Bentley Manor

Bentley Manor is a residential care home providing regulated activities of accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury. The service provides support to older people, people living with dementia, people with mental health needs and people with a physical disability. At the time of our inspection there were 73 people using the service. The service can support up to 80 people. Bentley Manor accommodates people in one adapted building set out over 2 floors.

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

People living at the service told us there were enough staff to meet their needs and this was observed during the inspection. However, we received mixed feedback from staff on the staffing levels in one area of the service. The registered manager reviewed the staffing levels in this area during the inspection and deployed an additional staff member permanently.

Medicines were managed safely and risks relating to people and the environment were assessed and monitored. The service appeared clean and infection prevention and control measures were in place to keep people safe. Staff understood the importance of safeguarding, and people told us they thought the service was safe.

People’s needs and choices were assessed and recorded clearly in their care plans. People received care and support inline with their changing needs and were able to exercise choice in their daily lives. People’s consumption of food and fluids were recorded where appropriate, and people spoke positively of the food offered. Staff completed a range of mandatory training and training specific to the needs of the people they supported. Staff supported people alongside external health professionals to ensure their needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives praised the staff approach to providing care and support. Staff felt valued and listened to by the management team and were confident in raising concerns should they need to. Auditing and quality monitoring was effective and there were a range of meetings taking place which evidenced the involvement of staff, people and their relatives. The provider evidenced good partnership working and continuous learning and improving care.

Rating at last inspection

The last rating for this service was good (published 10 September 2018).

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

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. 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 risk of accidents and incidents. This inspection examined those risks.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Bentley Manor on our website at www.cqc.org.uk.

Follow up

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

We were not fully assured that staff training and practices prevented transmission of infection or that staff were using PPE effectively and safely. Procedures for the safe removal of PPE were not always being correctly followed. The registered manager confirmed that further training and direct observations would be carried out to address this immediately.

We found the following examples of good practice.

¿ The home was clean and hygienic. There were schedules in place to ensure frequent cleaning took place.

¿ People living at the home and staff were supported to take part in regular testing and had access to the vaccination programme.

¿ The provider had ensured staff had an ongoing supply of appropriate personal protective equipment (PPE).

¿ Isolation, cohorting and zoning was used to manage the spread of any infection. This meant that when necessary, people were encouraged to self-isolate in their rooms.

¿ Safe visiting arrangements were in place to enable people to have contact with their family. Individual risk assessments had been carried out in relation to visiting and an outdoor visiting pod had been created.

¿ Further changes to government guidance in relation to visiting arrangements were being implemented.

¿ Infection prevention and control audits took place which ensured the registered manager had oversight of infection control. Policies, procedures and risk assessments related to Covid-19 were up to date.

At our last inspection on 5 May and 23 June 2017, we found that the service was in breach of regulations relating to safeguarding, the management of risk and good governance. The service was rated overall as ‘requires improvement.’ We took action by requiring the provider to send us an action plan setting out how they would address these issues. During this inspection we found improvements had been made and the provider was no longer in breach of these regulations. We found that overall the service had improved and is now rated as “good”. However, some further improvements were still required related to the safe domain.

Bentley Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Bentley Manor accommodates up to 80 people across three separate units, each of which have separate adapted facilities. Two of the units specialises in providing care to people living with dementia. At the time of the inspection there were 74 people living at the home.

The majority of people were very positive and complementary about the care and support they received at Bentley Manor. Improvements had been made to demonstrate that risks to people were assessed and action taken to mitigate these risks. We specifically looked at people at risk of falling and found that appropriate action had been taken. In some instances we saw that records had not been updated to reflect the action taken.

Overall, we found that there were sufficient staff to meet the needs of people. However, at certain times levels were affected by unexpected staff absences such as sickness. The registered manager confirmed that action would be taken to ensure all staff understood the systems for managing staff absences, especially at short notice.

Where necessary safeguarding concerns had been identified and reported to the local authority and CQC had also been notified. Staff understood when and how to report safeguarding concerns. Staff were recruited following safer recruitment processes. We found that medicines were managed safely.

