Archived: Benthorn Lodge

Updated 29 September 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.

This inspection took place on 20 July 2016 and was unannounced. The inspection was carried out by three adult social care inspectors; one of whom was a pharmacy inspector.

We checked the information we held about the service and the provider, such as notifications and any safeguarding or whistleblowing incidents which may have occurred. A notification is information about important events which the provider is required to send us by law.

In addition, we received concerning information from the local authority in relation to insufficient staffing, poor support for staff and a lack of leadership and management.

Following the previous inspection we did not receive an action plan to inform the Care Quality Commission how the service would address the concerns identified and how long this would take them to complete.

In addition, we asked for feedback from the local authority, which have a quality monitoring and commissioning role with the service.

During the inspection we used different methods to help us understand the experiences of people using the service, because some people had complex needs which meant most were not able to talk to us about their experiences.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with two people who lived at the service and observed the care being provided to a number of other people during key points of the day, including lunch time and when medication was being administered. We also spoke with one relative of a person using the service to determine their views of service delivery on behalf of their family member. In addition, we spoke with seven members of staff, including the registered provider, the manager, the administration manager and four care staff. We also spoke with one visiting healthcare professional.

We looked at four people’s care files to see if their records were accurate and reflected their care and treatment needs. We also examined other records relating to the running of the service such as staff records, medication records, audits and meeting minutes; so that we could corroborate our findings and ensure the care being provided to people was appropriate for them.

Updated 29 September 2016

This inspection took place on 20 July 2016 was unannounced.

This was a third comprehensive inspection carried out at Benthorn Lodge. At our previous comprehensive inspection carried out on 14 and 15 April 2016 we found the service to be in breach of ten regulations and received a rating of inadequate. Following our inspection in April 2016 the service was put into special measures.

Prior to this inspection we received concerns from the local authority about a lack of staffing and poor care practices which meant that people were not receiving the best possible care. Concerns were also raised in respect of poor management and leadership at the service.

Benthorn Lodge provides care and support for up to 20 older people who have physical and mental health needs. Most people living at the service have advanced dementia care needs. There were 11 people using the service when we inspected the service.

There was a manger in place but they had not registered with the Care Quality Commission (CQC). 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 previous inspection we found that staff were not confident that any concerns they raised with the registered provider would be dealt with effectively. During this inspection we found two potential safeguarding incidents that had not been reported to the local safeguarding team and the Care Quality Commission. This meant that safeguarding concerns had not always been reported and escalated appropriately and placed people at risk of harm.

At the previous inspection we found that recruitment procedures were not robust and staffing levels were not adequate to meet the needs of people using the service, in a timely manner. During this visit we found that areas of concern in relation to the recruitment of staff had not been addressed. There remained insufficient numbers of suitably qualified, competent, skilled and experienced staff providing care or treatment to people.

People had not been protected against the risks associated with unsafe or unsuitable premises. At this inspection we saw that many areas of the premises had not been regularly maintained and showed that appropriate action to ensure people were safe through a regular programme of servicing and maintenance of the premises and equipment had not been carried out.

At our previous inspection we found that staff did not receive appropriate support and training to perform their roles and responsibilities effectively. During this inspection we saw that although staff had completed distance learning courses, they did not always feel supported and some staff had not received formal supervision. There was no recognised induction programme in place for staff new to the service. During the previous inspection we found that people’s consent to care and treatment had not been sought in line with current legislation and people were not supported to access healthcare facilities as needed. During this inspection we found that staff had completed some training courses, however no improvements had been made to the induction programme. In addition we saw that people’s capacity to make decisions had not been assessed meaning that decisions were made for people without their involvement or consent. People did not have access to dental care to maintain their oral health needs.

During our last inspection we found that people were not always offered choices about their care and were not involved in decisions about their routines. In addition, people did not receive care that was responsive to their needs or focused on them as individuals. During this visit we found that although some improvements had been made, people did not always receive the care described in their care plan and in line with their preferences.

At the previous inspection there was no registered manager and the registered provider was running the service which had led to poor management and leadership. During this inspection we found there was a manager in post; however they had not yet registered with the Care Quality Commission (CQC). Staff told us the manager was not always visible at the service and said it was often difficult to contact him for support. Effective quality assurance systems were not in place to obtain feedback, monitor performance and manage risks on a regular basis.

These were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that people were receiving their medicines as prescribed. Improvements had been made to the systems and processes in place for the safe administration, storage and recording of medicines.

Staff had received practical training in moving and handling. In addition, staff had completed distance learning courses in mandatory subjects. People had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required. However, we found that people did not have access to dental care on a regular basis.

We saw that staff treated people with kindness and patience. Improvements had been made to the storage of personal information and we found that people were treated with privacy and dignity.

A complaints procedure was in place to let people know how to raise concerns about the service if they needed to. The service had not received any complaints since the last inspection.

The overall rating for this service remains as inadequate and the service remains in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. 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.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.