Benridge Residential Care Home

Benridge Residential Care Home is a residential care home providing personal care to up to 27 people. The service provides support to older people, including those living with dementia. At the time of our inspection there were 20 people using the service.

The home is located in a Victorian dwelling and accommodation is over three floors. Facilities include two lounges, a dining area and an enclosed rear garden.

People’s experience of using this service and what we found

People living at the home benefitted from a service that was safe and well-led.

The service embedded a proactive approach to assessing and mitigating risks to people to help maintain people's safety. There was an open culture of learning from incidents, accidents and other relevant events. Adequate systems were in place to ensure the environment was sufficiently clean and well maintained. The service had undergone some refurbishment work since our last inspection. People received their medicines as prescribed and by staff who were trained and competent.

Staffing levels were sufficient to ensure people received the care and support they needed in a timely way. People received care that was person centred and based on their individual needs and preferences.

Clear and effective governance processes to monitor and improve the quality and safety of the service were in place. Processes were used to help drive improvement in the quality of care, which was underpinned by a commitment to deliver care and support tailored to the person.

The provider involved people, their relatives and staff in a meaningful way. People’s views were listened to and acted upon, meaning they had a direct say in the running of the home.

The registered manager acted in accordance with their legal and regulatory requirements and shared information in an open, honest and timely manner.

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 (report published 8 July 2021).

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 improvements had been made and the provider was no longer in breach of regulations.

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 COVID-19 and other infection outbreaks effectively.

We carried out an unannounced focused inspection of this service on 7, 9, 14 and 21 April 2021. Breaches of legal requirements in safe care and treatment and good governance were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Benridge Residential Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Benridge Residential Care Home is a residential care service that provides accommodation and personal care for up to 27 people, including those living with dementia. At the time of our inspection, there were 23 people living at the service.

People’s experience of using this service and what we found

Not all risks were safely assessed and mitigated to maintain people's safety. The registered manager failed to ensure the environment was sufficiently clean and well maintained. There were missed opportunities to effectively analyse accidents and incidents.

There were systems in place to assess people's level of need and staffing requirements. However, we observed there were not enough staff and that people did not always receive the support they needed in a timely way. We have made a recommendation that contingency plans for critical staff shortages are reviewed.

Systems and processes to monitor and improve the quality and safety of the service were not always effective. Some of the concerns found during the inspection had been identified by the providers monitoring systems. However, where issues had been identified, actions were not put in place to address these in a timely manner.

People received their medicines as prescribed. People received care that was person centred and based on their individual needs and preferences. Relatives told us staff knew people well and how to communicate with them in a way they understood

Staff spoke positively about using technology to produce an individual activity programme which was tailored to people’s likes and dislikes. The provider ensured safe visiting procedures were in place to allow relatives to visit their loved ones at the end of their life, as per the governments COVID-19 guidance.

The provider recognised the value of regular communication with people using the service, relatives and staff. The registered manager acted in accordance with their duty and shared information in an open, honest and timely manner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about staffing and infection control. A decision was made for us to inspect and examine those risks.

We inspected and found there were concerns in relation to the environment, infection control and staffing levels, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Responsive and Well-Led.

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 COVID-19 and other infection outbreaks effectively.

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 the previous comprehensive inspection for those key questions not looked at on this occasion 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 and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Benridge Residential Care Home on our website at www.cqc.org.uk.

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 the safe care and treatment of people and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Benridge Care Home is a residential care service that provides accommodation and personal care for up to twenty-five people, including those living with dementia. The care home is situated in a large Victorian property and accommodates people across two floors. At the time of our inspection, there were nineteen people living at the service.

People's experience of using this service and what we found

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good for the safe, effective, caring and well-led domains. There has however been a change of rating for the service to Outstanding based on our findings for the responsive domain.

The culture and philosophy of the service ensured the provision of care and support was as individual as the person receiving it. Management and staff displayed clear vision and values in relation to the provision of care and support. People were supported by staff to engage their time in a way which was genuinely meaningful to them.

People using this service benefitted from exceptional individualised care which was unique to each of the people living at Benridge. Staff were motivated to get care just right for people.

People and their relatives had confidence in the staff who took care of them. People received care from staff who were caring and compassionate. It was evident that staff had formed warm relationships with the people they were caring for. Staff were considerate and provided care and support in a dignified way. Staff knew people's individual needs, routines and preferences well.

Systems were in place to identify what people enjoyed doing and staff were pivotal in the deliverance of individualised activities and pastimes. People were supported and encouraged to maintain contact with friends and relatives and be a part of their local community.

People were supported in such a way that allowed them 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.

Regular checks and audits were carried out to determine the quality and safety of the environment and the care being provided. Risk to people was appropriately assessed and measures were put in place to support people safely, whilst still respecting their freedom.

People were treated with the utmost respect. Staff took care to encourage and maintain people’s independence as far as possible.

