This unannounced inspection was conducted on 18 April 2017.

Benridge Care Home is situated in Southport close to the town centre. It is registered to provide personal care for up to 27 people who may have dementia. At the time of the inspection 25 people were living at Benridge. The service has bedrooms and shared areas over four floors. People with mobility difficulties were able to access the building by the use of stair-lifts. The service is owned by Benridge Care Homes Ltd.

A registered manager was 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.

At the inspection in November 2016 we found that the provider was in breach of regulation relating to person-centred care. This was because the care provided during the early morning was not meeting people’s need for social interaction and support and did not reflect personal preferences. In addition we made a recommendation regarding the safe deployment of staff in the early morning. As part of this inspection we observed the delivery of care in the early morning and throughout the day. We also spoke with staff and visiting relatives to gather their views.

We saw that people’s personal preferences were met through the provision of staff in accordance with their plans of care. Staff were able to explain what time people preferred to get up and how this could change depending on the previous night.

Another concern noted at the previous inspection was that one person was not offered a drink as outlined in their plan of care. At this inspection we observed staff offering hot and cold drinks to people as they waited to go into the dining room. They were also offered a drink with their breakfast. The service was no longer in breach of regulation with respect to person-centred care.

We saw that staff were deployed in sufficient numbers to monitor people’s safety. The visitors that we spoke with were generally positive about the numbers of staff and their deployment. We saw that staff were vigilant in monitoring safety and acted to protect people from harm.

The staff that we spoke with had completed training in adult safeguarding and knew what action to take if they suspected that a person was being abused or neglected. Each staff member told us that they would not hesitate to raise a concern and was able to explain how they could report outside of the service (whistleblow) if necessary.

Individual risk was appropriately assessed and recorded in care files. We saw examples of risk being regularly reviewed in conjunction with care plans and with the involvement of relatives and care staff. However, one plan of care contained contradictory and confusing guidance for staff.

We were provided with evidence that regular checks were completed on other aspects of the service with regards to their safety. For example, electrical condition, gas safety, hoists, water temperatures and fire safety equipment. Each check had been conducted by an external professional and was supported by an appropriate certificate.

Medicines were stored and administered safely. Where errors had been identified appropriate action had been taken to improve safety and practice.

Family members told us that they felt the staff were competent to deliver their relative’s care and staff spoke positively about the quality and frequency of training and supervision available to them. The records that we saw indicated that all training had been completed as required by the provider.

We saw that the service was operating in accordance with the principles of the MCA and that applications to deprive people of their liberty had been made to the local authority. Capacity assessments clearly indicated that the people living at Benrid

Benridge Residential Care Home is registered to provide personal care for up to 27 people who are living with dementia. The home is owned by Benridge Care Homes Ltd.

The service was last inspected in November 2014 and at that time was found to be meeting standards. The service was rated as 'Good' at this inspection.

There was 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 undertook an early morning focused inspection of the care home on 25 November 2016. This was in light of concerns raised with us about the current staffing levels, people living at the home being supported to get up early for the convenience of the staff and concerns around food hygiene standards.

When we arrived at the home, only two people were up and they appeared settled and comfortable. Staff were beginning to support other people down to the lounges. They were also undertaking care duties in accordance with people’s needs.

Our observations in one of the lounges over two set time frames and talking with staff showed minimal staff support and interaction early morning for people who were up and were sitting in the day areas. Staff we spoke with told us that people could vary in their needs at this time of morning but essentially people started waking up and needed support from 6am onwards. This period of time until 7.45 am when the day staff arrive for the shift hand over meant it was difficult to cover the day areas as staff were supporting people to get up and dressed. People were therefore left at this time with little social support or involvement and interaction.

We looked at three people’s care files. Two of the care files we saw did not contain information regarding the times both people preferred to get up and go to bed. One care file recorded the person preferred to ‘get up at 8am with a cup of tea. We saw this person was up from 7am and up until our last observation at 8.15am had not received a cup of tea.

We saw that the people sat in the lounge over this period did not interact spontaneously but when we engaged with them they became more alert and responded positively.

We saw that when more staff arrived at 8am there was still no staff allocated to the lounge areas to support people and provide a level of personal interaction and social support.

The care provided during the early morning was not meeting people’s need for social interaction and support and did not reflect personal preferences.

