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Archived: Benamy Care Inadequate

Reports


Inspection carried out on 13 September 2016

During a routine inspection

This inspection took place on 13 September 2016 and was unannounced. This meant the staff or registered provider did not know we would be coming.

The service was last inspected on 12 February 2016 at which time we found the registered provider had failed to implement the majority of an action plan they told us was intended to address a range of breaches of the Health and Social Care Act 2008, identified in a previous inspection of 19 and 20 August 2015. These breaches of legislation were:

• Regulation 9 – Person-centred care

• Regulation 11 – Consent

• Regulation 12 – Safe care and treatment

• Regulation 17 – Good governance

• Regulation 18 - Staffing

We took enforcement action following the inspection of 19 and 20 August 2015 and the service was put into ‘Special Measures’. This meant the service was kept under review and a return inspection planned within six months, with the expectation that significant improvements should have been made within this timeframe. At the inspection of 12 February 2016 we found the registered provider had failed to make any significant improvements and remained in breach of these regulations. The service therefore remained in ‘Special Measures.’

On this inspection of 13 September 2016 the inspection team were unable to undertake a full inspection of the service due to the obstruction of the registered providers and the registered manager (who is also one of the registered providers). The registered providers confirmed they had made no changes or improvements since the last inspection and did not intend to do so.

The obstruction of an inspection is a criminal offence under Section 63 (7) of the Health and Social Care Act 2008. CQC has considered the appropriate regulatory response to this obstructed inspection and has shared information regarding the conduct of the registered providers with local authority commissioning professionals.

The service therefore remains in Special Measures.

Benamy Care is a small residential care home in Seaham providing accommodation and personal care for up to five adults with learning disabilities. There were five people using the service when we attempted to inspect the service.

The home had a registered manager in place. 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.

Of the documentation we saw, as per the comments by the registered providers, we saw care files had not been reviewed since the last inspection and there was no evidence of quality assurance work being undertaken.

The registered providers confirmed they had put in place no action plan since the last inspection. The registered providers obstructed the inspection by way of refusing to answer further questions and requesting that we leave the premises and we were unable to complete a comprehensive inspection of the service at this time.

During our inspection we found no evidence to indicate that the previous breaches of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 (as identified in previous inspections) had been addressed, or that any improvements had been made.

Inspection carried out on 12 February 2016

During a routine inspection

This inspection took place on 12 February 2016 and was unannounced. This meant the staff or registered provider did not know we would be coming.

The service was last inspected on 19 and 20 August 2015 at which time we found the registered provider had failed to implement an action plan intended to address a range of breaches of the Health and Social Care Act 2008, identified in a previous inspection of 24 July 2014. Following the inspection of 19 and 20 August 2015 (published on 15 October 2015) the service was rated as ‘Inadequate’ and therefore in ‘Special Measures’. This meant the service was kept under review and a return inspection planned within six months, with the expectation that significant improvements should have been made within this timeframe.

On the inspection of 12 February 2016 whilst we found some improvements had been made, significant aspects of the latest action plan provided to CQC had not been completed and the service continued to be in breach of Regulations 9, 11, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This registered provider remains in special measures. This inspection found that there was not enough improvement to take the registered provider out of special measures.

CQC is now considering the appropriate regulatory response to the latest findings.

Benamy Care is a small residential care home in Seaham providing accommodation and personal care for up to five adults with learning disabilities. There were five people using the service when we inspected.

The home had a registered manager in place. 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 found that there were insufficient numbers of staff to adequately care for people using the service and to meet their range of needs.

Some aspects of the action plan submitted to CQC had been completed with regard to the safety of medicines management but we identified other areas where risk assessments were not sufficiently detailed neither were staff sufficiently knowledgeable of those risks. Emergency and evacuation plans had been reviewed and improved, meaning people were better supported should there be a need to evacuate the premises in an emergency. As there were no emergencies, we did not observe this in practice during the inspection.

Mental Capacity Act training had not been attended by the registered provider, who undertook caring responsibilities, at the time of the inspection. All four other staff had received this training although we found staff had a poor understanding of the Mental Capacity Act 2005 (MCA) and supporting people through best interests decision-making and Deprivation of Liberty Safeguards (DoLS). We found documentation reflected this lack of understanding, for example people without capacity had been asked to sign documents to give their consent to care and treatment despite other documents stating they did not have capacity to do so.

