Archived: Bentley Court Care Home

Bentley Court is a nursing home providing personal care to 37 people at the time of the inspection, some of whom were living with dementia. The service can support up to 76 people in a purpose-built building although at the time of the inspection the provider was limiting occupancy to 41 people.

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

People could not be assured that the provider quality assurance systems would identify all areas of improvements required at the home.

People were assured the environment would be safe as the provider maintained the building and carried out remedial work in a timely manner. Equipment was serviced within the manufacturer’s timescales.

People could be assured by the systems in place to assess and manage their safety.

People could be assured that if they were involved in an accident or incident, the provider would take step to learn from them and take action to prevent a re-occurrence.

People's care plans were reflective of their current needs.

People were supported by enough staff who supported them in a timely manner and staff members received training on how to keep people safe from the risk of abuse.

People's medicines were managed effectively.

We found there was a positive culture shared between staff to promote good outcomes for people.

Managers and staff were open and honest. People, their relatives and staff had the opportunity to make changes to the service.

Staff worked in partnership with other healthcare professionals.

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

Rating at last inspection

The last rating for this service was requires improvement (published 8 November 2019).

Why we inspected

The inspection of [insert location name] commenced on [insert date] and was unannounced.

The inspection was prompted in part by notification of an incident following which a person using the service developed serious health conditions. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of health conditions, fluid intake and the environment. This inspection examined those risks.

We found no evidence during this inspection people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

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 previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same.

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 coronavirus and other infection outbreaks effectively.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bentley Court Care Home is a nursing home providing personal and nursing care to 38 older adults. Care is

provided on two floors. Some of the people are living with dementia. The service can support up to 77

people.

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

We received information about poor infection prevention control (IPC) practices within the home and a number of positive cases of covid-19 for both people and staff members.

The home was split in to three zones, two red zones where people had tested positive for covid-19 and one green zone where people were negative.

The provider had processes and audits in place around infection prevention control.

The home was clean and tidy and free of malodour.

Staff told us they had received training on infection prevention control.

The provider was working closely with Public Health England to implement sufficient IPC practices within the home to protect people and staff from the pandemic.

Prior to the inspection we received information that IPC protocols were not being followed. Whilst we did not identify any immediate concerns in relation to Bentley Court care home, we found the provider still had further improvements to make to keep people safe.

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

Rating at last inspection

The last rating for this service was requires improvement (07 November 2019).

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 around preventing and controlling infection. A decision was made for us to inspect and examine those risks.

Bentley Court Care Home is a nursing home providing personal and nursing care to 43 older adults. Care is provided on two floors. Some of the people are living with dementia. The service can support up to 77 people.

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

Bentley Court Care Home continues to be rated as requires improvement. The provider had identified areas of improvement and continued to work through these actions. Further improvements were needed to ensure consistency and to demonstrate these improvements can be sustained.

People felt safe living at the home and risks assessments were in place and reviewed. Staff understood peoples risks and how to support them in a safe way. Infection control procedures were in place and followed. Lessons were being learnt when things had gone wrong. There were enough staff available for people. Staff understood safeguarding and how to protect people from potential harm. Medicines were managed in a safe way.

Audits were carried out in the home, so improvements could be identified. People and relatives were involved with care and the provider was seeking feedback. We were notified of significant events as needed. Staff felt supported and listened to.

Rating at last inspection and update

The last rating for this service was Inadequate. This service has been rated Inadequate or requires improvement for the last seven consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 22 February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

After the last inspection a decision was made to inspect this home within 3 months of the last inspection.

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.

The 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 Inadequate to Requires Improvement. 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 Bentley Court Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to Regulation 17 at this inspection as the home has continued to be rated as requires Improvement.

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.

Bentley Court Care Home is a residential care home providing personal and nursing care for up to 77 people aged 65 and over. At the time of the inspection there were 48 people who were living at the service, many of whom were living with dementia. The service has a specialist dementia unit which was home to 18 of the people who were living at Bentley Court Care Home during the inspection.

