Archived: Blenheim Care Centres

Blenheim Care Centres is a nursing and residential care home for up to 80 people located near to

Gainsborough, West Lincolnshire. The home is in two buildings, Blenheim House and Blenheim Lodge. Blenheim Lodge was closed on the day of our inspection. Blenheim house consists of 35 bedrooms and some flats.

The home caters for people of ages 18 years and older, and who have physical disabilities and/or neurological conditions. On the day of our inspection 19 people were living at the home, 10 of these people received nursing care.

An unannounced comprehensive inspection was carried out on 9 August 2016 during which we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to medicines arrangements, risk assessments, the environment, infection control and prevention, governance, staffing levels and capacity assessments. At two further inspections in September and November 2016 we found that although the registered provider had taken some actions, they had not made sufficient progress to become compliant with legal requirements and improvements had not been tested for sustainability. We completed a further comprehensive inspection on 21 February 2017 where we identified that there were still concerns related to medicines management, risk assessments, completeness of care plans, staffing levels and mental capacity assessments. The home was placed into special measures after this inspection. We inspected again on 4 September 2017 we found that the provider had failed to make the improvements needed and the overall rating for this home was Inadequate and the home remained in special measures.

At this inspection on 14 March 2018, we found that some improvements had been made. For example, the management of medicines had improved and people’s medicines were now ordered, stored and administered safely and accurate records were kept. However, other areas had not improved and the overall rating for this home remained Inadequate and the home remained in special measures.

Homes 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 home, 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 home. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This home 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 home. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care homes the maximum time for being in special measures will usually be no more than 12 months. If the home 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.”

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.

There was a registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The registered manager was not able to fully identify all the concerns in the home and lacked the ability to drive improvements in all areas so that people received the standard of care that they were entitled to. While staff received the training and support they needed they were not able to identify that the care provided was not meeting the latest guidance or evidence based practice. The registered manager had failed to see that the tool used to identify staffing levels was not working correctly. The turnover of staff did not support people to receive safe consistent care. Recruitment processes ensured that staff employed were safe to work with people living at the home. However, the registered manager facilitated the handyman starting before their DBS was received by asking them to work as self-employed until disclosure and barring service checks were completed.

Staff did not ensure that they accurately assessed the risks while providing care or ensure that they recorded clear guidance on how care should be delivered. Care plans contained conflicting information and would not support staff to provide safe care.

The environment did not support people’s dignity and was not maintained to an appropriate standard. Empty rooms were not maintained to a standard which would reduce the risk of infection. Plans in place to improve the quality of the environment were not effective.

The audits in place to monitor the quality and safety of care were not effective and did not result in improvements to the care that people received. Systems to ensure that care reflected the latest guidance and best practice were not successful.

Blenheim Care Centres is a nursing and residential care home for up to 80 people located near to Gainsborough, West Lincolnshire. The home is divided in to three units, Blenheim House, Blenheim Lodge and some semi-independent flats. Blenheim Lodge was closed on the day of our inspection. The home caters for people whose ages range from 18 years and above, and who have physical disabilities and/or neurological conditions. On the day of our inspection 21 people were living at the home, 12 of these people received nursing care.

An unannounced comprehensive inspection was carried out on 9 August 2016 during which we identified five breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to medicines arrangements, risk assessments, the environment, infection control and prevention, governance, staffing levels and capacity assessments. At two further inspections we found that although the registered provider had taken some actions, they had not made sufficient progress to become compliant with legal requirements and improvements had not been tested for sustainability. We completed a further comprehensive inspection on 21 February 2017 where we identified that there still concerns related to medicines management, risk assessments, completeness of care plans, staffing levels and mental capacity assessments. The home was placed into special measures after this inspection.

At out inspection on 4 September 2017 we found that the provider had failed to make the improvements needed and the overall rating for this home is Inadequate and the home remains 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 home, 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 home. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This home 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 home. 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 home 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 a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The premises of the home were not maintained to a standard which supported people’s wellbeing and the delivery of person centred care. The provider had failed to develop a plan to support the refurbishment of the building to an appropriate standard. The quality monitoring of the home failed to give an accurate view of all the improvements needed and where improvements were identified inadequate action plans meant that appropriate action was not taken. This followed a pattern as the provider, who was the sole director of the company was also the sole director and person with significant control for two other providers each with a single home. The Care Quality Commission had identified significant concerns in one home and need for improvement in the other.

