Archived: Benthorn Lodge

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.

This was the second comprehensive inspection carried out at Benthorn Lodge since the service was last inspected on 11 December 2015. At this time they were found to be in breach of three regulations.

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 inadequate training for staff, a lack of activities to stimulate people and poor management and leadership of 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 15 people using the service when we visited, one of whom was in hospital at the time of our visit. .

The service 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.

At the previous inspection we found that staffing levels were not adequate to meet the needs of people using the service, in a timely manner. During this visit we found that there were still insufficient numbers of suitably qualified, competent, skilled and experienced staff providing care or treatment to people.

At the previous inspection we found that there was a lack of stimulation and interaction between staff and people using the service and the provision of meaningful activities. During this visit we found and records confirmed that few meaningful activities took place and people were at risk of being socially isolated.

At the previous inspection we found that there was a difference in the philosophy and ethos of the management of the service between the registered manager and the provider. This had led to poor management and leadership. At this visit we found the registered manger had left and although the registered provider was at the service everyday they were not providing any direct leadership or management of the service.

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

Although people told us they felt safe at the service the staff we spoke with felt that people were not always safe because of insufficient staffing numbers. They told us they would not feel confident that any concerns they raised with the registered provider would be dealt with effectively. This meant that while people said they felt safe, safeguarding concerns had not always been reported and escalated appropriately and placed people at risk of harm.

We found that risks to people’s safety had been assessed, however for one person new to the service they did not have any risk management plans in pace. This meant that staff were not provided with guidance to provide support safely.

People had not been protected against the risks associated with unsafe or unsuitable premises. Service certificates for the premises and equipment had expired and environmental checks had not been undertaken. This showed that the provider had not taken appropriate action to ensure people were safe through a regular programme of servicing and maintenance of the premises and equipment.

A dependency tool was used to assess the number of staff needed to provide care and support for people. However, this tool did not reflect the current dependency levels of people using the service and as a result we found staffing levels were not sufficient to meet people’s needs and this was having an impact on the quality of care received by people using the service.

Robust recruitment policies and procedures had not been consistently followed to ensure that staff were suitable to work with people.

Systems and processes in place for obtaining, administrating, storage and recording of medicines were not always safe. This meant that people’s care and treatment was not provided in a safe way and the registered provider had failed to deliver the safe and proper management of medicines. This has subsequently placed people’s health and wellbeing at immediate risk.

Staff did not receive appropriate support and training to perform their roles and responsibilities effectively. They told us they had not received practical training in moving and handling. This placed people at risk of receiving unsafe care by staff who were not trained appropriately to carry out their roles.

People’s consent to care and treatment was not sought in line with current legislation. People’s capacity to make their own specific decisions had not been assessed. There was no evidence that best interest meetings took place when specific decisions needed to be made or evidence that any least restrictive options were explored for any decisions about their care.

People did not always have timely access to health care professionals to meet their specific health care needs. This meant people may be left in pain or discomfort until they were supported to see a healthcare professional. This also placed people at further risk of deterioration of their condition.

People were not always offered choices about their care and were not involved in decisions about their routines. We also found that staff did not always promote people’s privacy and dignity, and confidential information was not always stored securely. This meant that staff did not always have due to regard to people’s right to dignity, privacy and confidentiality.

People did not receive care that was responsive to their needs or focused on them as individuals. We found one person using the service had not received an initial assessment, and as a result of this there was no care plan or associated risk assessments in place. This placed the person at risk of unsafe and inappropriate care and treatment.

Records showed that people and their relatives were not involved in the care planning and review process. The registered provider confirmed that reviews of people's care had not been held regularly and were overdue for some people. This showed that changes to people's care and treatment were not consistently reviewed and updated with the involvement of people to whose care they related and their family members.

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The service did not have a complaints procedure in place and we found there was no system for logging and recording complaints. This demonstrated that people’s concerns were not listened to and acted upon by the registered provider.

We found the culture at the service was not open and transparent and we found a lack of leadership in the day to day running of the service. Quality assurance, health and safety checks and feedback from people had not been undertaken for a lengthy period and did not therefore effectively check the care and welfare of people using the service. Required notifications had not been sent to the Care Quality Commission. This meant that the management of the service and systems in place were not effective or robust enough to ensure that risks relating to the health, safety and welfare of people using the service were responded to.

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During this inspection we identified a number of areas where the provider was not meeting expectations and where they had breached Regulations 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 the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 timeframe. 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.

We carried out an unannounced comprehensive inspection of this service on 14 and 15 April 2016. After that inspection we received concerns that the stair lifts at the service had broken down and staff were carrying people up and down the stairs. It was also reported that staff were unable to contact the manager. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Benthorn Lodge on our website at www.cqc.org.uk

Benthorn Lodge provides care and support for up to 20 older people who are physically and mentally frail. Most people living at the service have dementia care needs. There were 11 people using the service when we visited.

The service did not had 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 no contingency plan in place for the event of the stair lifts breaking down.

Two stair lifts had broken down the day prior to our inspection. However they had been repaired on the same day and we saw them in working order on the day of our visit.

Service certificates demonstrated that the stair lifts were routinely serviced.

We saw that staff spent time with people in an unhurried manner. We observed people taking part in different activities, mainly on an individual basis with a staff member who geared the activity to suit the person's interests. We saw that people enjoyed this interaction.

We saw that each person has a medication care plan which detailed how they took their medication and the assistance they required from staff. The home used an electronic system for recording the administration of medication. Staff explained that there were safeguards built into the electronic system that ensured people were administered their medication as prescribed.

We saw that there was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.