St Bennett’s is a 'care home'. People in care homes receive accommodation and

personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

St Bennett’s accommodates up to 24 people in one adapted building. At the time of this inspection, 17 people were using the service.

At our last inspection in January 2016, we rated the service 'Good'. At this inspection, we found the evidence continued to support the rating of 'Good.'

This inspection report is written in shorter format because our overall rating of the service has not changed since our last inspection.

People and relatives felt safe with the staff providing their care and support. Staff were aware of their responsibilities for keeping people safe from abuse and avoidable harm.

The registered manager understood their responsibilities to keep people safe and was aware to notify the local safeguarding authority and Care Quality Commission (CQC) of safeguarding concerns and carry out investigations as required, although the safeguarding procedure was not clear that all suspicions of abuse needed to be reported.

People felt safe in the service.

Staffing arrangements met the individual dependency needs of people currently using the service.

Staff had the appropriate skills, competency and knowledge to meet people's individual needs. Health and safety training followed current relevant national guidance to prevention and control of infection.

On-going support and one to one supervision was provided for staff to reflect on their practice.

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People received their medicines safely and staff supported people to access support from healthcare professionals when required, to ensure people continued to receive coordinated care and support.

The registered manager and staff understood the Mental Capacity Act, 2005 (MCA) legislation and followed this in practice.

The environment was clean, and repairs and refurbishment works had been and were taking place to the building. Routine safety checks were carried out on the fire, water, gas and electrical systems.

Risk assessments to manage assessed risk to people’s safety were not always comprehensively in place.

Staff recruitment procedures were in place to ensure that appropriate pre-employment checks were carried out to assure staff were suitable to work at the service, although these needed to be strengthened to ensure all known risks were fully explored.

People were involved in planning their on-going care. People told us they liked the staff and got on well with them. We saw many examples of staff working with people in a friendly and caring way. People and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and covered their health and social care needs. Activities were organised to provide stimulation for people and they had opportunities to take part in activities in the community if they chose.

People and their relatives told us they would tell staff if they had any concerns and were confident these would be followed up.

People, staff and representatives were satisfied with how the home was run by the registered manager. Management carried out audits and checks to ensure the home was running properly to meet people's needs, though not all essential issues had been comprehensively audited.

This inspection took place on the 30 October 2014 and was unannounced.

St Bennett’s Care Home provides residential care for up to 27 older people, some of whom are living with dementia, learning disabilities, and sensory impairments. On the day of the inspection 24 people were living at the home.

The home is situated in a large detached property on the London Road in Leicester. The accommodation is on three floors with a passenger lift for access. The home has a range of lounge areas, a dining room, and secluded gardens at the back of the property.

At the last inspection on 2 September 2013, we asked the provider to take action to make improvements. We issued compliance actions to improve how people’s consent was obtained and how medicines and complaints were managed. At this inspection we found the provider had made improvements in relation to the management of medicines and complaints.

At the time of the inspection we found that one of the two registered managers had resigned their position but had not applied to have their registration cancelled with the CQC. We will liaise with the provider to resolve this. 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 told us they felt safe in the home but thought it was short-staffed. We found there were not enough staff on duty to meet people’s needs safely and promptly and this had had a negative impact on people’s care. There were gaps in people’s records so we could not determine whether people were getting the support they needed.

We found the provider did not have effective arrangements in place to assess whether people could make decisions about the care and treatment they received. Staff were not following the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and did not demonstrate an understanding of people’s rights in relation to their care and support.

People told us they could choose from different dishes at mealtimes. People who needed assistance with their meals had to wait for this. Some people did not receive adequate support with their nutrition and hydration.

Relationships between staff and the people who used the service were good. People told us the staff were kind, caring and helpful. People were encouraged to make choices about their lifestyles.

Staff maintained people’s privacy and treated them with dignity and respect.

Some people told us they were bored living at the home. When we spoke to people we found they had hobbies and interests, things they’d like to do, and fascinating life stories. However their plans of care made little reference to this and did not give consideration to their social or emotional needs, or any reference to them having the opportunity to take part in meaningful activities.

Due to insufficient records we were unable to confirm that care had always been carried out as planned. One person’s plan of care and risk assessment was not fit for purpose. In some daily records there was insufficient recording to confirm care had been carried out as set out in people’s plans of care.

The registered manager had made improvements to the provider’s complaints procedure and all complaints received had been investigated and the complainant made aware of the outcome.

The registered manager was helpful and approachable and knew the people who used the service and their relatives well. ‘Residents meetings’ were held every three months to give the people who used the service and their relatives an opportunity to share their views on the home.

Staff told us they received regular support and advice from the registered manager and felt she was available if they had any concerns. However some staff told us morale in the home was low due to inadequate staffing levels and problems with the environment.

Some areas of the premises were not suitable for people living with dementia. For example highly-patterned and multi-coloured carpets and wallpapers had been used in parts of the home. This style of décor is not considered suitable for people living with dementia as it has been shown to cause this service user group difficulty in orientation.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with four people using the service and four relatives visiting their family members. We also spoke to five members of staff and three visiting healthcare professionals.

We found the provider had policies and procedures in place relating to people who did not have the capacity to consent. However, it was not clear if these had been followed.

