About the service: Bebington Care Home is a purpose-built care home providing residential and nursing care for up to 87 people with varying needs. These include specialist nursing support, respite care, end of life and general assistance with everyday living for people living with dementia. At the time of inspection 74 people were living in the home.

People’s experience of using this service: The quality of care had deteriorated since the last inspection. The provider and manager had not assessed and managed risk, which placed people at risk of harm. People’s emergency evacuation plans had not improved and there were continuing issues with people not having access to their call bells.

There was an insufficient number of permanent staff to meet people's needs and a high use of agency staff. Staff had not been appropriately inducted into the home and the issues we identified during the inspection made us question the effectiveness of staff training.

There were concerns with staff practices regarding monitoring of people’s health and not acting on identified concerns. Medicines had not been managed safely.

Complaints were inadequately managed and accidents and incidents were not adequately reported by staff. People had assessments and plans regarding their care and support needs. However, the care plans lacked important information and were not always kept up-to-date. Quality assurance processes were inadequate.

The service was not well-led and there was a lack of effective governance and oversight by the provider and manager. Records were not always accurate and up to date.

Rating at last inspection: At the last inspection the service was rated requires improvement (January 2018)

Why we inspected: This inspection brought forward due to information of concern from the local authority.

Enforcement: The service met the characteristics of Inadequate in four key questions of safe, effective, responsive and well-led and Requires Improvement in caring. We are taking enforcement action and will report on this when it is completed.

Follow up: Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for Bebington Care Home is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider following this report being published to discuss how they will make change

This comprehensive inspection took place on 24 and 26 January 2018 and was unannounced.

At our last inspection in December 2016 we found breaches of Regulation 12 and 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 where we had seen some people were not able to access emergency call bells in their bedrooms, documentation regarding nutrition had not been completed, checks had not been fully completed, staff needed additional training regarding pressure area care and people's privacy was not always respected. During this inspection we saw that improvements had been made and that two domains had improved to a rating of Good. However, we found that other areas needed improvement.

Bebington Care Home is a purpose built care home providing residential and nursing care for up to 87 people with varying needs. These include specialist nursing support, respite care, end of life and general assistance with everyday living for people with dementia. Bebington Care Home is a ‘care home’. People in care homes receive accommodation and nursing or 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.

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. The home had a registered manager in place.

At this inspection we found breaches of Regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider and manager had not taken the appropriate action to provide care in a safe way for people who lived in the home and had not ensured that an up-to-date plan of care was maintained for people living in the home. You can see what action we told the provider to take at the back of the full version of this report.

People received support with their health care. However, care plans and risk assessments did not always reflect the need of the person. Monitoring documentation was not always appropriately stored, this meant that a full picture of a person’s care would not always be available.

Emergency evacuation plans for people had not been updated, in some cases for over a year. This meant that people would not have been able to be safely evacuated by emergency services. This was acted on by the second day of inspection. However, these documents need to be regularly reviewed to ensure the ongoing safety of people living in the home. Documentation about covert medication showed that the proper processes were not always followed before people were given medication without their knowledge.

The home had quality assurance processes in place including audits and quality questionnaires. However, the issues we found during the inspection showed that some of the audits that had been completed were not always effective to ensure the quality of the service.

People we spoke with told us they felt safe at the home and they had no worries or concerns. People’s relatives and friends also told us they felt people were safe. The staff at the home knew the people they were supporting and the care they needed. We observed staff to be kind and respectful towards people. The home provided a range of activities to occupy and interest people.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The provider told us the majority of people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care.

People we spoke to were happy with the food being provided and we saw that people had a choice of nutritious me

This inspection was carried out on 12 and 13 December 2016, the first day of the inspection was unannounced. Bebington Care Home is a purpose built care home with four units providing residential and nursing care for up to 87 people with varying needs. These include specialist nursing support, respite care, end of life care and general assistance with every day living for people with dementia. At the time of inspection the were 79 people living at the home.

The home has a registered manager. 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. The registered manager, regional manager and deputy manager were in attendance at the time of the inspection.

People we spoke with told us they felt safe at the home and people’s relatives also told us they felt people were safe. During our visit, however we identified concerns with the service.

We found breaches of Regulation 12 and 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We saw that some people at the home could not access emergency call bells in their bedrooms for various reasons, documentation regarding nutrition, checks had not been fully completed, staff needed additional training regarding pressure area care and people’s privacy was not always respected.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been followed. The provider told us that DoLS applications had been submitted to the Local Authority for some people

All medication records were completed legibly and properly signed for. All staff giving out medication had been trained in medication administration and all medicines were stored safely.

We saw that infection control standards in the home were monitored and managed appropriately.

Staff were recruited safely and the majority of staff had been supervised and appraised. The registered nurses had the appropriate checks regarding their registration with the Nursing and Midwifery Council.

The provider had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults.

We considered all of the evidence we have gathered under the outcomes we had inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

On the day of our inspection we found the environment to be clean and fresh.

We found that protective equipment to minimise the risk of infection was available and staff had easy access to aprons, gloves and hand gels.

We saw enough staff on duty to meet the needs of the people who lived at the home.

We looked at the care records of seven people who lived at the home. We found that each care record contained assessment and support plan information that identified people's individual needs and risks in the delivery of care. Support plans gave clear information to staff on the care required by each person and these plans were regularly reviewed to ensure safe and appropriate care was provided.

One relative commented that they felt reassured their relative was safe when they left to go home.

Is the service effective?

People appeared calm and well cared for throughout the day. They told us that they were happy with the care and that their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew individuals well.

We saw training records which identified that staff received training relevant to the needs of the people who lived in the home.

Is the service caring?

We spent time in all areas of the home where we observed staff caring for people with dignity and respect. People living at the home appeared settled and well cared for. Nobody raised any issues of concern with us.

All the relatives we spoke with who were visiting the home told us they were happy with the care of their loved ones.

Is the service responsive?

People's needs were assessed before they moved into the home and records confirmed their preferences, interests and health needs which were recorded. We saw information recorded on 'Connecting with your community' booklets which informed readers of the person's life prior to moving to the home and gave staff the insight in supporting people compassionately.

We saw that when people's needs changed they had been referred appropriately to the relevant health professionals such as the G.P., dietician, tissue viability specialist nurses or others such as occupational therapists.

Is the service well led?

Staff had a good understanding of what was required of them in their role and the good standards of care that they were expected to deliver.

The manager is relatively new in post having previously been the deputy and is not yet registered. Staff told us that they found her approachable and supportive.

Staff told us that the manager supported them to attend training.

The manager had appropriate monitoring and audit systems in place to ensure the safety and well-being of people living in the home, visitors and staff.

During our visit to the home we spoke with eleven people who used the service, six relatives and ten members of staff. We asked people if they were happy at the home and if they felt comfortable and well cared for.

Comments included;

“It is very nice here, the staff are good - wonderful.”;

“Staff seem to know what they are doing”.

Relatives said;

“I am very happy with the care and very happy with the home.”;

“Since the management changed it's much better.”;

"They care because they want to, not because they have to."

We looked at a total of seven care records, four of which belonged to family members of relatives we spoke with. Information contained in the records about each person’s care requirements reflected information told to us by their relatives. They showed that people consented to care and treatment when they were able and if they were unable to do this then a relative or advocate did so on their behalf.

We observed staff interacted in a familiar, knowledgeable and helpful way with people using the service and spoke with family members many times during the day.

We spent time with the registered manager and the provider and reviewed how they monitored and checked the service they provided. Regular audits were carried out and we saw action plans to address concerns that had been identified. Records were concise and contained clear information about people’s needs and risk management. They were easily accessible and stored appropriately.

We carried out an unannounced comprehensive inspection of Bebington Care Home on 28 and 30 September 2015.

Bebington Care Home is a purpose built care home providing residential and nursing care for up to 87 people with varying needs. These include specialist nursing support, respite care, end of life and general assistance with everyday living for people with dementia. At the time of our visit 77 people were living at the home.

The home comprised of 4 units. One general nursing unit, two dementia nursing units and one dementia residential unit. Each unit has communal bathrooms, communal areas and dining areas. The home is currently undergoing some redecoration. Bebington Care Home is within walking distance of the local shops and has good transport links.

The home required a registered manager. 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. There was a registered manager in post, registration date with Care Quality Commission November 2014.

We spoke with the regional manager and the registered manager and they were very transparent and told us that they recognised that the home needed to improve and that they were committed to the work required.

People we spoke with told us they felt safe at the home. They had no worries or concerns. People’s relatives and friends also told us they felt people were safe. During our visit, however we identified concerns with the service.

We found breaches in relation to Regulations 9,12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Care plans were not up to date and we had concerns that risks relating to people’s safe care and treatment were not managed safely. We also found concerns with how the quality of the service was managed.

The staff in the home knew the people they were supporting and the care they needed. We

observed staff to be kind and respectful and the home provided a range of activities to occupy and interest people. This promoted their well-being.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. All medication records were completely legibly

and properly signed for. All staff giving out medication had been medication trained.

We reviewed peoples care plans, not all of these provided sufficient information on people’s needs and risks and guidance to staff on how to meet them.

People’s dependency needs had been considered in the way that staffing levels were determined although the rota we saw didn’t reflect the actual number of staff deployed.

Staff were recruited safely and there was sufficient evidence that staff had received a proper induction or suitable training to do their job role effectively. The majority of staff had been supervised and appraised. The registered nurses had appropriate PIN checks and were able to work safely.

Infection control standards at the home were good and standards were monitored and managed. Maintenance records were up to date and legible, this meant the home was a safe environment.

We observed a medication round and saw that the way medication was administered was safe. Records relating to people’s medicines matched what had been administered. Medicines were stored safely and there was evidence that staff administering medication were trained and competent to do so.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to in the home. The provider told us the majority of people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care.

We saw that the management team used a computerised system to access feedback from families and we saw evidence of the manager acting on feedback from these.