Bentley House

Bentley House is a residential care home providing personal and nursing care to people aged 65 and over, some of who were living with dementia at the time of the inspection. The service can support up to 90 people. There were 60 people living at the home at the time of our inspection but only 48 were in receipt of accommodation and personal care.

Bentley House accommodates people across six floors in one purpose-built building. Each floor of the building has separate adapted facilities that accommodate people who require nursing, dementia and residential care.

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

Staff told us there were not enough staff deployed in the home to support people. People’s risk assessments were not always accurately completed. Incidents that suggested people may have been at risk of harm were investigated but safeguarding concerns were not reported as required. Prior to this inspection people had not received their medicine as the prescriber intended.

Further improvements were required to governance systems to ensure the concerns found during the inspection were identified as part of the home's own auditing systems. Staff told us they did not all feel valued by or engaged with the management of the service.

People felt safe living in Bentley House. Risk to people’s health and welfare were identified and staff knew how to support these needs safely. People said there were sufficient staff and were happy living in the home. Infection control procedures were followed and assured safe practices were followed with regards to social distancing and the use of PPE.

Staff told us there was enough training available to support them in their roles, with supervision sessions also held to discuss their work. People told us they received appropriate support to maintain good nutrition and hydration and the home had good links with other health care professionals.

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 received person centred care. People were supported kind and caring staff who they trusted. Staff promoted people's independence and respected their rights, privacy and dignity. Staff knew people well and respected their choices and culture.

People and their relatives were actively involved in the development of their support plans. These were personalised and reflective of how people wished to receive their care. People were supported to pursue hobbies and interests and supported to avoid social isolation.

People's views about the service were sought individually and through meetings and surveys. People and relatives told us the registered manager and provider were approachable and they were confident concerns would be addressed.

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 good [published 12/10/2017].

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

Previously when we carried out a comprehensive inspection at Bentley House we found that some areas in Safe and Well-led required improvements. We followed up these areas in a focused inspection on 14 December 2016 and found that the service was Good. At this inspection we found that they remained Good. This inspection was carried out on the 19 September 2017 by one inspector.

The home had a manager in post who was in the process of registering with the Care Quality Commission (CQC). 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 told us they were safe and staff met their needs in a safe way. Staff were aware of safeguarding processes and how to report any concerns to the manager or local safeguarding authorities. Staff were enthusiastic and knowledgeable about people`s needs, likes, dislikes and preferences.

People were supported by sufficient numbers of staff who responded to people when they required assistance. Staff were knowledgeable about risk management and how to mitigate risks to keep people safe.

People’s choices, likes, dislikes and preferences were well known to staff who delivered care and support in a personalised way.

The provider had a robust recruitment process in place which ensured that qualified and experienced staff were employed at the home. Staff received training and support and were aware of their responsibilities when providing care and support to people at the service.

People and their relatives where appropriate were involved in the development and the review of their care and support plans. Support plans were kept electronically and automatically updated when staff recorded on their handheld devices the support people received. People were supported to take decisions about their care and to be independent.

People were supported to have sufficient food and drinks. People had access to healthcare professionals such as their GP as and when required. People received appropriate support from staff to take their medicines safely.

The manager and the provider carried out a regular programme of audits to assess the quality of the service, and we saw that these were capable of identifying shortfalls which needed to be addressed. Where shortfalls were identified, records demonstrated that these were acted upon promptly.

We carried out an unannounced comprehensive inspection of this service on 18 July 2016 where two breaches of legal requirements were found. These were in relation to shortfalls in medicine management, incident management and record keeping. The provider wrote to us on 08 September 2016 to say what they would do to meet legal requirements in relation to the identified shortfalls.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the 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 Bentley House on our website at www.cqc.org.uk.

The registered manager had left their post since our previous inspection and the home was being managed on an interim basis by a member of the provider’s senior management team. The interim manager had submitted an application to register with CQC whilst a suitable candidate was recruited for the post. 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.

People felt safe living at Bentley House. Staff understood how to keep people safe and risks to people’s safety and well-being were identified and managed. The home was calm and people’s needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People’s medicines were managed safely.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

People’s records were kept up to date and reflected their current care needs. There was an open and respectful culture in the home and relatives and staff were comfortable to speak with the manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

Bentley House is registered to provide accommodation, nursing and personal care to a maximum of 90 people. At the time of the inspection 44 people were using the service.