Staff were well supported in their role with appropriate training and supervision. Staff had received additional training to meet the specific needs of the people they were caring for.

Without exception, feedback about the management of the home from people, their relatives and staff was positive. The registered manager adopted a hands-on approach to the deliverance of care and was a visible presence in the home.

The registered manager and registered provider had met their legal requirements with the Care Quality Commission (CQC). They promoted a person centred and transparent culture within the service. The registered manager adopted innovative approaches, such as the use of technology, to directly enhance the quality of the lives of people living at Benridge.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At our last inspection, the service was rated "Good." (Report published May 2017).

Why we inspected

This was a planned inspection based on the rating of the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Benridge Care Home is situated in Southport close to the town centre. It is registered to provide personal care for up to 27 people who may have dementia. At the time of the inspection 25 people were living at Benridge. The service has bedrooms and shared areas over four floors. People with mobility difficulties were able to access the building by the use of stair-lifts. The service is owned by Benridge Care Homes Ltd.

A registered manager was 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.

At the inspection in November 2016 we found that the provider was in breach of regulation relating to person-centred care. This was because the care provided during the early morning was not meeting people’s need for social interaction and support and did not reflect personal preferences. In addition we made a recommendation regarding the safe deployment of staff in the early morning. As part of this inspection we observed the delivery of care in the early morning and throughout the day. We also spoke with staff and visiting relatives to gather their views.

We saw that people’s personal preferences were met through the provision of staff in accordance with their plans of care. Staff were able to explain what time people preferred to get up and how this could change depending on the previous night.

Another concern noted at the previous inspection was that one person was not offered a drink as outlined in their plan of care. At this inspection we observed staff offering hot and cold drinks to people as they waited to go into the dining room. They were also offered a drink with their breakfast. The service was no longer in breach of regulation with respect to person-centred care.

We saw that staff were deployed in sufficient numbers to monitor people’s safety. The visitors that we spoke with were generally positive about the numbers of staff and their deployment. We saw that staff were vigilant in monitoring safety and acted to protect people from harm.

The staff that we spoke with had completed training in adult safeguarding and knew what action to take if they suspected that a person was being abused or neglected. Each staff member told us that they would not hesitate to raise a concern and was able to explain how they could report outside of the service (whistleblow) if necessary.

Individual risk was appropriately assessed and recorded in care files. We saw examples of risk being regularly reviewed in conjunction with care plans and with the involvement of relatives and care staff. However, one plan of care contained contradictory and confusing guidance for staff.

We were provided with evidence that regular checks were completed on other aspects of the service with regards to their safety. For example, electrical condition, gas safety, hoists, water temperatures and fire safety equipment. Each check had been conducted by an external professional and was supported by an appropriate certificate.

Medicines were stored and administered safely. Where errors had been identified appropriate action had been taken to improve safety and practice.

Family members told us that they felt the staff were competent to deliver their relative’s care and staff spoke positively about the quality and frequency of training and supervision available to them. The records that we saw indicated that all training had been completed as required by the provider.

We saw that the service was operating in accordance with the principles of the MCA and that applications to deprive people of their liberty had been made to the local authority. Capacity assessments clearly indicated that the people living at Benridge were not able to provide meaningful consent, but we saw evidence that families and professionals had been involved in best-interests decisions regarding various aspects of people’s care.

People also told us that their relatives enjoyed the food at Benridge and had a good choice. There was a choice of main meal and dessert. Relatives told us that their family members got enough to eat and drink.

Relatives spoke positively about the staff, the manner in which they provided care and the way that they treated their family members. Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff demonstrated that they knew the people living at Benridge and accommodated their needs in the provision of care.

Records contained care plans in relation to; bathing, mobility, social needs and nutrition amongst others. We saw evidence that care had been reviewed regularly and that some changes had been made as a result. We asked people and their relatives if they had been involved in their care planning and reviewing care needs. The people living at Benridge were unable to provide appropriate responses because of their dementia, but it was clear from the level of detail in the records that people and their relatives had been involved.

There was limited detail throughout the care records in relation to individual activities, but staff did inform us that there were a range of different activities taking place throughout the week which some of the residents enjoyed. The service kept a photographic record of important activities to remind people of what they had done.

A copy of the complaints procedure was displayed in the entrance hall and people told us that they knew who to complain to if they had any issues. However, records indicated that the service had not received any formal complaints recently.

Senior staff dealt with the questions and issues arising out of the inspection process openly and honestly. They were able to provide information and evidence on request and provided additional information and evidence after the inspection.

The service completed a wide range of audits covering; care plans, health and safety and cleaning. Audits were completed weekly and monthly by different staff and were checked in a comprehensive monthly quality and compliance audit which provided a rating for important aspects of the service.

The service had recently updated the majority of its paperwork and associated systems. The new systems utilised a mixture of paper-based and electronic records which allowed staff to record important information in real-time, but also allowed senior staff and managers to access and assess other information to monitor the safety and quality of the service.

