Background to this inspection
Updated
24 March 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, looked at the overall quality of the service, and provided a rating for the service under the Care Act 2014.
We undertook an unannounced focused inspection of Benham Nursing and Residential Home on 21 January 2015. This inspection was carried out to check that the provider and manager had meet legal warning notices we had served on them following our comprehensive inspection which took place on 20 October 2014. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well led. This is because the service was not meeting some relevant legal requirements.
The inspection was undertaken by an Adult Social Care (ASC) manager, an ASC lead inspector and a pharmacist inspector. During our inspection we spoke with five of the people living at the home, a relative of one of the people living there and four members of staff including the registered manager and provider. We looked at medication records and observed medication practices. We also looked at care records relating to the people living at the home and at records relating to quality assurance systems.
Updated
24 March 2015
We carried out an unannounced comprehensive inspection of this service on 20 October 2014. Breaches of legal requirements were found. As a result we undertook a focused inspection on 21 January 2015 to follow up on whether action had been taken to deal with the breaches.
Focused Inspection of 21 January 2015.
Following the inspection we carried out on 20 October 2014 we served three warning notices for breaches of legal requirements. These related to breaches of the following regulations.
Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities).This was because service users were not safeguarded against the risk of abuse.
Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because service users were not protected against risks associated with the unsafe use and management of medicines.
Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because service users were not protected against the risks of inappropriate or unsafe care and treatment, by means of the effective operation of systems to regularly assess and monitor the quality of the services provided.
The warning notices stated that the provider and manager must become compliant with these regulations by 31 December 2014. We undertook a focused inspection to check that they had met these legal requirements and found that they had not.
During the inspection we spoke with five people who lived at the home, one of their relatives and two members of staff. We also spoke with the registered manager and provider.
People were not protected from the risk of abuse. We saw that an incident of potential abuse had not been reported to the appropriate authorities for investigation under safeguarding adult’s procedures.
People were not protected against risks associated with the unsafe use and management of medicines People did not always receive their medication as prescribed or on time, records about people’s medication were not always accurate and medication was not stored safely. Medication practices at the home were unsafe.
Quality assurance systems within the home were not robust enough to identify and improve areas of concern that had been highlighted within the warning notices. This included the lack of a system in use for auditing care records. This meant that there was no reliable system in place to check whether people were getting their planned care and to ensure that care was effective. We also found that quality assurance systems failed to ensure people’s medication was managed safely.