This is a breach of Regulation 9 (1) (a) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staffing rotas recorded the numbers of staff on duty to provide care and support to people living at the care home. The night staff consisted of two care staff, with a staff member providing one to one care for a person living at the home and a floating senior manager who was ‘on call’ over two homes within the organisation to cover for emergencies.

Staff told us they undertook some cleaning and kitchen duties however people’s care needs came first and that they did not have to complete them if they were busy supporting people during the night. We found the home to be very clean and staff had access to gloves and aprons to help ensure good standards of hygiene. We did not see any evidence of poor standards of hygiene when staff were undertaking care or kitchen duties.

Staffing levels were subject to review and we saw there was a willingness to provide staff flexibly.

Based on our findings we have made a recommendation about reviewing staffing over this early morning period so that sufficient staff are deployed to ensure people are monitored to help ensure their safety.

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We looked at care plans and other care records for three people who lived at Benridge and they all had an assessment of the person’s health and social needs completed. The care plans were up to date and reviewed on a monthly basis.

We looked at menus and food that was available to people who lived at Benridge. We found there was a good variety of meals available and people said the food was good.

We spoke with four people who used the service, two relatives, two visiting professionals and four staff members. People who used the service said: “The staff are nice”, “I like the food” and “The staff are kind.”

Relatives commented: “The staff are so kind and caring”, “The home has a lovely feeling” and “The staff are friendly and appear well trained.” They didn’t have any concerns or complaints about the home.

Visiting professionals said: “The staff know the client’s needs well”, “The home is clean”, “I am happy with the service”, “The home has improved over the last year. It looks much better” and “The staff are helpful.”

Staff commented: “We have regular meetings”, “The staff get on well together and are a nice team”, “I like being able to spend time with the residents”, “The staff pull together well” and “I like caring for the residents and knowing I can help them.” All the staff said they got good support from the management team and that the registered manager was always there to listen to staff and has a high standard.

We looked at the staff recruitment and selection. We discussed staff recruitment with the manager and they stated that recruitment could be a problem at times and that they spent a lot of time aiming to recruit good staff to support the people who lived at Benridge.

We undertook a tour of the home. We found it to be clean and free from unpleasant odours. We saw that the décor was good and the home had been well maintained.

We saw the complaints policy and procedure and noted that no complaints had been made since the last inspection. People who we spoke with said they had no complaints or concerns regarding the home.

Many of the people who lived at Benridge were not able to talk to us, so throughout the day we observed interactions between the people who used the service and staff and found there was a relaxed and friendly atmosphere between them.

People we spoke with, who expressed an opinion told us that they were able to make choices about meals, activities and daily living routines. The home took account of people’s ability in terms of decision making and worked closely with people, their families and external professionals.

People living in the home told us they were happy and well cared for. One person commented, ”I’ve no complaints. I am at ease here. I just do what I want.” We saw good interaction and communication between staff and people living in the home. The atmosphere was relaxed and staff were attentive to people’s needs.

We looked in detail at three care records and found they were organised and included detailed assessments of people’s individual needs. We saw a number of short term care plans in place to support temporary changes in people’s care needs for mobility, medication and pain relief.

The home reviewed people’s care every month and we saw that these reviews were up to date and signed. The records included a summary of when plans or assessments were amended and this provided a useful way of alerting staff to changes to people’s care needs.

The home had a system of annual appraisal, quarterly reviews, observations and supervision to monitor performance and support staff to carry out their work.

The home had accurate and up to date records related to the running of the home which assisted in maintaining a safe environment for people and staff to live and work in.

We spoke with four people who live in the home and observed part of the lunchtime medicines round.

Nobody raised any direct concerns about the way their medicines were handled.

On the day of the site visit people who live in the home were spoken with. Feedback was limited due to the level of people’s communication due to their condition, however we were able to make general observations of people’s wellbeing as evidence of inclusion.

People spoken with generally confirmed that they felt like they were encouraged to express their views openly. They said staff were friendly and always on hand to talk to. One person said. ‘’Staff are lovely and there’s always plenty to do.’’

People spoken with expressed the view that they felt like they were treated with respect and dignity. They said that their wishes were listened to.

We made some observations of the support given to people in the main day areas. We saw this was positive and people were well supported.

Those people we spoke with said that staff supported them well. We saw there was good communication when staff carried out the delivery of care.

People looked clean and were dressed in clothing of their choice showing that staff paid good attention to standards around personal hygiene.

