place to identify where the service needed to make improvements, and where issues had been identified the manager took action to continuously improve the service. However, quality assurance procedures did not always identify areas where improvements needed to be made.

We also spoke with three visiting family members, who told us they were happy with the support provided to their relatives. They said they were involved and consulted about their family members care plans and confirmed that they were kept informed of any health issues as they arose.

We saw there was a relaxed atmosphere in the home evidenced by the open manner in which staff communicated with people, relatives and with each other. We observed staff interacting and talking with people in a respectful and friendly way.

A variety of activities were available for people to participate in and these were observed on the day of our visit. People told us they enjoyed the activities available.

Care records provided sufficient information regarding people's support needs. This information was reviewed on a regular basis to ensure it remained relevant.

People told us they felt safe and said if they had any concerns they would speak to the staff or their relatives. Visitors told us that they were aware of the complaints procedure and said they were confident that any issues they had would be addressed.