Bentinck Crescent

Bentinck Crescent is a small residential care home which can support a maximum of 7 people. The home provides care and support to people with physical disabilities, people with a learning disability and autistic people. At the time of the inspection 7 people were living at the home.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Best interest decisions and mental capacity assessments were not in place for all decisions made. DoLS were not up to date for all people living at Bentinck Crescent.

Although people had aspirations recorded in care documentation, they were not always supported to achieve these.

Medicines were not always managed safely. We could not be assured people received their medicines with sufficient time between doses. Some people did not have appropriate paperwork in place for ‘as required’ medicines.

Staff did support people to make decisions about their care, and people, relatives and healthcare professionals were involved in care decisions.

Right Care

Risks to people had been assessed and mitigated in most cases. However, the service had not taken action to mitigate risks around fire evacuations in a timely manner.

People were supported by enough staff to meet their needs. Staff were trained to support people. However, some staff had not received specialist training to meet people’s individual needs.

People and their relatives were happy with the care people received. People felt safe and that staff were kind. Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse.

Right Culture

The culture of the service was not always person-centred. Some aspects of the service, such as the times of shifts, were not considered with people’s needs in mind.

Quality assurance and monitoring systems were in place. However, these were not always effective. At the time of the inspection some improvements were being made but were not yet embedded.

Staff said the interim manager was supportive. Relatives thought the service was friendly, people enjoyed living there, although needed more activities.

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 22 September 2022).

Why we inspected

We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bentinck Crescent on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management, mitigating risks, person-centred care and consent to care at this inspection. We have also made a recommendation in relation to staffing.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Bentinck Crescent is a residential care home providing personal care for up to seven people. At the time of the inspection seven people were accommodated at the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independent and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were supported in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

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.

Incidents and concerns were investigated, and lessons learned. Medicines were administered by trained staff however we found some gaps in recording which had not been addressed by the governance and audit system. We have made recommendations about medicines recording and medicines audits.

Right Care:

There were enough appropriately skilled staff to meet people’s needs and keep them safe. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture:

People were supported by staff who understood the range of strengths, needs and sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff said the registered manager was approachable, supportive and managed the home well.

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 30 April 2020).

At our last inspection we recommended the provider reviewed records relating to health and safety to ensure they were fully available and monitored. At this inspection we found the provider had acted on the recommendation and health and safety records were readily available and monitored.

Why we inspected

We received concerns in relation to the culture and management of the service including the provision of appropriate care and support related to safeguarding, medicines, PPE, the availability of on call support and low staff morale. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. The provider had taken action to mitigate risks however, we have made recommendations in relation to the safe management of medicines and governance procedures.

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.

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

The overall rating for the service has remained good based on the findings of this inspection.

Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bentinck Crescent on our website at www.cqc.org.uk.

Recommendations

We have made recommendations in the safe and well-led key questions. Please see these sections for further details.

Follow up

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

Bentinck Crescent is registered to provide accommodation and personal care to a maximum of seven

people. Care is provided to people who have learning disabilities, including some people who have a physical disability. There were seven people living at the home at the time of the inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was registered to provide accommodation, care and support for up to seven people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people, was mitigated by the building design which fitted in well within the residential area where it was located. In addition, staff did not wear anything that suggested they were care staff when coming and going with people.

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

Everyone we spoke with and contacted were positive about the home and the care and support provided. A health and social care professional told us, “The service seems settled and reliable and when I visited, the staff were upbeat and seemed to know the clients well. I have no concerns about the service.” A relative said, “I don’t think she could be in a finer home.”

There were systems in place to protect people from the risk of abuse. People appeared relaxed and comfortable with staff. A relative told us, “[Name of person] refers it to her as home, it means she is comfortable. The staff are all very attentive.”

There were enough staff deployed to meet people’s needs. Safe recruitment procedures were followed.

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 had a choice and access to sufficient food and drink. People were supported to have access to a range of healthcare professionals to help ensure they remained healthy.

People were treated with kindness. A relative told us, “ They are caring, I see staff sitting with [name of person] giving her a cuddle and a hug.” Staff respected people’s privacy and dignity and promoted their independence.

People's care was developed around their wishes, preferences and goals. A health professional told us, “Staff focus has always had [name of person] at the centre to ensure their safety and well-being is maintained.”

People’s social needs were met. People were supported to continue their hobbies and interests both within and outside of the home.

A range of audits and checks were carried out to monitor the quality and safety of the service. Information relating to certain health and safety checks and remedial work were not always easy to locate or fully available. We have made a recommendation that the provider reviews the maintenance of records relating to health and safety, to ensure these are fully available and monitored.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 19 July 2017).

Why we inspected

This was a planned inspection based on our inspection programme.

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.

At the last inspection in February 2015 we had rated the service as 'Good'. At this inspection we found the service remained 'Good' and met each of the fundamental standards we inspected.

Due to their health conditions and complex needs not all of the people who used the service were able to share their views about the support they received.

People appeared safe and comfortable with the staff who supported them. There was a relaxed and friendly atmosphere around the home. There were sufficient staff to provide safe and individual care to people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

The staff team knew people well and provided support discreetly and with compassion. People’s privacy was respected and people were supported to maintain contact with relatives. Staff had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves.

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 support this practice. Care plans were in place detailing how people wished to be supported. Information was made available in a format that helped people to understand if they did not read. This included a complaints procedure. Complaints were taken seriously and records maintained of the action taken by the service in response to any form of dissatisfaction or concern.

People had access to health care professionals to make sure they received appropriate care and treatment. Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way. People received a varied and balanced diet to meet their nutritional needs.

People were provided with opportunities to follow their interests and hobbies and they were introduced to new activities. They were supported to contribute and to be part of the local community. They had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. People had access to an advocate if required. Staff said the management team were approachable. Appropriate training was provided and staff were supervised and supported.

Further information is in the detailed findings below.

We found that people were provided with a choice of food which was suitable and nutritious to meet their needs.

Appropriate arrangements were in place to ensure the premises were well maintained to provide people with a pleasant and suitable place to live.

An effective recruitment procedure was in place to help ensure people were cared for by staff who were qualified and trained to meet their needs.

We found that records contained accurate and appropriate information. People's care records were held securely in an office but were easily accessible for reference.

Six people who lived at the home were there on the day we visited. We saw they were relaxed and engaged well with staff. People had detailed care plans covering a range of care aspects. These plans were signed by the person's next of kin, indicating they agreed to the care being given to their relatives.

We found people's needs were assessed and care was planned and delivered in line with their individual plan. We saw people looked well cared for and were wearing clean clothes. One staff member told us, "It is our job to try and make the best life possible for people."

We noted signatures were in place to indicate medicines had been given with no gaps in the records. Plans were in place to deal with medicines taken occasionally or 'as necessary' and for homely medicines. We saw staff had completed a medicine administration course and copies of certificates confirmed this.

Staff told us they felt there were enough staff on duty. We examined the staff rota and confirmed there were usually three or four staff on duty. We established there was a mix of care workers and senior staff across the week. This meant there was a range of suitably experienced staff available to offer support.

The home had a written complaints procedure with a process to follow in the event of a complaint. We noted no complaints had been received by the home recently.