We spoke with one person who said ‘The staff look after me very well. They are very kind’. We spoke with a professional visitor who said that staff worked well with them and reported any changes in people's care needs very quickly. This shows that the home is responsive to people’s care needs.

People, when asked, said that they felt ‘safe’ and they felt any concerns would be listened to and addressed. Those we spoke with who expressed an opinion had no concerns with the general running of the home.

An unannounced inspection took place on 5 and 6 November 2014.

Benridge Residential Care Home provides accommodation and personal care for up to 27 people who need support with personal care and who are living with dementia. The home is a large converted property providing accommodation over four levels. Nursing care is provided by the local district nurse team when needed. The care home is situated close to close amenities provided by the town. At the time of our inspection 22 people were living there.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law. 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 found there was a relaxed and friendly atmosphere and staff support was given in a kind, respectful and gentle manner. We observed positive and warm interactions between people living at the home and staff throughout the inspection.

People living at the home were kept safe from abuse because the staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported. Relatives told us they thought the home was safe.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. People and their families told us there was generally sufficient numbers of staff on duty at all times.

Family members told the home communicated well with them and they were kept informed of any changes regarding their relative’s care and support. People were able to see their families and friends when they wanted. There were no restrictions regarding the times when people could visit.

People were supported by external care professionals to maintain their optimum health and referrals were made at the appropriate time. A number of external care professionals were visiting during our inspection and the information from the visits was shared with the staff team.

People and family members told us the staff were polite, caring and respectful. Staff had a good knowledge of people’s care needs, wishes and preferences. We observed staff assisting people in accordance with individual need and we saw the staff positively engaging with the people they supported. Some people displayed behaviours that were challenging and unpredictable. We observed the staff supporting them to ensure their safety and wellbeing. This support was provided in a respectful manner. Family members told us they felt the home was safe.

Care records we looked at showed a range of risks assessments and plan of care to support people depending on their individual needs. It was recognised that the development of documentation around pain management and also more detailed recording of behaviours needed to be addressed.

The menu provided a good choice of hot and cold foods at different times of the day. People told us they liked the food and we saw staff offering alternative choices. Snacks and drinks were available throughout the day and special diets were catered for.

At the time of our visit sufficient numbers of staff were available to support people. Staff were skilled and trained to provide care to people at the home. A training programme was in place which included dementia awareness. Staff told us they were supported through induction, team meetings, supervision and appraisal. There was a high percentage of staff with formal qualifications in care which evidenced a good knowledge base for their role. Staff told us they had access to a good training programme.

Medicines were safely administered to people and were monitored and reviewed. Input was provided by a community pharmacist to ensure medicines were reconciled and reviewed appropriately.

The principles of the Mental Capacity Act (2005) (MCA) were adhered to for people who lacked mental capacity to make their own decisions. We saw examples where care and treatment had been carried out in people’s best interest and this had included assessment of the person’s mental capacity. Deprivation of Liberty Safeguarding (DoLS) authorisations had been applied for around restrictions that were currently in place to keep people safe. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the manager and senior staff knowledgeable regarding the process involved.

Audits and checks of the environment were undertaken to ensure it was safe and well maintained. On-going work was evident with regard to upgrading the fire prevention system in the home. As part of ensuring fire safety, we saw Personal Emergency Evacuation Plans (PEEPs) were not in place for people at the home. The home are currently working with the local fire authority regarding the implementation of these under the Regulatory Reform [Fire Safety] Order 2005 and its relevant legislation. This will help fire evacuation to optimise the safety of people living at the home. Following the inspection the manager informed us PEEPS had been implemented.

Consideration had been given to ensure the environment promoted people’s safety and independence. Contrasting colours were evident and pictorial signs to help orientation, as well as a clutter free environment and sensor and pressure mats in people’s rooms. We found the home to be clean and tidy.

The culture within the service was person-centred and open. This meant people’s care and support was planned individually to meet their needs. A process was in place for managing complaints and the quality of care was monitored to ensure it was safe and in accordance with ‘best practice’.

People who lived at the home and their family members were able to give feedback about the home through meetings and day to day discussions.

A service user guide provided information about the service and the manager informed us this was reviewed and updated as required. The manager continues to send statutory notifications to us to identify key events in the home. We were aware that there were people in the home who were subject to Deprivation of Liberty Authorisations from the local authority. We had been notified of these.