The service was last inspected in November 2014 and at that time was found to be meeting standards. The service was rated as 'Good' at this 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 undertook an early morning focused inspection of the care home on 25 November 2016. This was in light of concerns raised with us about the current staffing levels, people living at the home being supported to get up early for the convenience of the staff and concerns around food hygiene standards.

When we arrived at the home, only two people were up and they appeared settled and comfortable. Staff were beginning to support other people down to the lounges. They were also undertaking care duties in accordance with people’s needs.

Our observations in one of the lounges over two set time frames and talking with staff showed minimal staff support and interaction early morning for people who were up and were sitting in the day areas. Staff we spoke with told us that people could vary in their needs at this time of morning but essentially people started waking up and needed support from 6am onwards. This period of time until 7.45 am when the day staff arrive for the shift hand over meant it was difficult to cover the day areas as staff were supporting people to get up and dressed. People were therefore left at this time with little social support or involvement and interaction.

We looked at three people’s care files. Two of the care files we saw did not contain information regarding the times both people preferred to get up and go to bed. One care file recorded the person preferred to ‘get up at 8am with a cup of tea. We saw this person was up from 7am and up until our last observation at 8.15am had not received a cup of tea.

We saw that the people sat in the lounge over this period did not interact spontaneously but when we engaged with them they became more alert and responded positively.

We saw that when more staff arrived at 8am there was still no staff allocated to the lounge areas to support people and provide a level of personal interaction and social support.

The care provided during the early morning was not meeting people’s need for social interaction and support and did not reflect personal preferences.

This is a breach of Regulation 9 (1) (a) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staffing rotas recorded the numbers of staff on duty to provide care and support to people living at the care home. The night staff consisted of two care staff, with a staff member providing one to one care for a person living at the home and a floating senior manager who was ‘on call’ over two homes within the organisation to cover for emergencies.

Staff told us they undertook some cleaning and kitchen duties however people’s care needs came first and that they did not have to complete them if they were busy supporting people during the night. We found the home to be very clean and staff had access to gloves and aprons to help ensure good standards of hygiene. We did not see any evidence of poor standards of hygiene when staff were undertaking care or kitchen duties.

Staffing levels were subject to review and we saw there was a willingness to provide staff flexibly.

Based on our findings we have made a recommendation about reviewing staffing over this early morning period so that sufficient staff are deployed to ensure people are monitored to help ensure their safety.

You can see what action we took at the back of this report.

We looked at menus and food that was available to people who lived at Benridge. We found there was a good variety of meals available and people said the food was good.

We spoke with four people who used the service, two relatives, two visiting professionals and four staff members. People who used the service said: 'The staff are nice', 'I like the food' and 'The staff are kind.'

Relatives commented: 'The staff are so kind and caring', 'The home has a lovely feeling' and 'The staff are friendly and appear well trained.' They didn't have any concerns or complaints about the home.

Visiting professionals said: 'The staff know the client's needs well', 'The home is clean', 'I am happy with the service', 'The home has improved over the last year. It looks much better' and 'The staff are helpful.'

Staff commented: 'We have regular meetings', 'The staff get on well together and are a nice team', 'I like being able to spend time with the residents', 'The staff pull together well' and 'I like caring for the residents and knowing I can help them.' All the staff said they got good support from the management team and that the registered manager was always there to listen to staff and has a high standard.

We looked at the staff recruitment and selection. We discussed staff recruitment with the manager and they stated that recruitment could be a problem at times and that they spent a lot of time aiming to recruit good staff to support the people who lived at Benridge.

We undertook a tour of the home. We found it to be clean and free from unpleasant odours. We saw that the d'cor was good and the home had been well maintained.

We saw the complaints policy and procedure and noted that no complaints had been made since the last inspection. People who we spoke with said they had no complaints or concerns regarding the home.

Many of the people who lived at Benridge were not able to talk to us, so throughout the day we observed interactions between the people who used the service and staff and found there was a relaxed and friendly atmosphere between them.

People living in the home told us they were happy and well cared for. One person commented, 'I've no complaints. I am at ease here. I just do what I want.' We saw good interaction and communication between staff and people living in the home. The atmosphere was relaxed and staff were attentive to people's needs.

We looked in detail at three care records and found they were organised and included detailed assessments of people's individual needs. We saw a number of short term care plans in place to support temporary changes in people's care needs for mobility, medication and pain relief.

The home reviewed people's care every month and we saw that these reviews were up to date and signed. The records included a summary of when plans or assessments were amended and this provided a useful way of alerting staff to changes to people's care needs.

The home had a system of annual appraisal, quarterly reviews, observations and supervision to monitor performance and support staff to carry out their work.

The home had accurate and up to date records related to the running of the home which assisted in maintaining a safe environment for people and staff to live and work in.