About the service Bentley Lodge Care Home is a nursing home providing personal and nursing care to 51 people aged 65 and over at the time of the inspection. The service can support up to 56 people. The service supports older people who may have a physical disability, sensory impairment or who are living with dementia. People are accommodated either within the main building or in the new purpose built extension.
Since 12 October 2020 ten rooms within the home were contracted as ‘Discharge to Assess’ beds. These beds were for people discharged from hospital, as they no longer required an acute bed, but who required a period of up to six weeks assessment or rehabilitation. People referred could be living with dementia or have complex health needs. The discharge to assess beds were all located on the same ground floor corridor in the main building. Each of these bedrooms had an ensuite bathroom and there was a communal shower room on the same corridor.
People’s experience of using this service and what we found
People and their relatives told us overall, their physical needs were met, and they liked the staff who were kind. However, they also said people’s emotional and welfare needs had not been met. A relative said, “Staff do what they have to do and then go – there is no chit chat” and that social interaction was “virtually nil.”
Processes, systems and staff practices to protect people from the risk of acquiring an infection were not adequate. This placed people at risk of acquiring an infection. There had been a failure to ensure the environment and equipment provided for people were always safe and properly maintained. The provider had failed to mitigate some identified risks to people. This placed people at risk of harm.
Staff did not have sufficient time to provide compassionate care. There was a focus on the provision of practical care tasks for people, but not enough focus on their welfare and sense of well-being. People had not been adequately supported to maintain relationships with their loved ones or their independence. People's emotional needs had not been met. People were not always involved in decisions about their care and their preferences were not always respected.
People accommodated in the ‘discharge to assess’ beds had been subjected to unnecessary restrictions on their movement once their 14 day self-isolation period had ended. People’s medicines were not always managed safely. This placed people at potential risk of harm, from not receiving their medicines correctly. There had been a failure to provide enough suitable staff. This placed people at risk of not receiving their care in a timely manner.
There was evidence safety and safeguarding incidents were investigated when things went wrong. However, actions taken to improve people’s safety were not fully effective.
Management responsibilities were not clear, there was not sufficient oversight and risks to people had not always been assessed or acted upon. Processes to learn and improve were not robust. The culture during the pandemic had not been person-centred, open, inclusive or empowering and had not achieved good outcomes for people. The provider had sought relatives’ views on the service, but it was not clear what actions had been taken in response to their feedback.
Links with the local community had been maintained during the pandemic. The service worked in partnership with other agencies.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 15 December 2017).
Why we inspected
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 coronavirus and other infection outbreaks effectively.
We had received concerns in relation to people’s safety, staffing and support for the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led. During the inspection we identified further concerns in relation to the key question of caring, so we included this key question within the inspection.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this report.
Since the site visit, the manager has reacted positively and started to take the actions required to address the issues identified.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, safeguarding, staffing, dignity, person-centred care and good governance at this inspection. Two warning notices were served on the provider in relation to the breaches of safe care and treatment and good governance.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.