Whilst we saw that some basic staff training was in place, training generally was not planned in a coherent or effective manner. We found that safeguarding training had not been refreshed in line with the service’s policy, MCA awareness training had not been completed for all staff and that training specific to the needs of people who used the service had not been delivered. For example, we found staff had not been trained with regard to Diabetes awareness.

We found that people enjoyed meals and were involved in their own meal planning and preparation. We did not find evidence of poor nutrition; lunches and evening meals contained a range of vegetables. We found however the registered provider had failed to ensure menus benefitted from th

Inspection carried out on 19 and 20 August 2015

During a routine inspection

This inspection took place on 19 and 20 August 2015 and was unannounced. This meant the staff or provider did not know we would be coming.

The service was last inspected on 24 July 2014 at which time there were multiple breaches of the Health and Social Care Act 2008 identified. We asked the provider to take action in relation to those breaches and they provided CQC with an action plan with which they confirmed they would be compliant by July 2015.

We found that, whilst some improvements had been made in relation to those identified breaches of legislation, the majority of the action plan had not been implemented and we identified further evidences of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’.

The service will be kept under review and, if we have not taken action to propose to cancel the provider’s registration, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Benamy Care is a small residential care home in Seaham providing accommodation and personal care for up to five adults with learning disabilities. There were five people using the service when we inspected.

The home had a registered manager in place. 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 found that there were insufficient numbers of staff to adequately care for people using the service and to meet their complex needs. Some aspects of the action plan had been completed with regard to the safety of the premises but we identified other areas where the service was not managing risks presented by equipment in the premises. Specifics risks to individuals, whether in relation to their complex needs or due to external factors, were not adequately identified or reviewed or therefore, mitigated against. Emergency and evacuation plans were not fit for purpose and presented significant risks to people should there be a need to evacuate the premises in an emergency.

Whilst Mental Capacity Act training had been implemented, the service had not understood or

applied the principles of the Mental Capacity Act 2005 when considering issues of consent and capacity. People using the service had not had their capacity assessed, meaning no best interests meetings or decisions had been arranged. The service had sought signed consent from people they considered to lack capacity in 2013 and there was no evidence to suggest this had been revisited. The registered manager presented an understanding of what capacity meant for each person at odds with existing care plans and risk assessments.

We saw that staff training was largely in place, although risk assessment refresher training had not been implemented. This was one commitment detailed in the action plan. Training generally was not planned in a coherent or effective manner.

We found that people enjoyed a balanced diet and were involved in their own meal planning and preparation. Relatives of people using the service told us people were well cared for and happy in the service.

We found that independence within the community was not promoted and no efforts had been made to tailor care plans to a mode of communication people could understand.

We found that people were supported to access medical appointments to ensure their health needs were met.

We found that the service did not respond appropriately to the advice of external professionals and found a number of care plans lacking pertinent medical information that had been made available to the service by healthcare and other external professionals. The service was neither proactive in terms of planning ahead, nor reactive in terms of responding to concerns highlighted by other agencies. The majority of care planning, staff and all other documentation had not been meaningfully amended or reviewed since 2013.

We found that no audits, surveys or other quality assurance work had taken place since the last CQC inspection, meaning the service was unable to identify any trends nor put in place any improvements. Putting in place a range of audits and surveys was an agreed action on the plan submitted by the provider.

We found that the action plan submitted to CQC had not been acted upon to a satisfactory standard. The majority of actions had not been undertaken.

During our inspection we found a number of breaches 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.

Inspection carried out on 24 July 2014

During a routine inspection

We inspected the service on 24 July 2014 and it was unannounced.

Benamy Care is an end of terrace house in Seaham. The home provides care and accommodation to five people with learning disabilities.

At the time of our inspection there was a registered manager in post. 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 found the provider carried out annual appraisals for staff but could find no evidence of supervisions being carried.

Staff working in the home were provided with training but this was not refreshed regularly and there was no evidence of training being updated as regulations and best practice changed.

Staffing levels in the home meant that activities were restricted to group activities rather than individual activities. Staff worked long staff worked long days, for example 8am to 8pm and had no support whilst on duty except via telephone. This breached Regulation 22 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 the report.

The provider failed to follow advice given by health professionals and there was evidence of active disregard to recommendations health professionals had made. This breached Regulation 9 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 the report.

