Bentley Lodge Care Home

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

People told us there had been improvements and changes in the service. They liked the new manager and said, “The staff are happy, it makes it jolly” and “We always have a laugh.” They told us staff were kind, gentle and caring.

People and their relatives told us they were safe in the care of staff. Processes and practices were in place to safeguard people from the risk of abuse and staff understood the need to report any concerns. Risks to people had been assessed and their safety managed. Measures had been taken to ensure the environment and equipment were maintained and in full working order. It will take further time to fully complete all of the provider’s planned actions in response to their new fire risk assessment, completed following the last inspection.

The provider employed sufficient staff in all roles to meet people’s needs and support them safely. Staff had been re-trained since the last inspection to ensure they had the required knowledge and skills. The manager had recruited new staff with sufficient verbal fluency in English and provided support to those staff who needed to further develop these skills. The provider’s pre-employment checks were not fully robust during the period of the home’s COVID-19 outbreak and we have recommended the provider reviews the guidance on staff recruitment during the pandemic.

People’s medicines were managed safely. We identified two issues regards medicines recording which were brought to the manager’s attention and addressed. Processes were in place to protect people from the risk of acquiring an infection. A relative confirmed, “The home is always very clean.”

Staff treated people with kindness and compassion. They had sufficient time to spend with people as they provided their care. Staff involved people in decisions about their day to day care. People’s privacy, dignity and independence were upheld during the provision of their care.

People and their relatives told us there had been improvements in the management of the service. A relative said, “The manager is professional, and his communication is much better.” Quality assurance arrangements were consistent and effective at driving improvements within the service. The manager had led positive improvements in the culture of the service for people. Processes were in place to seek people’s feedback on the service. The manager worked openly with statutory services in the provision of people’s care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 January 2021) and there were six breaches of regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 26 November 2020, breaches of legal requirements were found. Two Warning Notices were issued in relation to safe care and treatment and good governance. The provider completed an action plan to show what they would do and by when to improve person centred care, dignity, safeguarding and staffing.

We undertook this focused inspection to check they had met the requirements of the two Warning Notices and to confirm they met legal requirements for the other four breaches of legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Caring and Well-led which contain these 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 requires improvement to good. 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 Lodge Care Home on our website at www.cqc.org.uk.

In January 2021, the home had an outbreak of COVID-19. 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 COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bentley Lodge Care Home is a nursing home providing personal and nursing care to 51 people aged 65 and over at the time of the inspection. The service can support up to 56 people. The service supports older people who may have a physical disability, sensory impairment or who are living with dementia. People are accommodated either within the main building or in the new purpose built extension.

Since 12 October 2020 ten rooms within the home were contracted as ‘Discharge to Assess’ beds. These beds were for people discharged from hospital, as they no longer required an acute bed, but who required a period of up to six weeks assessment or rehabilitation. People referred could be living with dementia or have complex health needs. The discharge to assess beds were all located on the same ground floor corridor in the main building. Each of these bedrooms had an ensuite bathroom and there was a communal shower room on the same corridor.

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

People and their relatives told us overall, their physical needs were met, and they liked the staff who were kind. However, they also said people’s emotional and welfare needs had not been met. A relative said, “Staff do what they have to do and then go – there is no chit chat” and that social interaction was “virtually nil.”

Processes, systems and staff practices to protect people from the risk of acquiring an infection were not adequate. This placed people at risk of acquiring an infection. There had been a failure to ensure the environment and equipment provided for people were always safe and properly maintained. The provider had failed to mitigate some identified risks to people. This placed people at risk of harm.

Staff did not have sufficient time to provide compassionate care. There was a focus on the provision of practical care tasks for people, but not enough focus on their welfare and sense of well-being. People had not been adequately supported to maintain relationships with their loved ones or their independence. People's emotional needs had not been met. People were not always involved in decisions about their care and their preferences were not always respected.