We found people experienced care and support that met their needs and protected their rights. One person told us “the staff look after me well and do a good job. The food is nice.” Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines. The number of controlled drugs in the controlled drugs cupboard did not match with the number recorded in the controlled drugs register.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found the provider had a complaints policy in place. However, the service did not keep an accurate log of complaints received. We found it was difficult to assess if complaints had been dealt with appropriately.

We were able to speak to a limited number of people using the service. However, the people we were able to speak with indicated they were content with how they were cared for in the home. We sat in the main lounge areas for a number of hours and observed that people were being cared for in a variety of ways that met their differing needs. We observed positive interactions between people and care staff. One of the people living in the home was very excited as the staff had shown him the diamond jubilee hats and flags they had just bought for the residents. People at the home were due to attend a party in the community on the next day. The lounge was also decorated to reflect this special occasion.

We were told that a range of activities took place on a regular basis at the home. These included; bingo, catch, skittles, story-telling, painting and chair aerobics. The home had recently introduced 'singing for the brain', this included bringing in a variety of instruments which staff and people in the home would play and sing together. People reported it to be great fun.

The operations manager for the home also provided a quality assurance report (based on surveys of people living in the home, visitors, external professionals and staff) , dated 2012. This included a review of responses from all of the above, including specific comments. Overall the great majority of responses were very positive. Some of the comments from people living in the home included:

"The lounges look much better after the decoration", "The lady who cleans my room is very good", "I'm so pleased with the activities, especially the story-telling".

Some of the comments from visitors included:

"We are very happy with the home and the care", "Furniture and on-going decorating seems to be done".

An action plan was in place to ensure improvements were made based on some of the comments made.

We asked people if they were happy with their environment. They told us they were. Their comments included . “I like my room it’s very nice.” And “It's alright here, everything’s pleasant. I can’t find any faults.”

People told us that suitable staff were employed. One said “The staff are alright. They treat you right and they are all kind to you. They always ask you if you are alright.”

People told us that they were satisfied with the level of cleanliness at the home. They told us they received the medicines they needed. One person said "They’re very careful with the medicines; they make sure it’s right what we’re having."

People also said that the staff were suitable. Comments included "I'm very well cared for" and "If I want something doing, I just have to ask and they do it straight away."

People we spoke to were satisfied with their environment although delays in getting some areas redecorated compromised people's dignity. People were able to have a say in the running of the service but were not always aware of this.

People were more involved in consenting to the care that was being provided at the home and they were better protected against the risk of abuse.

The environment was generally cleaner, this meant that people lived in a more dignified environment and were better protected against the risk of infection. We saw that the monitoring of hygiene and medication use within the service did not offer people the same level of protection.

People benefitted from safer equipment and major risks to their safety within the environment had been reduced. Care workers were also more equipped to fulfill their duties. People who used the service told us that the care workers had the right skills to do their job. One said “they are always willing to help here”. We observed staff anticipating people’s needs well and treating people as individuals.

The overall management of the service at both local and provider level had not ensured that people were protected from avoidable risks in their environment, and through recruitment of staff.

People were able to have enough privacy at the home and were able to make choices within their daily lives.

People did not always record their consent to treatments but told us they were involved in making decisions. ”. One person who used the service said “no-one has said anything to me about that (care plan) but I’m not that interested in plans. Everyone talks to me”. Another told us “no, I don’t see the records, there’s no need, they look after me alright”.

People’s care needs were being recorded using a better record keeping system. This meant that staff knew where to find information easily. People who used the service told us they received visits from the GP. One said “I’ve had the doctor come in twice, or three times”. We saw that charts were used to record the personal care that people received during the night. We also saw that staff completed charts to show when they had undertaken personal care with people. All the people that we saw had been assisted to maintain good personal hygiene and were dressed in a dignified way.

People told us that they enjoyed the food; one said “the food is terrific”. Another told us “I’ve enjoyed every meal I’ve had here”. We saw that there were plenty of staff around assisting people to eat their lunch and have drinks. This was done in an unhurried way.

Care files showed that staff were working with GP’s, dentists and opticians to ensure people received services form other professionals in the community.

People told us that they felt safe living at the home. One relative told us “if I didn’t think he was being treated right I would let you know”. We found that staff did not all have the necessary training to keep people safe and were not always reporting incidents to the relevant authorities.

The cleanliness of the home did not ensure that people were protected from the risk of infection.

The management of medicines did not always ensure that people received their tablets, or that people who self-medicated were properly assessed.

The environment was not being safely maintained and did not promote fully the dignity of people living there. There was plenty of equipment available to support people to live as independently as possible such as walking aids and wheelchairs.

There were some gaps found in recruitment procedures. This meant that people were not fully protected from unsuitable workers. People told us that there were enough staff to meet their needs. One told us “I don’t think it could be better; they are there if you need it”. Another said “there is always someone around. They don’t keep you waiting long if you want something doing”.

The new manager had made improvements in the amount of training that staff received but there were still some gaps in essential training. Staff files showed that they had received ongoing supervision and appraisal.

Lack of quality assurance systems in the service had meant that people were exposed to preventable risks.

People told us that they were happy with the system for raising concerns and knew who to speak to. Comments included “all complaints go to the office”; “the manager will always talk to me even if they are doing something. I’ve never been told to come again another time” and “I would speak to the one in charge if I had a complaint. They would sort it out.”