Archived: Benham Lodge

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.

We saw that people's consent was obtained where possible before care and treatment was undertaken. We observed that the care given was safe and appropriate and based on effective care planning and risk assessments. This meant that people's individual needs were met and preferences were taken into account.

People were protected from abuse and cared for in a safe and inclusive environment. We noted that there were adequate numbers of skilled and experienced staff to deliver safe and appropriate care. In addition, the provider had an effective system to regularly assess and monitor the quality of service that people received.

Staff showed a good understanding of people's needs and preferences and we noted that staff treated people with respect.

We found that the property was reasonably well maintained and there were regular checks on the fire and water systems. Electrical items underwent regular testing to ensure they were safe to use and did not pose a risk to service users or staff.

People told us that they were able to have a say in how their rooms were decorated and we saw that each bedroom had been furnished with personal affects such as photographs, posters, televisions and stereos.

There was a system in place for managing medications and the provider took a pro-active approach to managing medication incidents. Staff underwent appropriate training so that they could safely handle and administer medication to people using the service.

We found that staff received the training they needed to provide care and support safely and showed us that they understood the needs of the people using the service. We saw that there was a lively atmosphere in the home and that people chose how they spent their time.

There was a complaints procedure available which was in an easy-to-read format and was accessible to people using the service, their relatives and visitors.