Archived: Beechcroft - Torquay

Beechcroft -Torquay (hereafter referred to as Beechcroft) is a residential care home registered to provide care and support up to 34 people, aged 65 and over. The service is over three floors, with access to upper floors by stair lifts and a shaft lift. At the time of the inspection there were 34 people living at the service.

People’s experience of using this service and what we found

People lived in a service which was being managed safely in line with current government infection, prevention and control guidance. Since our last inspection, improvements had been made to the way in which people’s laundry was handled.

People now lived in a service which had been assessed for fire safety, and action had been taken to comply with fire regulations. Staff now had a good understanding of the signs of abuse, and of what action to take should they be concerned someone was being abused, mistreated or neglected.

People had their medicines managed safely, and risks associated with people’s care were known and mitigated to ensure their ongoing safety with records now in place.

People were observed to be supported by suitable numbers of staff; however, some staff felt the service was understaffed. The registered manager told us they would take action to speak with staff about how they were feeling, and act as required.

The service now had a registered manager. The registered manager was passionate about getting things right for the benefit of people and was open and transparent when things had gone wrong. There was now an improved learning culture with investigations being carried out when complaints or concerns had been raised. Staff expressed they were well supported and since our last inspection told us they had seen improvements. Overarching governance systems were now in place to help monitor the ongoing quality and safety of the service. The registered manager had created a service improvement plan but expressed how their focus over the last year had been on managing the pandemic and keeping people safe. They shared how they were looking forward to focusing on the future.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection (and update)

The last rating for the service was Requires Improvement published on (4 September 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beechcroft – Torquay on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beechcroft -Torquay (hereafter referred to as Beechcroft) is a residential care home providing personal care and accommodation to 30 people aged 65 years and over at the time of the inspection. The service is in one large adapted building over three floors that is registered to accommodate up to 34 people. It has a garden, stair lifts and a lift and is within walking distance of a local park and the sea.

People’s experience of using this service and what we found

People were not always protected from the risk of harm and we had a concern that a safeguarding investigation had not been carried out where a suspected case of avoidable harm had occurred.

There were some improvements needed in infection control practises in the laundry, these were actioned by the provider after the inspection. Some risk assessments were overdue for review. We had some concerns about fire safety and asked the service to act to remedy these and asked the fire brigade to work with the service. Despite these issues, people told us they felt safe.

People were supported to stay hydrated and were offered choices in their meals. The lunchtime meal we observed was calm and people chatted happily amongst themselves.

Staff were not always supported through supervision of their practice, however despite this they told us they felt supported. Staff had not always completed the required training to be able to meet people’s needs. However, the manager had recently arranged for a ‘mop up’ session to ensure staff had all mandatory training required to meet people’s needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Several people were being deprived of their liberty in contravention with the Mental Capacity Act 2005.

Staff were caring and spoke to people with dignity and respect. Staff knew people’s needs well and were able to engage people. People were starting to be more involved in the planning and review of their care.

People were not always provided with care that met their preferences in regard to showering and bathing. Care plans that were completed were person centred. Staff spent time with people talking and holding their hands.

We recommended the service record their responses to complaints and what learning they have had from them.

The service had undergone recent management changes and needed time to embed their new structure. We found several concerns throughout the inspection that needed addressing. Not all of these had been acted on promptly enough when the service became aware of them, or the service were not aware of them. This showed that although some improvements had been recently made, the system for assessing the safety and quality in the service needed further work and time to improve, and be embedded in the running of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report was published on 22 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, person centred care, and good governance.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out a previous inspection of this service on 22 April 2015 where we found the service was rated ‘good’.

This inspection took place on 8 and 15 March 2017 and the first day was unannounced. At the time of our inspection there were 32 people living in Beechcroft - Torquay. People had a range of needs, with some being more independent and others requiring a significant amount of support relating to their physical health, dementia and wellbeing.

The home 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff treated people with kindness and respect. People enjoyed pleasant interactions with staff which demonstrated people felt comfortable in their presence. During our inspection we saw positive and caring interactions between people and staff. We found staff had caring attitudes towards people and provided people with affection and humour. Staff knew people’s needs, preferences, likes and dislikes and spoke about people with respect and admiration.

Staff knew how to recognise possible signs of abuse which also helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report concerns. Safeguarding information and contact numbers for the relevant bodies were accessible. Staff told us they felt comfortable raising concerns.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were vulnerable.

Staffing numbers at the service were sufficient to meet people’s needs and provide them with the care and support they required. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training as well as regular supervision and appraisal. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

The registered manager was in the process of introducing new care plans for people, which contained more detailed information about their histories, individual needs, preferences and interests. The registered manager was then using this information to develop more comprehensive and personalised activity plans for people to ensure they had stimulation and activities that met their desires, interests and needs.

People were protected from risks relating to their health, mobility, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and as prescribed by their doctor.

People were supported to have enough to eat and drink in ways that met their needs and preferences. People were supported to make choices about what they wanted to eat and food was presented in ways which met people’s individual needs. People spoke highly of the food and where people had specific needs relating to their diet, these were responded to.

There was open and effective management at Beechcroft - Torquay. The provider and registered manager led by example to ensure best practice was followed. People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were effective systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

The registered manager had identified where improvements were needed and were working hard to improve standards. They were working to improve the environment for people, the ways in which people were involved in their care and the running of the home. They were also in the process of improving the activities available for people and the need for care plans to be more ‘person centred’. This work was underway.

People told us 'You won't find somewhere better' and 'Staff are lovely, do anything for you'. We looked at the care records for three people. The records showed that people's needs and risks had been identified and planned for. Care workers that we spoke with were able to tell us what they did to support people and knew what to do for them if they needed any additional support.

There were arrangements in place to deal with foreseeable emergencies. For example, care files contained Personal Emergency Evacuation Plans (PEEPS), this meant that care workers had access to the information they would need if an evacuation of the premises was needed.

We saw that there were policies and procedures in place for staff to follow if they suspected abuse had occurred. Care workers were aware of the documents and knew how to access them.

Care workers' files showed there were effective recruitment procedures in place. For example, there was evidence that Disclosure and Barring Service (DBS) (criminal records) checks had been performed.

We found that people's personal records including medical records were accurate and fit for purpose. For example, we found that people's care plans gave good directions to staff and were regularly reviewed.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We (the Care Quality Commission) spoke with three people, four staff, one relative and one visiting healthcare professional. We also spent time observing care and lunch time and looked at four care plans. On the day of our inspection 31 people were living at the home and receiving care from the service. One person was receiving respite care.

We saw staff interact with people in a caring, respectful and polite manner. People enjoyed good humour with staff. We observed that visitors were made welcome by staff. One person said 'Everything is nice. In my opinion they treat us very, very well.' A relative we spoke with said 'I couldn't ask for anything more. The staff are very helpful and caring.' All the staff we spoke with were complimentary about the standard of care and the support they received.

Medicines were managed safely and systems were in use to monitor the quality of the service.