The provider failed to ensure people’s medicines were properly stored and administered and was unable to provide evidence of staff having received appropriate training in the handling of medicines. This breached Regulation 13 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 the report.

The provider failed to carry out infection control audits and failed to store items like toothbrushes and first aid equipment in a way which would prevent the risk of exposure and spread of infection. This breached Regulation 12 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 the report.

The provider failed to obtain proper consent to carry out care on the people who used the service. This breached Regulation 18 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 the report.

The provider failed to ensure that the home was safe because appropriate maintenance and testing was not carried out in the home. This breached Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The provider failed to assess and monitor the quality of the service provided. This breached Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Inspection carried out on 21 October 2013

During a routine inspection

We found that five people lived at the home. During the inspection we were able to observe the experiences of all the people who used the service. We also spoke with three of the people who used the service. One person told us “We’ve just been on a trip to Blackpool”. Another person told us that “The staff are good here”. Due to the particular medical conditions some of the people using the service had we did not speak with them. In order to determine how care and treatment was provided we spoke with staff, observed their practices and looked at everyone’s records.

We were able to observe the experiences of people who use the service. We saw that staff treated people with dignity and respect. For instance, people told us that they all had their own rooms, with a key, and that they would not go into anyone’s room without the person’s permission. We saw that the people using the service related well with the staff. We saw the staff communicated well and appropriately with people in a way that was easily understood. We saw that staff were attentive and interacted well with people. People told us that they liked to make their own choices. They told us that they liked to go on holiday and told us they had just been on a long weekend trip away to Blackpool. We observed how people demonstrated choice with meals. On the day of the visit we observed that some people using the service preferred a packed lunch when going out for the day.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have capacity to consent, the provider acted in accordance with legal requirements.

We found that people who used the service had their care and welfare needs met.

We found that there were good systems in place for the involvement of other health or social care professionals.

We found that staff were supported in their roles and had received training and guidance in supporting people. We found that people were safeguarded against abuse.

We found that there was an effective complaints system in place and people had been able to raise any concerns or issues effectively.

Inspection carried out on 4 January 2013

During a routine inspection

Due to their general medical conditions we did not speak with people who use the service. In order to determine how care and treatment was provided we spoke with staff, observed their practices and looked at some people's care records.

We looked closely at the condition of the home, how the provider maintained it and how unforeseen damage was dealt with. We found the building had been properly maintained and when unexpected damage occurred, immediate steps had been taken to ensure the safety of people who lived or worked there. We found the provider had also taken steps to ensure the safety of people who used the service by carrying out regular checks and making improvements based on their findings.

We saw people who used the service, their relatives and other professionals were welcomed to the home and their views were sought on the way the home was run. We found people’s diversity was valued, respected and encouraged.

Inspection carried out on 16 May 2012

During an inspection to make sure that the improvements required had been made

People told us they were happy with the staff and the care and support they provided them with. One person said "I like all of the staff."

Inspection carried out on 9 January 2012

During an inspection in response to concerns

We received concerns that a teenage relative of the provider was working at the home without any recruitment checks, training or supervision. We carried out an unannounced visit to the home to discuss this with the provider and to check recruitment records, staff rotas and training records.

We also spoke with each of the five people who lived there, a relative and a member of care staff.

People told us that they felt very involved in making choices about all aspects of their lives at Benamy Care home. For example, people described all the holidays and trips they had enjoyed with the provider and how they had been fully involved in choosing the destinations.

People told us that they felt involved in the daily running of the home and social outings. One person said, “It’s really good because we get to choose what we’re going to do each night.”

People told us that they felt able to discuss their care with the provider. One person said, “I’m happy here. I can talk with (the provider) anytime.”

Relatives told us that they could visit frequently and were always made welcome. One relative said, “I’m very happy with the service. I was so pleased he managed to get a place here because he already knew the other lads who live here.”

A relative told us that they also felt supported by the provider. They told us that they were collected by the provider to come and visit each week, and then supported with their weekly grocery shopping on the way home. This meant that the resident was also able to be involved in helping their relative.

People told us that they were “happy” with the service and had no complaints.

Relatives told us that they felt able to discuss any aspects of the care service with the provider. One relative told us, “They are very approachable and any time I’ve raised any concerns they’ve put it right with no problems.”

The people who lived here and their relatives had positive comments to make about the staff. One person said, “All the staff are very nice. It’s like a big family.”

Reports under our old system of regulation (including those from before CQC was created)