We carried out an unannounced inspection of Benjamin House on 4 and 5 July 2018.

Benjamin House is a ‘care home’, which is registered to provide care and accommodation for up to 10 adults with mental ill health. People in care homes receive accommodation and nursing care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Nursing care is not provided. At the time of our inspection, eight people were using the service.

The service was managed by 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 our last inspection in the service was rated ‘Good’ overall. However, we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the provider not having proper oversight of Benjamin House, including a lack of effective systems for checking and improving the service. At this inspection we found sufficient improvements had been made.

We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

We found there were management and leadership arrangements in place to support the effective day to day running of the service. The registered manager had made some improvements and the provider was monitoring the service.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on supporting people safely and abuse and protection matters.

Processes were in place to make sure all appropriate recruitment checks were carried out before staff started working at the service.

There were enough staff available to provide care and support; we found staffing arrangements were flexible and kept under review. Systems were in place to support ongoing staff training and development.

There were some good processes in place to manage and store people's medicines safely. We found some improvements were needed with record keeping, this was put right during the inspection.

Systems were in place to maintain a safe environment for people who used the service and others. Processes were in place to maintain hygiene standards and the areas we saw looked were clean.

Arrangements were in place to gather information on people’s needs, abilities and preferences before they used the service. They were encouraged to visit, to meet with other people and staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and processes at the service supported this practice.

We found people were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to. People were offered opportunities and encouragement with physical exercise.

People were satisfied with the meals provided at Benjamin House. People were actively involved with planning menus, which meant they could make choices on the meals provided.

People made positive comments about the care and support they received from staff. We observed positive and respectful interactions between people who used the service and staff.

Each person had a care plan, describing their individual needs and choices. This provided guidance for staff on how to provide support. Peo

Benjamin House is registered to provide accommodation, care and support for up to 10 people with mental ill health. The service aims to put the rights of people using the service at the forefront of its philosophy of care and support. Benjamin House is a large end terraced house situated a short distance from Burnley town centre. There is a lounge and a dining kitchen with conservatory area. Bedrooms are single occupancy and have en-suite facilities. There are enclosed yards to the rear and side of the premises and a garden forecourt to the front. There are limited parking spaces to the rear of the premises. At the time of the inspection there were seven people accommodated at the service.

At the time of the inspection the service was without 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. The Commission had received an application for the position of registered manager which was being processed.

At the last inspection on 30 April 2014 we found the service was meeting all the standards assessed.

During this inspection we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the provider not having proper oversight of Benjamin House, including a lack of effective systems for checking and improving the service. You can see what action we told the provider to take at the back of the full version of this report.

The people we spoke with indicated they experienced good care and support. Their comments included, “Things are fantastic” and “Things are lovely here.”

We found arrangements were in place to help keep people safe and secure. Risks to people’s well-being were being assessed and managed. People using the service had no concerns about the way they were supported. They told us they felt safe living at the service, one person said, “I feel very safe here.”

Staff were aware of the various signs and indicators of abuse and they knew what to if they had any concerns. Appropriate character checks had been done before new staff started working at the service.

There were enough staff available to provide care and support and additional staff were being recruited. However, we have made a recommendation on monitoring staffing arrangements to make sure there are always enough staff available at the service.

There were systems in place to ensure all staff received regular training and supervision. We found some training was overdue but action had been taken to address this matter.

People were receiving safe support with their medicines. One person told us, “I am aware of all my medicines. The staff give them to me and I get them on time.” Staff responsible for supporting people with medicines had completed training and further training was being arranged. This had included an assessment to make sure staff were competent in this task.

The service was working within the principles of the MCA (Mental Capacity Act 2005). We found people were supported to make their own decisions and choices. They were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were satisfied with the meals provided at Benjamin House. Their individual dietary needs, likes and dislikes were known and catered for. Arrangements were in place to help make sure people were offered a balanced diet. People were actively involved with shopping for provisions and devising menus, which meant they could make choices on the meals provided.

People made positive comments about the care and support they received from staff. They said, "The staff are helpful” and “T

During the inspection we spoke with three people who used the service, the manager and two members of staff. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found:

Is the service safe?

People spoken with during the inspection did not express any concerns about the support they received with their medicines. There were appropriate arrangements in place to manage people's medicines safely. However, we found some records could be better kept to promote safer practices.

We found most of the required clearance checks had been thoroughly carried out for the safety and well- being of people who used the service. However improved practice was needed to ensure applicants are properly screened.

Is the service effective?

People told us they were happy with the care and support they experienced at Benjamin House. They said: “I have improved since being here” and “They look after my mental health needs”.

People were involved in discussions about support and regular reviews had been carried out. They told us, “They involve us, there are all sorts of things we can do” another said “They ask me all the time what I want to do”.

People told us they were involved with the selection of new staff, they said, “We interview them after their first interview” another commented, “We say if we don’t find them approachable”.

Processes were in place for care workers to attain nationally recognised qualifications in health and social care. Staff spoken with, told us of the training they had received. They were aware of people’s needs and gave examples of how they delivered support.

Is the service caring?

During the inspection we observed staff sensitively supporting people with their chosen activities and individual support needs. People told us they were happy with the staff team they said, “The care is fantastic” and “I like living at Benjamin House, I am happy here”.

Risks to peoples’ wellbeing and safety had been identified and managed, taking account of enabling their choices and their right to take risks. Staff told us they were aware of peoples’ individual needs and the information in their care plans.

Is the service responsive?

We found arrangements were in place to assess and review people's needs and abilities. This meant their individual needs and choices were considered and planned for.

Records and discussion showed peoples’ mental health, healthcare and general wellbeing was being monitored and responded to. People were getting appropriate attention from medical professionals.

We found people were supported to undertake planned activities both in the home and in the local community.

People were aware of the complaints processes and who to contact should they have any concerns about their support and care. One person explained, “I would be confident to tell anyone if I was not okay”.

Is the service well-led?

The service had a registered manager responsible for the day to day management of the home. The owners were also regularly involved with some aspects of management.

We found people were involved with decisions which affected them informally on a daily basis. One person said, “They always ask how we are, they listen to what we say”. People were also invited to complete satisfaction surveys for their views in the service.

There were systems in place to assess and monitor how the home was managed and to monitor the quality of the service.

Staff spoken with had no concerns about the management of the service. They felt they were appropriately supported.

People using the service told us they were satisfied with the support they received at Benjamin House. They told us, “Things here are good”, “I prefer to be at Benjamin House” and “They look after us very well”.

People were being involved as far as possible in planning their support and were enabled to make decisions about matters which affected them. Their ability to make their own decisions and choices needed to be more carefully considered.

People were treated with respect and valued as individuals, they were able to make choices and develop independence skills. They were supported to access resources and activities within the community and keep in touch with relatives.

People were getting support with healthcare needs and they had access to ongoing attention from health care professionals. We found some progress was needed in supporting people with dental checks.

People were provided with pleasant accommodation. But we found some matters were not being given proper attention.

People told us they liked the staff. We found people using the service were supported by enough trained, capable staff and more staff were being recruited.

We found that some checks on practices and systems were being carried out and action taken to improve and develop the service.

People using the service told us they were satisfied with the support they received at Benjamin House. They told us, “Its fine living at here”, “I think its okay” and “I have never been anything other than pleased at Benjamin House”.

People were being involved as far as possible in planning their support and were enabled to make decisions about matters which affected them.

People were treated with respect and valued as individuals, they were able to make choices and develop independence skills.

They were supported to access resources and activities within the community and keep in touch with relatives.

People were getting support with healthcare needs and they had access to ongoing attention from health care professionals.

People had no concerns about their care and treatment; they said they felt safe with the staff. They told us they liked the staff. We found people using the service were supported by trained, capable staff.

People were being consulted about their experience of service. We found that checks on practices and systems were being carried out and action taken to improve and develop the service.

People using the service told us they were satisfied with the support they received at Benjamin House, that they were involved in planning their support and were enabled to make choices and decisions about matters which affected them both individually and as a group. One person told us, “Yes I am aware of my care plan, I have signed and agreed with it”. Another said, “We have residents meetings we talk about meals, outings and activities, they give us a chance to have a say, our suggestions are now being dealt with better”. However, we found some further matters needed to be included in the care planning process.

They said staff treated them well, that they were enabled to develop independence skills and were supported to experience learning opportunities. Also, that they were supported to access resources and activities within the community and keep in touch with families and friends.

People said they were getting support with healthcare needs, with regular check ups being arranged.

Everyone spoken with was okay with the catering arrangements and how they were supported with food choices, meal preparation and cooking.

People said they would speak up if they were not happy with things, they considered the staff and manager to be approachable. They said staff were friendly and supportive, one person told us, “I always wanted to be part of a big family that’s what its like, we all get on well together”

One person said they had been involved with recruiting new staff. We were told there were enough staff to provide support and people were confident staff knew what they were doing. However, we found progress was needed with staff training and development to make sure the team had the right skills, knowledge and abilities.