There was not enough staff employed at the home to meet people’s needs and consequently there was a reliance on agency staff to fulfil both nursing and caring roles. The registered manager had not employed enough staff to fill the gaps in the rota. The registered manager had not used the needs of the people living at the home to inform the number of staff required to provide safe care for people. Appropriate checks had been completed for new staff to ensure they were safe to work with vulnerable people. Training had been provided for staff but this had not been reinforced with regular supervisions to support staff.

People’s care plans ensured that the care provided was safe and that they had their physical needs met safely. However, risk assessments were not always in place to protect people’s emotional needs and information about emotional needs were missing for the care plans. People’s medicines were given to them in a safe manner but people were not always supported to take their medicines as prescribed when they were away from the care home. People’s privacy and dignity was not fully respected and people had not been supported to access the hairdresser or chiropodist on a regular basis.

People’s wellbeing was not supported by the activities offered to them and some people chose not to take part in the planned activities. People had raised concerns about the activities in a survey in July 2017 but no action had been taken to improve the day to day activities.

Where people had been unable to make the decision to live at the home the provider had submitted appropriate applications for assessment under the Deprivation of Liberty Safeguards. Where people were not able to make decisions for themselves decisions had been taken in their best interest. However the recording of assessments was not clear and the registered manager had not taken into account how alcohol may affect people’s ability to make decision. People were able to make some decisions about their everyday lives but sometimes care was limited by the availability of staff.

Staff knew how to raise any safeguarding concerns but people were not always provided with somewhere safe to store their valuables. The registered manager investigated safeguarding concerns and took appropriate action. People living at the home were happy to raise any concerns and complaints with the registered manager or staff.

Blenheim Care Centres is a nursing and residential care home for up to 80 people located near to Gainsborough, West Lincolnshire. The home is divided in to three units, Blenheim House, Blenheim Lodge and some semi-independent flats. Blenheim Lodge was closed on the day of our inspection. The home caters for people whose ages range from 18 years and above, and who have physical disabilities and/or neurological conditions. On the day of our inspection 24 people were living at the home as full time residents. One person was receiving regular respite care.

An unannounced comprehensive inspection was carried out on 9 August 2016 during which we identified five breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to medicines arrangements, risk assessments, the environment, infection control and prevention, governance, staffing levels and capacity assessments. At two further inspections we found that although the registered provider had taken some actions, they had not made sufficient progress to become compliant with legal requirements and improvements had not been tested for sustainability.

There was not a registered manager in post. A new manager had been appointed and they had applied to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with CQC 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 we found that the provider had taken sufficient action to demonstrate compliance with legal requirements related to the provision of healthcare, the physical environment and infection prevention and control. However, the registered provider had failed to ensure that other previous improvements had been sustained and there were three continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a further breach of legal requirements related to the implementation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

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

We found that staff had not always acted in accordance with the requirements of the MCA and DoLS and they demonstrated a lack of understanding about how to implement the requirements. The MCA provides a legal framework to assess people’s capacity to make decisions for themselves. If the location is a care home CQC is required by law to monitor the operation of the MCA and DoLS and to report on what we find.

Medicines were not always managed in a safe and appropriate manner. People could not be assured they would receive their medicines in the ways they had been prescribed or in a timely manner.

People could not be assured that risks to their safety and welfare would be robustly assessed, or that their care would be provided in a way that minimised the risks.

People were treated in a kind and caring way. However, some aspects of their care did not fully promote their dignity.

People who were able to do so had the opportunity to express their views about their experiences of the care and support they received. They had access to information to help them raise concerns or make contact with advocacy services. However, systems were not in place to ensure people whose first language was not English and people who had complex communication needs would be afforded the same opportunities.

Some improvements had been made to the way staffing levels were managed. However there was a continued reliance on agency nurses to fill vacant posts. Taken together with shortfalls in the way people’s care was planned and recorded, this increased the risk that people would not receive their care in a consistent, effective and responsive manner.

Some improvements had been made to the training programme for staff. However, there were continued shortfalls in the provision of training that was specific to people’s needs; this included training about how to implement the requirements of the MCA and DoLS.

Some systems were in place to assess and monitor the quality and safety of the services provided within the home. However, the systems had not identified the issues we found during this and our previous inspections. They had not led to sufficient improvements in the quality of the services provided for people.

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 registered providers found to have been providing inadequate care should have made significant improvements within this time frame.

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.

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.

Blenheim Care Centres is a nursing and residential care home for up to 80 people located near Gainsborough, West Lincolnshire. The home is divided into three units, Blenheim House, Blenheim Lodge and some semi-independent flats. Blenheim Lodge was closed for refurbishment on the day of the inspection.

