Benkhill Lodge

Benkhill Lodge is a care home providing personal care for up to 30 people. At the time of this inspection there were 20 people living at the home. People had access to communal areas. The home is built over three floors.

We found the following examples of good practice.

All essential visitors had to wear appropriate personal protective equipment (PPE). In addition, they also completed NHS Track and Trace information, were required to have a negative COVID-19 test result and have their temperature checked prior to entering the home.

People were supported to receive organised visits from relatives in a designated safe indoor ‘visiting pod’ area with robust cleaning and PPE procedures in place.

Staff supported people’s social and emotional wellbeing. Meaningful activities were adapted and taking place in smaller groups or individually. The service used different methods including information technology to assist communication and staff supported people to use this for making video calls.

The home had ample supplies of appropriate PPE which was stored hygienically and kept safe. Staff were provided with separate changing areas to put on, take off and dispose PPE safely.

Social distancing practices were in place at the home, where people used communal areas such as dining rooms and lounge areas, they were able to share these spaces safely.

Additional cleaning of all areas including frequent touch surfaces was being carried out and recorded regularly by housekeeping staff. Additional deep cleaning was also carried out where required.

Staff completed online training and paper-based learning booklets provided by the local NHS infection prevention and control team. Training included putting on and taking off PPE, hand hygiene and other COVID-19 related training.

Additional competency checks and spot checks were carried out by the registered manager with all staff regarding safe use of PPE and senior staff were given extra responsibilities to help manage PPE requirements with staff.

The registered manager had quality systems in place to check the service was providing safe care. There was a robust communication system in place to ensure staff received consistent updates in relation to infection control policy and practice.

A registered manager was in post. 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 time of our inspection 19 people lived at the service permanently and one was receiving short term respite care. Benkhill Lodge has a room reserved for people from the community who need additional support following discharge from hospital or to prevent them from being admitted to hospital. These are known as step up / step down beds. Health professional's work alongside staff to ensure people who require this level of support have their needs met.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

There were systems in place for the safe management and administration of medicines. The premises and equipment were well maintained and were regularly checked to ensure they were safe to use.

Staffing levels were sufficient to meet people's needs. There were safe recruitment and selection procedures in place and appropriate checks had been undertaken before staff began work. Staff received the support and training they needed to give them the necessary skills and knowledge to meet people's assessed needs.

Staff supported people to access healthcare professionals and services. People were provided with sufficient food and drink to maintain their health and wellbeing. Care records contained information about people's needs, preferences, likes and dislikes.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were kind and treated people with dignity and respect. People told us they were happy and felt well cared for. Care was person-centred and people were provided with choice. There were positive interactions between people and staff. Staff knew people well and promoted their independence.

Staff understood people were individuals and protected them from discrimination.

Complaints and feedback were taken seriously and action was taken to address any concerns. The registered manager and provider monitored the quality of service provided to ensure that people received a safe and effective service which met their needs.

Further information is in the detailed findings below.

We undertook this unannounced focused inspection on 15 December 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

Benkhill Lodge is registered to provide personal care for up to 30 older people. At the time of our inspection the service was providing care to 19 people on a permanent basis and three people on a temporary basis.

The service 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.

At this inspection we found that improvements had been made to the way staff administered medicines and this was now done safely. Staff had received additional training and competency checks took place to ensure staff administered medicines safely.

Medicines were stored safely and records relating to oral medicines and controlled drugs indicated that these had been administered in accordance with prescribing instructions. Records relating to creams were generally up to date, although we found one example where recording was inconsistent.

Records and checks were in place to support staff in the monitoring and ordering of medicine stock. This helped to ensure that medicines were available when people needed them.

Clear information was available to support the safe use of medicines used when required and topical medicines [medicines applied externally, such as creams].

Systems were in place to help ensure that people received their medicines when they needed them, including time specific medicines. Safe processes were in place to monitor the safe use of warfarin, to help ensure people always received the correct prescribed dose.

Audits and checks took place to ensure that medicines were being managed safely. This included responding appropriately to any ‘near misses’ or errors, to ensure that people were kept safe and the risks of reoccurrence were minimised.

The provider had a policy for medicine administration. This was in the process of being reviewed to ensure that it was up to date and reflected best practice guidelines.

Overall we found that improvements had been made and the service was no longer in breach of regulation.

Benkhill Lodge is registered to provide personal care and accommodation for up to 30 older people and is situated in the market town of Bedale, close to the centre of town and local amenities. The service is not registered to provide nursing care. At the time of our inspection 19 people lived at the service permanently and three were receiving short term respite care.

The registered provider is North Yorkshire County Council. The service had a registered manager, who had been registered with us since 5 October 2015. 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.

Medicines were safely stored and there was evidence that people received the medicines they had been prescribed. However, we saw a staff member using unsafe administration practices.

Staff were recruited safely. People who used the service told us that care staff were very busy and that they sometimes had to wait for assistance. The registered manager was recruiting staff and covering shifts with the available staff team. However, we have recommended that the registered manager reviews the numbers and deployment of staff taking into account the feedback received from people using the service.

People using the service, and their relatives, told us they felt safe at Benkhill Lodge. Staff knew how to report any concerns about people’s welfare and had confidence in the registered manager taking an action needed. People had individual risk assessments in place which ensured staff were aware of the risks relevant to each person’s care.

The service’s premises and equipment were well maintained and in safe working order.

Staff were supported to have the skills and knowledge they needed through relevant training. Staff felt well supported and received supervision, although the frequency of formal supervision varied because of recent staff [line manager] absences.

The service was following the principles of the Mental Capacity Act 2005. At the time of the inspection one person was subject to a Deprivation of Liberty Safeguards authorisation. The registered manager understood the DoLS and when they were needed.

People told us that the food was good. Snacks and drinks were available between meals if people wanted them. People’s dietary needs were assessed and monitored and support was requested from relevant health care professionals if there were concerns about people’s nutritional wellbeing.

We received positive feedback from a health care professional, who told us the service worked well with them and provided a good standard of care to people.

People told us that they were well cared for and treated with dignity and respect. We saw some very good examples of person centred care and a caring attitude by staff members.

Care staff knew people well and were able to describe people’s individual needs. People had their needs assessed and had care plans in place. Care plans were not very individual or person centred, but the registered manager was in the process of improving this.

People had access to activities and were involved in their local community. Visitors were made welcome and could visit when they wanted.

A complaints procedure was in place and information about this was available in the reception area. The registered manager encouraged feedback from people who used the service and their relatives, through meetings, surveys and a suggestion box.

There was a strong staff team, with many staff who had worked at the service for a long time. The registered manager and staff were committed to providing good, individual care to people. Audits and checks were completed and a service improvement plan was in place, to help the service continually improve.

We identified a breach of Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2014: Safe care and treatment, because the registered provider had not ensured the proper and safe management of medicines. We have required that the registered person make improvements. You can see what action we told the provider to take at the back of the full version of the report.

We spent time speaking with people who lived at Benkhill Lodge as well as speaking with staff. We reviewed records and spent time observing people in the home. If you want to see the evidence that supports our summary please read the full report. We used the evidence to answer five questions.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people who lived there. We spent time observing people and saw they were cared for safely. Every member of staff we spoke with said they were happy with staffing levels and this helped them to provide safe and appropriate care.

Staff records demonstrated that mandatory training was up to date and staff were trained to meet the complex needs of people. Staff were trained in caring for people with dementia related conditions, moving and handling and nutritional needs.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

During our visit we spent time observing people enjoying activities with staff and spent time with people who wanted to tell us about their experiences of the home. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and knew them well. For example, we noted that staff were able to tailor the way they spoke to each person, particularly their sense of humour and speech, to be able to make each person feel listened to and important.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home and told us they were able to put their training into practice.

Is the service caring?

People were supported by kind and attentive staff. We saw staff showed patience and gave encouragement when supporting people, especially when they needed help moving around. Staff took into account the complex needs of people when planning activities so they could take part in these safely. Staff told us they worked hard to make sure their training was applied to the individual needs of people so they could be supported to take part in activities important to them.

Staff said they were very happy with the level of professional and emotional support they received from the management team.

Is the service responsive?

People's needs had been assessed before they moved into the home and these were checked by regular reviews, which the people themselves were involved in. People's needs assessments included an assessment of their capacity to make decisions as well as consideration of their dietary and nutrition requirements.

People's preferences and interests were acted on by staff who used monthly meetings to support people to meet their needs and goals. People had access to activities designed to stimulate them and they were able to influence the running of the home.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and management support helped them to do their job effectively. One person spent time talking with us and told us how comfortable they were living there because of the care received by staff.

People were provided with a suitable amount and choice of food and drink. People's dietary needs were assessed and special dietary requirements were provided for. Comments made to us about the food included 'If you don't like the choices you can ask for something else' and 'The food has been very nice and varied.'

People were protected from abuse. Staff had been trained on recognising and reporting abuse and were able to explain what they would do if they had concerns about anyone's care. Appropriate systems were in place to report any suspicions or allegations of abuse to the local safeguarding team.

Procedures were in place to make sure staff were recruited thoroughly and safely. People felt that the home's staff were professional and suited to their role. Comments made to us included 'Excellent staff' and 'They are angels, absolutely brilliant.'

The provider had an effective system to regularly assess and monitor the quality of service that people received. People told us that they were satisfied with the quality of the service. People who lived at the home and staff were given opportunities to raise their views and be involved in discussions about the service.

People told us they had not had cause to complain, but would feel able to raise issues if they did. We observed the care of people during our visit. People using the service were calm and relaxed, and staff interacted with them in a nice friendly manner.

Staff told us they felt the home provided a good standard of care, and they had sufficient training to allow them to do their jobs.