Background to this inspection
Updated
6 November 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was conducted by two inspectors, an assistant inspector, a member of the CQC medicines team and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Blenheim Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We looked at all the information we had received about the service, which included feedback from the local authority about concerns they had. We looked at notifications, safeguarding alerts and information from members of the public we had received. We also looked at the provider's action plan following the last inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with 20 people who used the service and nine visiting friends/relatives. We also spoke with a visiting healthcare professional. We looked at the care records, or part of the care records for 15 people using the service. We looked at staff recruitment files for six members of staff, records of team meetings, handovers, supervision meetings and staff training records. We also observed how people were being cared for and supported. Our observations included the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We inspected the environment and equipment being used. We also looked at how medicines were being managed.
We met and spoke with the registered manager and staff on duty, who included the deputy manager, care workers, senior care workers, nurses, activities staff and the provider's quality assurance manager.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
6 November 2019
About the service
Blenheim Care Centre is a residential care home providing personal and nursing care for up to 64 people. At the time of the inspection 54 people were living at the service. The provider offers a service to younger adults with disabilities and older people, some of whom were living with the experience of dementia. The home is divided into three units. The ground floor provides accommodation to the younger adults and some older people. The first floor is for people who do not have nursing needs but have dementia and the second floor is for people with dementia and nursing needs.
The service was owned and managed by MMCG (2) Limited, part of the Maria Mallaband Care Group, a private organisation providing care services in England.
People’s experience of using this service and what we found
People were not always safe at the service. Risks to their safety and wellbeing had not always been assessed or planned for. Some of the information about people's needs was inaccurate and staff did not always follow the guidance from healthcare professionals. This placed people at risk of harm. There were also potential risks within the environment which had not been assessed or mitigated.
Medicines were not always being managed safely.
The provider did not always investigate or respond adequately to concerns about people’s safety and wellbeing to rule out the risk of possible abuse. Where investigations had taken place, there was not always learning from these to make sure improvements were made.
People's needs were not always planned for or met in a personalised way. Care plans contained generic information which did not always specify people's needs or preferences. The care being provided was often task based and this meant people did not have the opportunity to engage with staff or make choices about their care. Some of the staff treated people disrespectfully.
The provider's systems for monitoring and improving the service had not always been operated effectively, because they had failed to identify or take action where regulations were not being met.
People using the service and their visitors told us they were happy with the service and the staff, they felt able to raise concerns and speak with the registered manager. However, they felt that improvements regarding the food and social activities were needed.
The staff told us they felt well supported and enjoyed their work. However, we found that the staff were not always knowledgeable about their work or the needs of people who they were supporting. Records of meetings with the staff did not address areas of concern about practice or adverse events at the service. Furthermore, where staff had raised concerns during individual meetings with their line manager, there was no record to show how these had been addressed.
There had been some improvements at the service, in particular there was now a more permanent staff team. There had also been improvements to the environment, and more were planned. People using the service, visitors and staff found the registered manager supportive and responsive.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 20 December 2018) and we identified breaches of regulations relating to person-centred care and good governance. The service had also been rated requires improvement for the previous two inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection, we found not enough improvement had been made and the provider was still in breach of these regulations. We also identified breaches of three other regulations relating to dignity and respect, safe care and treatment and safeguarding people from abuse and improper treatment.
Why we inspected
The inspection was prompted in part due to concerns received from the local authority regarding the leadership of the service and the provider's failure to identify and respond to safeguarding alerts. A decision was made for us to inspect and examine these areas as well as looking at whether they had made improvements since the last inspection in all areas.
We have found evidence that the provider needed to make improvements. The overall rating for the service has changed from requires improvement to inadequate.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blenheim Care Centre on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to person-centred care, treating people with dignity and respect, safe care and treatment, safeguarding people from abuse and good governance.
You can see what action we have asked the provider to take within our table of actions.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, 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.