People’s experience of using this service:

People were not sufficiently protected from the risk of harm; including potential abuse, the behaviour of others, health concerns or accidents and injury. The provider’s risk management systems were inadequate. People were not protected by consistently safe medicines management systems.

People were not supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not fully support this practice.

People’s needs were not being accurately assessed, understood and communicated. The quality of care in the service was inconsistent. Some people’s health and nutritional needs were met while some were not. Some interactions between staff and people were also of a high quality while others were not. The provider had not ensured support given to people was consistently caring and respectful and that people’s choices were promoted as far as possible.

People’s personal preferences and needs were not always fully understood and planned for. As a result, care did not always fulfil people’s needs. Care provided did not consistently meet people’s needs. People were not receiving care that was truly person-centred; including around personal care, leisure opportunities and meaningful activities.

People were not protected by robust quality assurance and governance systems. The provider failed to ensure the systems they had in place identified risk to people and areas of improvement needed. The provider failed to make sufficient improvements and as a result people were living in a deteriorating service and were exposed to the risk of harm.

Rating at last inspection (and update)

The last rating for this service was inadequate (report published 12 March 2019). This meant the service was entered into special measures. The provider was not meeting the regulations around staffing levels, person-centred care and good governance.

At this inspection we found sufficient improvement had not been made and the provider was still in breach of regulations. This service has been rated as requires improvement or inadequate for the last five consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating but was prompted in part due to concerns about the management of risk in the service, including the management of risks associate with behaviours that can challenge others. The inspection was also prompted in part by notification of specific incidents; following which a person using the service sustained a serious injury and another died. The information CQC received about the incidents indicated concerns about the management of risk and the management of specific health concerns. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. 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.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, the need for consent, person-centred care and good governance.

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.

Follow up

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our previous inspection of Bentley Court care home on the 9, and 18 July 2018 we found the provider had breached some regulations. These breaches were due to a lack of assurance as to people’s consent being sought and systems in place that should have ensured the quality of service provision not being effective. Following the last inspection, we asked the provider to complete an action plan to show what they would do to address these breaches of regulation. We received an action plan but at this latest inspection, despite some improvements, we found there was still a breach of regulation in respect of the service’s governance. We also found further breaches of regulation in respect of deployment of staff and ensuring person centred care was delivered.

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.”

Bentley Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bentley Court can accommodate up to 77 people in one purpose built property. There were two units, one for people with nursing needs and one for people that lived with dementia and nursing needs. The care home also accommodates people under retirement age. There were 65 people living at the home when we inspected.

At the time of our inspection there was a registered manager (who was present at the time of the inspection). 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 were informed at the inspection that the registered manager had given notice and was leaving the provider’s employment the same week.

People were not consistently protected as risk assessments did not always show how risk to a person’s safety was best minimised. There were occasions where people with fluctuating needs were not protected by the staffing deployment and numbers. Systems for the management of people’s medicines had not always ensured they were managed correctly. Staff knew how to respond should they have concerns that a person was abused. People were protected by the provider’s systems for recruitment of staff.

People living with dementia were not always given a choice of meal in a way that promoted their choices. Meal times were not always conducive to allowing people to have the support they needed to eat and enjoy their meals. People had inconsistent support to ensure they had enough to drink. People living with dementia could have access to a more appropriate environment that allowed their needs to be better met. People’s right to consent was understood and sought by staff and any restrictions applied to enhance people’s safety were agreed. People were supported by trained staff, with the provider also having identified further training needs they planned to support staff to take up. People had access to community health services as needed to promote their health.

People were not always treated with dignity and respect. People were not always able to have the support needed to express their views and make choices regarding their day to day life. We saw care was on occasions task not person focussed, this a concern for some of the staff who wanted to provide better care to people. People's independence was promoted and people were supported to maintain friendships and contact with families.