This inspection took place on 18 July 2016. This inspection was carried out by two inspectors and an expert by experience. An expert by experience is a person who has experience of the type of services provided by Bentley House.

The home had a 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.

We previously inspected Bentley House on 18, 26 February 2016 and on 07 March 2016 where we found breaches of regulations 09,12,13,14,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009. This was because people were not supported by sufficient numbers of suitably trained and skilled staff, people's nutritional and care needs were not met or monitored and responded to safely, and where staff identified concerns management did not respond to keep people safe. We also found that people were not treated in a dignified manner, people's care records were out of date and staff were not aware of people's needs and governance systems were not robust to allow management to sufficiently review, monitor and respond to identified concerns. At this inspection we found the provider had made significant improvements in areas relating to safe care and treatment, staffing levels, supporting staff, treating people with dignity, and communicating with people and relatives. However we also found improvements were still required in ensuring the service was well led, and records relating to people's care were accurate.

People were supported by sufficient numbers of staff who responded to people when they required assistance. Staff we spoke with were knowledgeable in relation to keeping people safe from harm and reporting incidents to management, however these were not always investigated and responded to quickly. Staff we spoke with were aware of people’s current needs, and where people required equipment such as pressure equipment or mobility aids these were in place. People’s medicines were not managed safely throughout and we found an incident where one person had not received their medicines as prescribed.

Staff felt supported by the manager who enabled them to carry out their role effectively. Staff had received training relevant to their role which included providing training to agency staff members. People's nutritional needs were met and their food and fluid intake and weight were monitored. People were able to choose what they ate from a varied menu, and significant work had been undertaken by the catering team to improve people’s meals and monitor their nutrition. People had access to a range of health professionals and were referred when needed.

Staff spoke with people in a kind, patient and friendly way and respected peoples dignity. People felt listened to and told us they felt they could shape their own care to reflect their own personalised choices.

Improvements with communication meant that complaints and concerns were responded to, and staff and people or their relatives were provided a regular forum to raise their views. This was attended by management and senior management from the provider.

Governance systems in place and a lack of sufficient recording meant the home continued to be not well led. Audits, care records and monitoring of the home had not identified some of the concerns addressed at this inspection sufficiently to mitigate further risks to people’s welfare through a lack of management oversight. People were positive about the management team and told us significant improvements had been made with communication across the home from the management. The manager continued to fail to notify CQC of events they are required to report.

At this inspection on 18, 26 February 2016 and on 07 March 2016 we found breaches of regulations 09, 12,13,14,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009. Subsequent to our inspection the Provider and Registered Manager, voluntarily suspended the further admission of those people who had nursing needs to the service.

The home had a registered manager in post who had been registered since February 2016. 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 registered manager had not reviewed and responded appropriately to incidents or accidents to keep people safe from harm. Risk assessments had not always been developed to positively manage risks which meant that identified issues relating to people’s health and welfare had led to people experiencing harm. People’s medicines were not always stored safely and information was not always available to staff about how to manage medicines. People were supported by staff who had undergone a robust recruitment process to ensure they were of good character to provide care to people.

Staff felt supported by the manager who enabled them to carry out their role effectively. Staff had not all received training relevant to their role including those staff who were in a supervisory capacity. Some people’s nutritional needs were not met and their food and fluid intake and weight was not robustly monitored. Where these people ate very little or none at all, this did not prompt a review of their condition. This meant that these people suffered harm as a result of this. People were able to choose what they ate from a varied menu, however some people told us the food was not always satisfactory for them. People we spoke with told us they had access to a range of health professionals however records showed that people were not always referred when needed.

Staff spoke with people in a kind, patient and friendly way and respected peoples dignity. People did not receive a robust assessment of their care needs prior to arriving at Bentley House, and people told us that the original care plan promised at assessment was not provided. Communication within Bentley House meant that complaints and concerns were not always responded to, and staff and people or their relatives were not provided a regular forum to raise their views.

People did not receive high quality care that was well led and regularly monitored. People’s personal care records were not regularly reviewed, completed or updated when required, and people felt the manager was not as visible around the home as they should have been.