Archived: Bearnett House

Bearnett House is a care home. People in care homes receive accommodation and 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. Bearnett House is registered to accommodate 25 people in one adapted building. The home accommodates people in one building and support is provided on two floors. There is a communal lounge, a dining area, a library and conservatory and a garden that people can access. Some of the people living at Bearnett House are living with dementia.

At the time of our inspection on 2 October 2018, 12 people were using the service. There were 10 people using the service on the 9 October 2018.

We have previously taken enforcement action against this home and there are currently conditions on their registration in place and people cannot be admitted into the home without the written permission of the CQC. After our visits on both 2 and 9 October 2018 we wrote to the provider to seek reassurances about peoples’ safety. We did not receive the reassurances we requested.

There is not a registered manager in place and has not been since January 2017. 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 this inspection people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Risks to people are not managed in a safe way and when needed action was not always taken to ensure people were safe. When falls occurred action was not taken to reduce the risk of reoccurrence and this resulted in a repetition of falls for people.

Staff demonstrated an understanding of safeguarding however we could not be assured all incidents had been fully considered or investigated to ensure people were protected from potential harm. There were not always suitably trained staff available who could administer medicines for people. People did not always receive support to eat or drink and were at risk of dehydration. When people had lost weight, action had not always been taken. People were not referred to health professionals for support when concerns were noted.

There were no systems in place so that lessons could be learnt when things went wrong. The audits completed did not drive improvement within the home. The provider had not made or sustained the necessary improvements since previous inspections.

Staff were kind in their approach however interactions were often task focused. People's cultural or dementia needs were not always fully considered. Staff received training however we could not be assured their knowledge in these areas was checked.

People's privacy was considered. People and relatives were happy with the staff and were free to visit anytime. The home was clean and decorated to consider people's preferences however was unsuitable for people living with dementia. The provider was displaying their rating as required.

The overall rating for this service is Inadequate and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, 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. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Bearnett House is a care home. People in care homes receive accommodation and 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. Bearnett House is registered to accommodate 25 people in one adapted building. At the time of our inspection 17 people were using the service. Bearnett House accommodates people in one building and support is provided on two floors. There is a communal lounge, a dining area, a library and conservatory and a garden that people can access. Some of the people living at Bearnett House are living with dementia.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when; to improve the key questions safe, effective and well led to at least good. The provider did not initially return the action plan as requested however when we requested this action plan again this was returned. When we completed our previous inspection on 31 May 2017 we found concerns that risks to people were not always managed in a safe way. People were not always supported in line with recommendations. We also found concerns with medicines management. Mental capacity assessments had been completed; however they were not individual or specific to the decision that was being made, and decisions were not always made in people’s best interests. People were not always offered the opportunity to participate in activities they enjoyed and felt there could be more to stimulate them. We also found people’s records had not always been completed to provide the information so they could receive personalised care. We could not be sure the systems in place were effective in identifying areas of improvement. The provider had not always ensured there was a suitable recruitment process in place. We have previously taken enforcement action against this home and there is currently a Notice of Decision in place and people cannot be admitted into the home without the written permission of the CQC.

At this inspection people are not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice. Risks to people are not managed in a safe way and when needed action was not always taken to ensure people were safe. When people displayed behaviours that may challenge we could not be sure the behaviour management plans in place gave staff the information to offer a consistent approach. Medicines were not always administered as prescribed. Staff demonstrated an understanding of safeguarding however we could not be assured all incidents had been fully considered.

Complaints were not always responded to in line with the provider’s policy. When health professionals made recommendations these were not always followed. When employment checks had been completed the provider had not assured staffs suitability to work within the home. There were no systems in place so that lessons could be learnt when things went wrong. The audits completed did not drive improvement within the home. The provider had not made or sustained the necessary improvements since the last inspection.

There were staff available however interactions were often task focused and people felt they could be more to do. People were not always offered choices or received care that was individual to them. People’s cultural or dementia needs were not always fully considered. Staff received training however we could be assured their knowledge in these areas was checked

Infection control procedures were in place and implemented within the home. People’s privacy was considered. People and relatives were happy with the staff and were free to visit anytime. People enjoyed the food and had access to GP and other health care professionals when needed. The home was clean and decorated to consider people’s preferences. The provider was displaying their rating as required.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was not a registered manager in post. A new manager had been appointed and was in the process of registering with us. 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.

Risks to people were not always managed in a safe way. When people were at risks of falls they were not always supported in line with recommendations. From our observations we could not be sure people were supported to transfer in a safe way. When people needed as required medicines there was not always guidance in place for staff to follow, therefore we could not be assured people received this medicines as prescribed. When people continually refused medicines there was no guidance in place for staff to follow and appropriate action was not always taken.

When people lacked capacity to make decisions for themselves, capacity assessments had been completed. However these were not individual or specific to the decisions being made. There were no records showing how the decisions had been made. When people were being restricted unlawfully application to the local authority had been made however there was no guidance in place for staff to follow while these were considered. We did not see any evidence of best interest decisions and people’s relatives had signed consent forms on their behalf.

People felt there could be more stimulation within the home and were not always provided with the opportunity to participate in activities they enjoyed. People did not always received personalised care and information about people was not always in their care plans, when people had dementia we could not be sure this had been fully considered.

The systems the provider had in place to drive improvement were not always effective in identifying concerns and a medicines error that had occurred at the home had not been identified. We could not be assured the recruitment process the provider had in place were suitable.

Staff understood safeguarding procedures and what to do if they were concerned about people. Staff received training that helped them offer care and support to people. There was a choice of food and drinks available to people that they enjoyed. When needed people had access to healthcare professionals. There were enough staff available to offer support to people when needed.

People were happy with the staff who supported them and were treated in a kind and caring way. Independence was promoted and people were encouraged to make choices how to spend their day. People’s privacy and dignity was maintained and they were encouraged to maintain relationships that were important to them.

Staff felt they were given the opportunity to raise concerns and felt listed to. There was a new manager in post who understood their responsibility around registering with us and notified us about events that occurred within the home.

We found 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 this report.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

After the comprehensive inspection in May 2016 we took enforcement action by restricting admissions to the service and introducing positive conditions around the management of falls.

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.

Risks to people were not always managed in a safe way. When incidents had occurred the provider had not always completed risk assessment to reduce the risk of this reoccurring. When people were at risk of falling people were not always supported in line with recommendations made. Risks assessments were not always reviewed in line with the provider’s procedure. The systems the provider had put in place to keep people safe were not always followed.

When capacity assessment had been completed it was unclear how decisions had been made. Staff were unsure when people were being restricted and offered an inconsistent approach. When applications had been made about restrictive practices there was no guidance in place to ensure people were supported in the least restricted way.

Complaints were not always responded to in line with the provider’s policy. Care plans were reviewed however people felt they were not always involved with this. Health professionals felt that the home lacked leadership. When employment checks had been completed the provider had not assured staffs suitability to work within the home. People’s files were stored insecurely. Some of the audits that were introduced were not always effective in identifying concerns.

We have lack of confidence in the actions the providers are telling us they are making in relation to the management of the home and to ensure compliance with the regulations.

Staff were able to recognise and report potential abuse. There were enough staff available and they received an induction and training that helped them to support people. People received their medicines in a safe way and they were stored and recorded to ensure people were protected from the risk associated to them.

When needed people had access to healthcare professionals. People felt they were supported in a kind and caring way by staff they were happy with. People were offered choice and their privacy and dignity was upheld.

People enjoyed the food and were offered a choice; they were able to participate in activities they enjoyed. There were daily arrangements in place to keep staff informed of people’s needs. Quality monitoring was completed and this information was used to make changes. Staff felt supported and were given the opportunity to raise concerns.

We found 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 this report.

This report covers our findings in relation to the information of concern we received. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the ‘all reports’ link for the Bearnett House on our website at www.cqc.org.uk.

The service is registered to provide accommodation for up to 25 people. At the time of the inspection 22 people were using the service.

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.

People continued not to be safe. Risks to people’s care such as falls were not managed appropriately. When incidents had occurred the provider had not taken action to reduce the risk of the incident reoccurring. Systems that had been implemented to mitigate errors were not effective. There were not sufficient staff as recommended by the provider to support people’s needs. The provider had breached the registration condition we had recently imposed.

We found 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.

The service was registered to provide accommodation for up to 29 people. At the time of our inspection 25 people were using the service.

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. The registered manager was not available on the day of our inspection.

People were not safe. Risks to people’s care such as falls prevention were not managed appropriately. When risks to people had been identified by the provider action had not been taken to mitigate their risk. There were an insufficient number of staff within the home to keep people safe. The dependency tool used to plan staffing levels was not reflective of people’s needs. We could not be sure people were receiving as required medicines as prescribed as there were not safe systems in place in relation to this.

When people were unable to consent, mental capacity assessments and best interest decisions were not always completed. The provider had considered when people were being restricted unlawfully but had not assessed how people could be supported in the least restrictive way. People told us they were not always involved with reviewing their care and they would like to be. We found that people were not protected from potential abuse as concerns were not always investigated or appropriately reported.

Referrals to health professionals were not made in a timely manner and there was a reliance on the district nurse team to make these referrals. When assessments had been completed by professionals the service did not ensure that their recommendations were implemented. We found that people’s nutritional needs were not monitored and recorded accurately. Staff told us they received training however this did not help them to support people. People did not always have the opportunity to make choices and staff had little time to spend and interact with people.

The systems that were in place to improve the quality of the service were not effective. The information from audits was not used to bring about improvements or make changes to the service. Opinions were sought from relatives however when concerns were identified no action was taken to address them. The systems in place to ensure staffs suitability to work in a caring environment were not always completed by the provider.

People enjoyed the food and were happy with the staff. People knew how to complain and staff felt they had the opportunity to raise their concerns.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it 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. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found 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 this report.

We were supported throughout the inspection by the registered manager. We spoke with people who used the service, staff, a relative and a visiting health professional during the inspection.

We looked to see if people who used the service consented to their care, treatment and support. We found that the service had systems in place to show that people had consented to their care.

We looked at care records, spoke to people who used the service and observed their care being delivered. We found that the service was meeting the care and welfare needs of people who used the service.

We checked that the service was managing medication appropriately. We found the service had systems in place to ensure that medication was handled safely, securely and appropriately.

We found that the service was following the correct recruitment procedures when employing new staff.

The service had a complaints procedure for people who used the service or their relatives to use if they felt the need to complain about the service.

Bearnett house was compliant in the five outcome areas we looked at.

When we arrived people who used the service were getting up or having breakfast.

Relatives we spoke with told us they like the staff and were happy with the quality of care given to the relative. One relative told us "They are on the ball with health issues".

We spoke with three people who used the service and they told us they liked it at Bearnett House. One person told us "It's nice here".

We saw that care plans about people's care were clear and easy to understand.

The staff were observed to be kind and caring and spoke to people that used the service at a level and pace they understand.

During the day people who used the service appeared and happy and relaxed, either choosing to stay in the communal areas or within their rooms.