People’s records did not always reflect what were their current needs and preferences and people did not always feel involved in planning their care, whilst others did. People’s preferences were known to staff, although staff felt they could be supported to know people better. People had access to activities if chosen, but there were times when there was not always sufficient staff to ensure more dependent people had access. People knew how to complain and we found when this happened the provider responded appropriately

Despite the provider having systems to monitor the quality of the service, these were not always effective and as a result we found there were still numerous areas where improvements were needed, as well as breaches of regulations. People said they could approach management, some telling us their views were sought but staff did not always feel supported by management.

This inspection was prompted in part by a notification of an incident when a person using the service died. This incident is subject to an investigation and as a result we did not examine the circumstances of the incident. However, as part of this inspection we looked to see if the risk to other people because of this incident had been mitigated.

Bentley Court provides care and support for up to 77 older people who require nursing or personal care, and who may be living with dementia. On the days of the inspection 69 people were living at the home. Bentley Court has two independent units. The ground floor provides nursing care to people and the first floor provides nursing care to people primarily living with dementia.

Since our last inspection the home has a new 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.

Although staff knew people’s risks care records were not always up to date or reflective of people’s needs. During day two of our inspection the provider had acted to ensure there were sufficient numbers of staff available to meet people’s needs. People told us they felt safe and staff understood their responsibilities to raise concerns regarding potential abuse. People told us they received their medicines as prescribed. People were protected from the risk of infection.

Not all staff had the skills and knowledge to meet people’s care and support needs. Staff lacked knowledge about which people were subject to a Deprivation of Liberty Safeguards [DoLS] and the application of DoLS by the provider was not effectively maintained. Staff missed the opportunity to engage with people as they were often focussed on tasks. People received adequate amounts of food and drink. We saw evidence people were supported to access healthcare professionals when required. People were not always treated with dignity and respect.

People had access to some activities. Care records were not reflective of people’s needs. People knew how to raise concerns or complaints and the provider had a system in place to investigate concerns.

The provider’s quality assurance systems were not always effective at identifying and addressing issues of concern that may affect people’s safety. People’s feedback in relation to the quality of the service was being sought. The registered manager understood their responsibilities for reporting incidents or events that occurred at the service to CQC. People and staff were positive about the new registered manager and said they were open and approachable.

We found two 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.

At our last comprehensive inspection in April 2017 we found the provider was in breach of Regulation 12 of the Health and Social Care Act in relation to medicines management. We also found that other areas required improvement including levels of staffing, the availability of personalised care and activities and the provider’s governance arrangements. During this our most recent inspection we found that the necessary improvements had been made to medicines management to meet the breach of the regulations. However there were some areas that showed that the necessary improvements were not fully embedded.

There was no registered manager in post at the time of our inspection. The newly appointed manager had commenced in post two weeks prior to our visit and was being supported by the Operations Director. 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.

A sufficient level of improvement had been made to meet the regulations and satisfy the breach from our inspection in April 2017; however we found that there were some areas of medicines management that could be further improvement. Staff demonstrated a good awareness of their role and responsibilities regarding protecting people and were confident a member of the management team would deal with any concerns reported. People had risks relating to the care and treatment assessed and staff had guidance to refer to about how these should be managed. Sufficient staff were on duty to meet people's needs and forthcoming rotas had addressed and reduced the use of agency staff. Staff were employed through safe recruitment practices.

People were assisted to maintain healthy nutrition but choices about food on offer were not made readily available to support and involve people. Staff were well supported though supervision, the availability and variety of training and the quality of the induction provided to them. Systems in place ensured people were not deprived of their liberty unlawfully and people were appropriately supported to provide consent for the care they received. People were supported to access a range of healthcare services.

People were supported to be comfortable and at ease and their care was provided with dignity and respect. Further work was needed in relation to how people’s sexuality was supported and explored as part of personalised care planning. People were supported by staff that were caring and respected their right to privacy. Staff treated people with dignity and respect. People and their representatives wherever possible were involved in making decisions about their care. Written information and contact numbers were not available for people about how to access and receive support from an independent advocate, although staff knew how to direct people.

People were actively supported to take part in a range of activities; in addition the environment had been improved in order to stimulate people’s interest. Staff demonstrated they were knowledgeable about people's individual needs and preferences. People's care records were written in a person-centred way and had been developed with the person or their relatives/representative. Complaints received by the provider were acknowledged, investigated and responded to complaints in line with their own policy.