Staff were knowledgeable about the Mental Capacity Act 2005 (MCA) and understood it’s principles. We saw that staff sought consent from people before providing support. Staff were trained to carry out their duties as required. Staff received supervision to support them with their development, however there were occasional gaps and variations in the frequency of these. The management team told us that they would focus on this.

People were supported to meet their nutritional needs. Overall people told us they were happy with the food on offer, however a few comments suggested that the food was sometimes cold and people would appreciate more fruit and vegetable choices. Any nutritional risks were monitored and action was taken in response.

A range of health professionals were involved in people's care. The registered manager had developed several clinical pathways because of learning from a recent incident at the service.

People told us that they were treated in a kind and caring manner. We saw that staff respected people’s dignity and privacy. We saw some good examples of care being provided in a way which met individuals’ needs. The service considered people’s diverse needs well

People’s care plans reflected their physical, mental, emotional and social needs. They included information about people’s histories, likes, dislikes and preferences. Activities were available to people, but these had recently reduced due to staff changes. The management team planned to get these back on track. The staff had trained in Namaste care, which provides specific support to people living with dementia.

There was a complaints procedure in place and people told us that they felt able to raise any concerns with staff.

People and staff were positive about the management of the service. The registered manager worked in an open and transparent way. There were arrangements in place to regularly assess and monitor the quality of the service.

Bentley Manor is a two-storey purpose-built care home set in its own grounds. The home is in a residential area close to Crewe town centre, local shops and other facilities. On the ground floor one unit provides accommodation for people living with dementia. The first floor contains two units, one for people with severe and enduring mental health needs and the other provides nursing and personal care. At the time of our inspection there were 74 people living at the home.

There was a registered manager in post at the time of our 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 identified three breaches of the relevant legislation, in respect of safe care and treatment, safeguarding and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Overall the people and relatives we spoke with were positive about the care and support they received at Bentley Manor.

Staff knew the importance of keeping people safe, including being safe from abuse and harassment. However we found that whilst the majority of safeguarding concerns had been reported to the local authority we identified some incidents where local procedures had not been robustly followed. This meant that we couldn't be sure that people were fully protected.

We found that potential risks had not always been fully recorded in people’s care records and appropriate risk assessments were not always evident. The registered manager assured us that people’s care plans would be reviewed to ensure that appropriate risk assessments were in place. We saw that accidents and incidents, along with any pressure ulcers and weight loss or gain were regularly monitored.

Medicines were managed safely. We saw that a new electronic medication management system had been implemented. Staff told us that this was easier and safer to use.

We found that there were sufficient staff to meet the needs of people within the service. People told us that there were unfamiliar staff at night and weekends. There had been some issues around staff sickness and agency staff were utilised. The management team had focused on the recruitment of new staff and we saw that a significant number of staff had been employed and were undertaking induction training.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. It was evident that the registered manager had a clear understanding of the MCA and its application. Records indicated that the majority of staff had attended MCA and DoLS training sessions and staff spoken with demonstrated an understanding the MCA.

We saw that staff received an induction and regular training was provided. Staff told us that they received the training and support they needed to carry out their roles effectively. Staff were also supported through supervisions and staff meetings.

We found that people’s nutritional needs were being met. People’s views on the quality of the food were positive. People were supported to have sufficient to eat and drink and maintain a balanced diet and staff were knowledgeable about people’s nutritional needs.

People and their relatives told us that staff were kind and caring in their approach. People were treated with dignity and respect. Dignity champions had been appointed to promote dignity within the home.

People received care that was personalised and responsive to their needs. Care plans were detailed and contained sufficient information to enable staff to meet people's needs. People spoken with told us that they were given choices about the way their care was provided.

People looked well cared for and well presented. However, we found that nail care could be improved.

There were varied activities going on and people could choose whether they wanted to take part. The home had two activities coordinators and there was a programme of events available. There was a complaints procedure available and people told us that they knew how to complain should they need to.

Staff told us that they had seen some improvements in the organisation of the service and were positive about the registered manager. Staff told us that they received supervision and felt supported.

We found that the home had some systems in place to assess and monitor the quality of service that people received, but systems to obtain feedback from people and residents were being developed. However, quality assurance systems had not been robust enough to identify the issues raised within this inspection.