Archived: Benham Lodge

Updated 1 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014

We inspected this service on the 8th and 9th March 2016. This was an unannounced inspection. The inspection team consisted of two inspectors.

Prior to the inspection we gathered and reviewed information we held about the service. This included notifications from the service, a pre-inspection questionnaire completed by the registered manager and information shared with us by the local authority. We reviewed notifications of incidents and safeguarding documentation that the provider had sent us since our last inspection. A notification is information about important events which the provider is required to tell us about by law.

We focused the inspection on speaking with people who lived at Benham Lodge, staff and observations that included staff interactions and the general cleanliness and safety of the home. We looked at two care plans, two staff files, staff training records and quality assurance documentation.

We spoke to seven people who lived at the service, four care staff, two relatives, the current registered manager, the acting manager, two relatives and a learning disabilities nurse who works with people at the home. We looked at people’s bedrooms, bathrooms, lounge, garden area, laundry room, kitchen and dining area.

Updated 1 June 2016

We inspected Benham Lodge on 8th and 9th March 2016. Benham Lodge provides accommodation and support for up to 9 people. Accommodation is provided in one large detached building located along a main road. There were nine people living at Benham Lodge at the time of the inspection. Two people had their bedrooms on the ground floor and seven people’s rooms were on the first floor. There was a large communal garden to the back of the property, two social communal areas and a kitchen/dining area.

The service provided care and support for people living with autism, Down’s syndrome, Williams syndrome and other learning disabilities. There were also people living at Benham Lodge who presented challenging behaviours. The service had a very low turnover of staff. This means that staff got to know the people at the service really well.

The service has a registered manager who is currently going through the processes of being de-registered to take on a new role. There was an acting manager in post who was in the process of registering as manager of the service. The acting manager was working alongside the registered manager and had been in role since 1st February 2016. 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 found that people’s medicine files were not being updated when people had been prescribed new medicine or when there had been changes in dosage of medicine. This can lead to errors in the administration of medicine to people as the files may not reflect what is actually prescribed.

We found occurrences where people were not being referred to the appropriate health professionals. One person came to Benham Lodge on a specific diet and had not been referred to a speech and language therapist for review. This is a concern because the person had not been reviewed for nearly seven years and there may be a change in the persons need during that time. We highlighted this to management on the day of inspection and an appointment was made for them.

Staff had not reported incidents and accidents consistently. We found that the reporting of seizures for one individual where six different incidents were logged in four different files at Benham Lodge. This means that there is no consistent record for the person and the seizures cannot be accurately monitored or managed.

In care files mental capacity assessments were not being consistently recorded for people and staff lacked an understanding of how to implement mental capacity assessments in practice. The registered manager identified this and all but one member of staff had recently received training on mental capacity assessments. The acting manager had booked the final member of staff on the next available training date. We were told by the acting manager that there would be a review of mental capacity assessments as part of the ongoing action plan.

There was no complaint log at the service. The provider’s policy stated that there should be a compliments and complaint log at every location. The acting manager showed us the new system for logging complaints but they could not provide us with a full history of complaints and how these had been managed.

Care plans contained information that was out of date and information was not recorded in a manner that was easy to follow and read. Risk assessments were not always being completed when they were required. We were shown the new layout for the care plans that included clear and easy to follow sections. This had yet to be implemented. The current layout makes it difficult for staff to find information about how they should support people. Important information could become lost as it is difficult to identify. This increases the risk of potential harm of people receiving inappropriate or unsafe care.

People were not always treated with dignity and respect. We found underwear being left to soak in a communal laundry area when there were appropriate washing facilities available to avoid this. We also observed that some staff were not behaving in a way that respected that their working environment was the people’s home.

We observed that the environment was well maintained but there were areas that needed improvement. We have made a recommendation about this in our report.

The provider had taken steps to ensure appropriate checks and routine servicing of the building and equipment were undertaken to keep people safe.

Checks were undertaken to ensure staff were safe to work within the care sector. Staff files did not included phot ID. We have made a recommendation about this in our report.

Staff had completed training on safeguarding and knew what action they should take if they suspected abuse was taking place.

People at the service told us that they liked the food and they were given the freedom to choose what they would like at a weekly residents meeting.

Staff had regular supervision sessions and told us the acting manager listened and responded to their concerns and they felt supported. However, appraisals had not been recorded. We have made a recommendation about this in our report.

We heard staff offering clear explanations to people in ways they understood. This reassured the people that were being supported and reduced the risk of any potential confusion or anxiety. Staff were seen to be kind and caring to people.

The service had a group of staff who had worked there for a long period of time. They had an excellent understanding and knowledge of each person living there.

People’s families were made welcome at the service. The service user’s guide stated that friends and relatives are allowed to visit at any time.

People living at the service, staff and relatives spoke positively about the acting manager. The acting manager showed us a recent internal audit that took place that identified shortfalls with the service and a time frame for when the improvements would be made.

On inspection we found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of the report.