Archived: Benham Nursing & Residential Home

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.

This was an unannounced inspection carried out on 20 October 2014. Benham Nursing & Residential Home provides accommodation and support with personal and nursing care for up to 43 people. The home mainly supports older people, some of whom also have dementia.

The home is a converted and extended period property with accommodation provided over three floors. Several lounge and dining rooms are available for people to use and all bedrooms provide single accommodation. A lift is available to enable people to access upper floors.

During the inspection we spoke with seven people who lived at the home, four of their relatives and six members of staff. We also spoke with 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.’

We last inspected the home in April 2014. Following that inspection we asked the provider to take action to make improvements to how the quality of the service was monitored. The provider sent us an action plan to tell us the improvements they were going to make, which they would complete by 30 June 2014. During this inspection we looked to see if these improvements had been made, we found that they had not all been completed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Care plans did not provide sufficient information to inform staff about the person’s health and personal care needs. Changes to people’s care needs were not always reflected within their care plan.

Quality assurance systems within the home failed to identity issues we noted during this inspection. They also failed to improve areas of concern that the registered manager was aware of. This included poor medication management and staff culture and attitudes.

People were not protected from the risk of abuse. Incidents of potential abuse that had occurred had not been reported to the appropriate authorities for investigation under safeguarding adult’s procedures.

Medication practices at the home were unsafe. People did not always receive their medication as prescribed or on time. Medication was not stored safely. Systems for checking medication had failed to improve practices in the home.

The majority of the people we spoke with told us that they liked the meals provided. We found that people were not always appropriately supported to eat their meals. No formal systems were in place to inform kitchen staff about people’s dietary requirements.

People living at the home did not always have the equipment available to support them safely and with dignity. Equipment in use for people was not always managed in line with the guidance provided.

People living at the home and their relatives had mixed views about their involvement in their care. No formal system was in place for consulting with people about the care provided for them. Two people told us that they did not have a choice of the gender of the member of staff supporting them.

The home did not meet the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). No assessments of people’s capacity to make decisions had been undertaken. The MCA and DoLS require providers to submit applications to a ‘supervisory’ body’ for authority to restrict peoples liberty. Where people lacked the ability to make a decision about living at the home no application for a DoLS assessment had been made.

People living at the home told us that they felt confident raising concerns with the registered manager. However two relatives told us that they would hesitant to do so. There was no formal system in use for recording, investigating and responding to complaints. We saw no evidence that learning from complaints had resulted in changes to practices within the home.

Accurate care records were not always maintained for people living at the home. Records relating to individuals living at the home were not always stored confidently and changes made to records were not always legible.

Not all required records were obtained or available for staff working at the home. This included references and a Disclosure and Barring Service check. These records provide a way for the home to check the person is suitable to work with adults who may be vulnerable.

Staff were not deployed in a way that ensured people received the care they needed in a timely manner. People told us that at times there were not enough staff available to answer their call bell and provide the support they needed.

There were gaps in staff training particularly around the health needs of people living at the home. People living at the home told us that they did not think staff always understood the impact their condition had upon them.