The home caters for people whose ages range from 18 years and above, and who have physical disabilities and/or neurological conditions. On the day of our inspection 24 people were living at the home as full time residents. One person was receiving regular respite care

A manager was in post who had not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager was not present at this inspection.

We carried out an unannounced comprehensive inspection of this home on 9 August 2016 during which breaches of legal requirements were found. In regard to Regulation 12 (2) (a) (b) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment, we told the registered provider that they must become compliant by 31 August 2016.

We carried out a focused inspection on 21 September 2016 to check that the provider had taken action to ensure that they now met legal requirements. During the inspection we found that although the provider had taken some actions, they had not made sufficient progress to become compliant with the previously identified breaches of legal requirements. Following this inspection we imposed conditions of registration on the registered provider. These conditions meant that the provider was required to take specific actions to improve the service and meet legal requirements.

This focused inspection took place on 2 November 2016 and was unannounced. We undertook this focused inspection following further concerns we had received and to check that the provider had taken action with regard to issues raised by ourselves and other agencies who commission care for people living at the home. We also wanted to confirm their progress against requirement notices and conditions of registration which were put in place following the inspections on 9 August 2016 and 21 September 2016. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection; by selecting the 'all reports' link for Blenheim Care Centres on our website at www.cqc.org.uk.

At this inspection we found that the provider had made improvements to the way in which medicines were managed. People had received their medicines in the way in which they had been prescribed for them.

There had been a number of improvements to the ways in which risks to people’s health, safety and welfare were managed. Risks associated with people’s individual needs had been identified and planned for. Staff followed individual risk management plans when providing care.

A number of improvements had been made to the way in which quality assurance systems were managed. The provider was adhering to the conditions of registration we imposed at the focused inspection on 21 September 2016.

However these improvements were not sufficient to change the ratings for these key questions and had not been tested for sustainability.

There were continuing concerns regarding staffing levels and deployment, infection control measures and the quality of training for staff related to safeguarding people. Further concerns which required improvements to be made were identified regarding arrangements for supporting people to express their needs and views, induction training and support for staff and team leadership.

This meant that provider continued to be in breach of Regulation 12, Regulation 15, Regulation 17 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently taking action against the provider to ensure that they make the necessary improvements to become compliant with legal requirements.

Blenheim Care Centres is a nursing and residential care home for up to 80 people located near Gainsborough, West Lincolnshire. The care centre is divided into three units, Blenheim House, Blenheim Lodge and some semi-independent flats. Blenheim Lodge was closed for refurbishment on the day of the inspection.

The centre caters for people whose ages range from 18 years and above, and who have physical disabilities and/or neurological conditions. On the day of our inspection 28 people were living at the care centre.

A newly appointed manager was in post who had not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 carried out an unannounced comprehensive inspection of this service on 9 August 2016 during which breaches of legal requirements were found. We told the registered provider that they must become compliant with Regulation 12 (2) (a) (b) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment by 31 August 2016.

We undertook this focused inspection to check that the provider had taken action to ensure that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blenheim Care Centres on our website at www.cqc.org.uk.

At this inspection we found that the registered provider had not made all of the improvements required to ensure they were compliant with legal requirements.

Improvements had been made to the way in which some medicine supplies were recorded. However, there were continued shortfalls in the recording of medicine stock levels, medicines administration and the transcribing of medicine prescriptions. In addition, there were no systems in place to ensure shortfalls would be identified and rectified in a timely manner.

Improvements had been made to the way in which some risks to people’s health, safety and welfare had been managed. However, risks for some people had not been identified and planned for despite previous experience of issues arising as a result of those risks not having been appropriately managed. Risk assessments and management plans that were in place did not provide sufficient detail to enable staff to monitor the level of risk or to provide the care and treatment required to minimise the risks.

We are currently taking action against the registered provider to ensure that they make the necessary improvements to become compliant with legal requirements.

Blenheim Care Centres is a nursing and residential care home for up to 80 people located near Gainsborough, West Lincolnshire. The care centre is divided into three units, Blenheim House, Blenheim Lodge and some semi-independent flats. Blenheim Lodge was closed for refurbishment on the day of the inspection.

The home caters for people whose ages range from 18 years and above, and who have physical disabilities and/or neurological conditions. On the day of our inspection there were 36 people were living at the care centre.