The home had on-going governance issues and had failed to provide the necessary evidence over the three inspections we had undertaken since December 2015 that the service was well-led. Providers supporting systems such as the Quality Lead role were on the whole positive in identifying and acting on issues at the home, through on-going monitoring, audits and checks. The newly appointed manager had made a positive start in addressing some of the issues at the home, such as taking action to reduce the use of agency staff. Staff received a good level of supervision and were able to could seek informal support when needed. People were actively encouraged to provide their thoughts and opinions about the service.

At our last inspection the home was rated as requires improvement in all the domains.

There was a registered manager, however, at the time of our inspection we were informed the registered manager had left and the home was being run by an interim manager who had started the day before our inspection and would be in post until a replacement could be found. 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.

Although people told us they received their medicine when they needed it, we found improvements were needed in the management of people’s medicine to ensure required medication was available so that people received their medicines as prescribed.

People told us there were times when there were insufficient staff to meet their needs. We saw there were sufficient staff available for people who chose to spend their time in the lounges however some people had to wait when they were nursed in their bedroom. People were supported by staff who knew how to manage risks to their health and safety and we saw staff put into practice their knowledge when supporting people. The provider operated a safe recruitment system which meant people were supported by staff who were suitable to work with vulnerable people.

People who lived at Bentley Court told us staff had been trained to meet their needs. Staff told us they received good training to help them support people and we saw them put into practice the training they had received. People’s rights were protected through effective use of the Mental Capacity Act. Where people were deprived of their liberty the provider had made the appropriate applications to the local authority for this deprivation to be authorised. People’s nutritional needs were met. People had access to other healthcare professionals when their health needs changed.

People told us staff respected their privacy and dignity. People told us they were supported by kind and considerate staff. We saw staff knew people well and positive relations had developed between people who lived at Bentley Court and the staff who supported them. We saw people had choices about their care, and staff respected the choices people made.

People told us and we saw people’s care was not always responsive to their individual needs. People did not have access to meaningful activities. People and their relatives were happy to raise complaints about the care they received and told us when they had complained they had been listened to.

The registered manager had left their post and where concerns had been highlighted action had not always been taken to ensure people got the care they required to meet their needs. Staff told us they were not always supported in their role. Prior to leaving the service the registered manager had given people and their relatives the opportunity to be involved in the running of the service. The provider had ensured that they had notified us of events that had taken place within the service.

During this inspection we found a breach 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.

At the time of our inspection the home had a registered manager. 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.

Medicines were not always managed safely. For example, people did not always get their medicines on time and medicine errors were not always recorded.

People told us and we saw there were insufficient numbers of staff to support people and keep them safe. Risks to people’s safety were not always managed appropriately.

People told us they felt safe. People were protected from the risk of harm because there were safe recruitment practices were in place to ensure staff were suitable to work in the home. Staff knew how to recognise and report any potential abuse.

People’s rights were not always protected. When people lacked capacity to make decisions for themselves the principles of the Mental Capacity Act had not always been followed. People told us they were supported by staff who had received appropriate training to meet their needs. Staff were supported in their roles and received training when they needed it.

People told us they enjoyed the food they received and that they were given choices at mealtimes. People who had special dietary requirements were catered for. People had access to outside healthcare professionals when their health needs changed.

Staff did not always have the time to spend with people and there were missed opportunities for interaction. People’s privacy and dignity was not always respected by staff.

People were not always supported to follow their leisure activities. We saw people were supported by staff who knew their individual needs and preferences but this was not always reflected in their care plan. People told us that they were encouraged to maintain relationships that mattered to them. People and their relatives knew how to complain. A system was in place to respond to people’s complaints when they had reason to complain.

Quality assurance systems were in place to improve the service for people however they were sometimes ineffective because they did not identify some of the shortfalls in the home. People told us that they were not always involved in the running of the home. Staff felt supported by the registered manager. We saw that that there was an open culture within the home.