People accommodated in the ‘discharge to assess’ beds had been subjected to unnecessary restrictions on their movement once their 14 day self-isolation period had ended. People’s medicines were not always managed safely. This placed people at potential risk of harm, from not receiving their medicines correctly. There had been a failure to provide enough suitable staff. This placed people at risk of not receiving their care in a timely manner.

There was evidence safety and safeguarding incidents were investigated when things went wrong. However, actions taken to improve people’s safety were not fully effective.

Management responsibilities were not clear, there was not sufficient oversight and risks to people had not always been assessed or acted upon. Processes to learn and improve were not robust. The culture during the pandemic had not been person-centred, open, inclusive or empowering and had not achieved good outcomes for people. The provider had sought relatives’ views on the service, but it was not clear what actions had been taken in response to their feedback.

Links with the local community had been maintained during the pandemic. The service worked in partnership with other agencies.

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

Rating at last inspection

The last rating for this service was good (published 15 December 2017).

Why we inspected

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.

We had received concerns in relation to people’s safety, staffing and support for the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led. During the inspection we identified further concerns in relation to the key question of caring, so we included this key question within the inspection.

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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, caring and well-led sections of this report.

Since the site visit, the manager has reacted positively and started to take the actions required to address the issues identified.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing, dignity, person-centred care and good governance at this inspection. Two warning notices were served on the provider in relation to the breaches of safe care and treatment and good governance.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The service had a registered manager. A registered manager is a person who has registered with the 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.

People were safeguarded from the risk of abuse; staff understood both their role and duty to protect people and had access to relevant guidance. Staff recognised people’s rights to take risks, where they had the capacity to make these decisions. Risks to people were assessed, identified and managed safely. Staffing levels were based upon an assessment of peoples’ needs. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider. Processes were in place to ensure people received their medicines safely as prescribed from trained staff. The service was clean and staff had undergone relevant training to enable them to understand how to protect people from the risk of infection. The clinical lead investigated and reviewed incidents to ensure any relevant learning took place for people’s future safety.

People’s needs were assessed prior to their admission and their care was based upon best practice guidance to achieve effective outcomes for them. Staff told us they felt well supported within their role and staff that were new to care underwent an induction to their role. Staff at all levels were encouraged to undertake professional development to further enhance their knowledge and skills and ensure people received effective care. Staff understood the importance of ensuring people received sufficient food and hydration that met their individual needs and this was provided. Records demonstrated that when people moved between services, staff ensured they had access to relevant information to enable them to provide the person’s care effectively. People were supported to access a range of healthcare professionals in order to promote their welfare. The registered manager had instigated a project to promote sound oral health care for people, in order to improve their dental health. The physical environment provided met people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People, their relatives and representatives told us the service was caring. Staff were observed to care for people in a kindly and compassionate manner. Staff understood, listened to and acted upon people’s preferences about their care. Staff ensured people’s privacy and dignity was upheld during the provision of their care.

People, where they could express their views, or relevant others, were consulted about their care. They had individualised care plans that reflected their needs and which were understood by staff. People were provided with a range of opportunities for social stimulation. Processes were in place to ensure people were informed of how to make a formal complaint. Any feedback received was investigated to ensure any required improvements in the quality of the care provided were made for people. People were appropriately supported with their end of life care. People’s own needs in relation to bereavement had been recognised, acknowledged and met.

The provider had a stated purpose, aims and objectives for the service underpinned by clearly defined values which staff were observed to apply in their work with people. There was an open and self-scrutinising culture, which enabled staff to drive improvements for people. Processes were in place to ensure staff understood their responsibilities and legal requirements were understood and met. People’s views were sought and acted upon to improve their experience of the service. Changes to the service had been made at peoples’ preferred pace. People had benefited from the links that had been forged with the local community. Processes were in place to enable staff to continuously evaluate the quality of the service provided. Health and social care professionals told us there were good, strong working relationships with the service.