A newly appointed manager was in post who had not yet registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 five breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was because registered provider did not have systems in place to ensure people who lived in the home received their medicines in a safe and timely manner. Risk assessments were not always recorded or reviewed in a robust manner. In addition, the registered provider had not effectively risk assessed the environment people were living in and taken action to address any issues highlighted. All of these problems resulted from the registered provider not operating a system of robust quality checks.

Further shortfalls involved the registered provider not employing sufficient numbers of staff with the appropriate skills to ensure people’s health, safety and welfare needs were met. Arrangements for assessing people’s capacity to make decisions and those decisions taken in people’s best interest were not always carried out or recorded in a robust manner. These breaches had reduced the registered provider’s ability to ensure people were kept safe. You can see what action we told the registered provider to take at the back of the full version of this report.

People received the personal care they required from staff who understood how to provide the care. They were supported to make their own decisions and choices on a daily basis. However, people were not provided with consistent or suitable support to engage in meaningful activities or to develop their personal interests.

People were treated respectfully and with dignity by care staff who ensured their privacy was maintained when they provided personal care. However, people’s privacy and dignity was compromised because the registered provider had not always considered these issues in the way they managed the home environment.

People's care plans did not set out clear guidance as to how their needs should be met and they had not benefitted from being involved in developing or reviewing the plans. This increased the risk that agency staff or newly appointed staff would not have a clear understanding of people's needs and how to support them. In addition, people had not benefitted from staff who were appropriately supported carry out their roles or encouraged to keep up to date with best practice methods.

People told us they felt their needs had been assessed appropriately and that their care plans were up to date and reflective of their needs. Comments included, “(Names of the manager and senior care worker) spoke with me last week about my care plans. And, “We (names of the nurse and manager) discuss any changes that are needed with my care plans.”

Our checks found medicines were given to people correctly. Records about medicines were complete and accurate. Appropriate arrangements were in place for the safe storage of medicines. Information was available to help make sure medicines were being safely administered to people.

People spoke highly of the staff team and told us they felt the staff met their needs well. People told us, “The staff are very good and helpful, you can talk to them about anything."

We saw the provider had internal quality, monitoring and audit systems in place. We saw the complaints procedure, and looked at the complaints received since our last inspection.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw people's care plans and risk assessments had been reviewed and amended to ensure people's assessed needs were met.

Since our last visit, the provider had appointed more care staff and were reviewing how staff employed at the service was deployed across all areas of the service.

We saw a new system had been developed so that all accidents and incidents were monitored, reviewed and analysed.

We found the records we read were found to be informative, reflective and fit for purpose showing how people's health, social care needs and safety were met.

We looked at eleven people's care records and a selection of other documents such as policies and procedures, meeting records, internal questionnaires and audits.

People we spoke with told us they felt staff listened and respected their views and wishes, and that they were asked for their consent before care and treatment was provided. One person told us, 'You are always asked what time you want to get up, they (staff) respond well to people's needs.' Another person said, 'I came here for respite and never went home. It's free and easy and you can do as you like.'

People who used the service told us they were happy with their care and treatment and that they felt their needs were well met. One person told us, 'The staff support you to attend health appointments, I've not missed an appointment since being here.'

We found the provider had made significant improvements in many areas but there were still some concerns with meeting people's health, care and welfare needs. We also had some concerns that there were not always the right amount of staff on duty.

We looked at five people's care records and a selection of other documents such as the infection control policies, procedures and cleaning audits. We also looked at information relating to staff such as staff training records, staff meetings and supervisions. We conducted an inspection of the buildings and equipment to check on the cleanliness.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

A person we spoke with who used the service told us they had received a new bed and new carpet since we last visited. Comments included, 'Even the care staff clean, they do it too.'

Another person told us, 'I've lived here a long time, the staff are brilliant, some have been here as long as I have, so they know what I like and need.'

People said things like, 'I think I'm well looked after' and 'They (staff) know my likes and dislikes, I like coming here.' Other people said, 'Care is often rushed' and 'There are two types of carers, caring carers who are brilliant at what they do, and job carers who are only here to put food on the table as quick as possible.'

People were not always involved in how the care centre was run and their dignity was not always respected. Some staff were able to describe the care they provided for people, others were not. Not all of the care plans contained accurate or up to date information about people's needs.

People were not protected against the risks of infection. Many areas of the care centre had not been cleaned effectively and infection control procedures were not followed appropriately by staff. Some staff told us their training was out of date and records confirmed this. Other staff said they had been supported to undertake nationally recognised qualifications.

There was no effective system in place to monitor the quality of the service provided for people. Most people were unaware of the provider's complaints policy.