Background to this inspection
Updated
12 September 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Inspection Team
One inspector carried out this inspection on the first day of our visit, on 27 August 2019. On the second day of the inspection, one inspector returned and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Benvarden 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.
The service had a manager registered with the Care Quality Commission. The manager is also the owner / provider. They are legally responsible for how the service is run and the quality and safety of the care provided.
Notice of inspection
The first day of the inspection was unannounced. We told the provider we would return on 28 August 2019 to complete our inspection.
What we did before the inspection
We reviewed information we had received about the service since our last inspection. This included details about incidents the provider must notify us about, such as abuse. We also sought feedback from the local authority, fire service and professionals who work with the service. We had received a concern about one incident and a complaint about another issue.
We used the information the provider sent to us in the provider information return. This is information providers are required to send to us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.
During the inspection
We spoke with ten people and seven relatives. We spent time with people in communal areas, observing interactions and support they received from staff. We spoke with five members of care staff, the cook and the provider. Following our inspection visit we had telephone conversations with night care staff.
We reviewed a range of records. This included a review of five people’s care plans, multiple medication records, daily checks and people’s food and drink records. We checked three staff employment files. We also looked at records relating to the management of the home. These included environmental safety checks and lifting equipment checks undertaken by external professionals as legally required. The provider’s checks undertaken on the health and safety of the home, the provider’s audits and staff training records.
Updated
12 September 2019
About the service
Benvarden is a residential care home, providing personal care and accommodation for up to 14 people. It provides care to older frail people, some of whom are living with dementia. There are 12 bedrooms over two floors, with shared bathroom facilities. There is a communal lounge and dining area on the ground floor. The home has a conservatory that opens onto a garden. At the time of our inspection visit ten people lived at the home.
People’s experience of using this service and what we found
At our last inspection we found breaches of the regulations and whilst, at this inspection, we found some improvements had been made, these were insufficient to meet the requirements of the regulations.
The provider’s quality assurance system did not consistently ensure quality and safety. The provider had not always acted on the recommendation of professionals to undertake safety work in the home.
The provider had not always undertaken general décor and maintenance repairs in a timely way, which posed potential risks of infection. The provider did not have sufficient governance or managerial oversight of checks on the safety and quality of the service they delegated to staff.
Overall, people were supported with their medicines as prescribed. However, staff did not consistently follow the prescriber’s or manufacturer’s instructions, which posed potential risks to people’s wellbeing.
Staff knew people well and how to protect them from risks of harm or injury, such as falls. Risk management plans lacked details and the provider assured us information would be added to these so staff had the information they needed to keep people safe.
Staff completed care records, such as those about people’s food and fluid intake so they had the information they needed. The home was clean and tidy, and staff knew how to reduce risks of cross infection.
There were sufficient trained staff on shift. Further training was planned for to increase and refresh staff’s knowledge and skills. Staff were supported by the provider and further plans included the appointment of a deputy manager, to support staff in the provider’s absence.
The provider had assured themselves of staff’s suitability to work with people. However, where staff had been employed for numerous years, the provider had not undertaken further checks to assure themselves staff’s suitability continued.
People had their needs assessed before they moved into the home. People had plans of care, though these were not always detailed and the provider told us more information would be added. People were satisfied with the activities offered.
People had access to healthcare when required. People were offered sufficient food and drink to meet their dietary requirements. Alternatives were made available to the set menu when needed and additional snacks were offered.
Positive caring interactions took place between people and staff, and people felt well cared for. Staff involved people in making day to day decisions about their care and gained people’s consent before undertaking personal care tasks. Mental capacity assessments had been completed for people and the provider understood their responsibilities under the Mental Capacity Act 2005.
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 procedures in the service supported this practice.
Systems were in place for people and their relatives to give feedback on the service, which they were happy with. People did not have any complaints.
We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Regulation 12 Regulated Activities Regulations 2014 – Safe care and treatment
Regulation 17 Good Governance
Rating at the last inspection
The last rating for this service was Inadequate (published 28 February 2019) and there were breaches of the regulations. We took enforcement action and imposed a condition of the provider’s registration. The provider submitted actions plans to tell us what they would do and by when to improve. The home was placed in ‘special measures’ and kept under review. We made a referral to the fire service due to serious concerns about fire safety at the home. The fire service undertook an inspection on 5 February 2019 and told the provider what actions they had to take. The fire service returned on 26 March 2019 to re-inspect.
At this inspection we found some improvements had been made. However, there was insufficient improvement in some areas and the provider continued to be in breach of regulations. The rating for the service is now Requires Improvement.
Why we inspected
This was a planned inspection based on the rating of the last inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk