Beech Lodge – Thames Ditton is a care home providing accommodation and personal care for up to nine people with learning disabilities and mental health needs.
The inspection took place on 10 November 2015 and was unannounced.
The home did not have 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 current manager had been working in the home since June 2015 and was in the process of applying to be registered.
We found that people were placed at unnecessary risk because hazards in respect of the environment and fire safety had not always been appropriately managed. For example we found that fire exits were not always kept free from obstruction and there were not adequate plans in place to demonstrate how people would be safely evacuated in the event of a fire. We reported our concerns to the local fire safety who visited and conducted their own inspection which resulted in requirements being made under The Regulatory Reform (Fire Safety) Order 2005.
The home was unclean and some areas were in need of refurbishment. Whilst a part-time cleaner was employed, the majority of cleaning was left to the people who lived there and they received minimal support and supervision in respect of this. Our shoes stuck to non-carpeted floors as we walked around the home and surfaces in communal areas were sticky to touch. In some of the bedrooms, people’s shelves and units were thick with dust and sinks heavily stained. Communal toilets were soiled and unpleasant to access.
Whilst people received most of their medicines as prescribed, the systems in place for checking medicines were appropriately disposed of had failed. We found a number of stock medicines that were out of date and other items that had been opened and not discarded after use. There were no guidelines in place for the use of homely remedies such as paracetamol and cough medicines despite there being a stock of these being held. People were otherwise supported to maintain good health and had regular access to a range of healthcare professionals.
Staffing levels were sufficient to meet people’s needs, but were not always deployed appropriately. Not all staff had the specialist skills and experience to support people effectively. The training programme in place for staff did not include key areas such as how to support people with mental health needs. The result of this was that some staff did not engage appropriately with people and motivate them to participate in meaningful activities.
Care plans were personalised and well documented, but were not always followed in practice. Staff were not always good at instinctively giving people choice and control over their lives. For people who did not have their own aspirations, there was a lack of engagement and development.
Staff took appropriate steps to maintain people’s privacy and dignity and were respectful of their personal space and belongings. The language used in supporting some people with behaviour that challenges was not always respectful. One person told us that they felt they were sometimes treated as child and we heard other people talking about the need to be “Good” or “Quiet.”
There was choice in respect of mealtimes, but this was offered reactively rather than as a matter of course. Whilst people had the capacity and ability to make their own decisions about meals, they felt obliged to seek permission or were heavily supervised in the process. It was not clear how the staff supported people to maintain a sufficiently varied and balanced choice of meals. We have made a recommendation to the provider about this issue.
The provider had a range of audit tools in place, but these were not always effective in identifying quality issues within the home. The manager was seeking to effect change as a result of concerns raised in a recent survey completed by people, but more was needed to provide adequate leadership and development to staff.
Appropriate checks were undertaken when new staff were employed and staff understood their safeguarding responsibilities. People’s legal rights were protected because staff routinely gained their consent and understood that each person had the capacity to make decisions for themselves.
Equality and diversity was managed well and people were supported to follow their own religious and cultural preferences. We saw that people who wished to attend church were supported to so and consideration was given to the attendance at religious festivals and carnivals.
We found a number of breaches of regulations. You can see what action we asked the provider to take at the back of this report.