Archived: Beechwood Residential Home

We found the following examples of good practice.

The service had a screening process for visitors on entry to the building. All visitors had their temperature checked, were provided with personal protective equipment (PPE) and asked to use a hand sanitiser before approaching the main communal area. There were sufficient amounts of PPE in stock to ensure people and staff followed safe PPE practice. This allowed the provider to manage the risks of exposure to COVID-19.

The service had adopted creative ways to ensure the wellbeing of people at the home. We observed two people who communicated with friends and took part in weekly college sessions, using video calling technology. Although there had not been many visitors to the home, the registered manager was aware of the requirements of visiting guidelines for people living in a care home. This helped the service to minimise the spread of infection whilst maintaining the well-being of people living at the home.

The provider had appropriate arrangements in place to test people and staff for COVID-19 and was following government guidance on testing. People’s communication needs were considered using an easy read pictorial leaflet, to explain the COVID-19 pandemic and reasons why testing and use of PPE were important. This helped staff to manage any anxiety of people living at the home.

Beechwood is a residential care home providing care and support to four adults with learning disabilities. Beechwood is a terraced house in a residential area of East London.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People received a safe service. People told us they felt safe with their staff. People were supported to take their medicines in a safe way. Risks people faced during their day to day lives had been assessed and steps put in place to mitigate the risks. Staff were recruited in a safe way. People told us there were enough staff on duty. The home was clean and people were protected by the prevention and control of infection.

People were involved in reviewing their needs assessments, with their family involved where they wished for this. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff told us they received regular supervision and had the training they needed to do their jobs. People told us staff helped them with their health and any appointments. There had been improvements to the health records and information was now clear and easy to find. The provider had made adaptations to make the building suitable for everyone who lived in the home.

People told us staff were kind and we saw positive, compassionate interactions between people and staff. People were involved in making decisions about their care. People’s relationships and religious beliefs were promoted and supported. People were treated with dignity and respect.

People were supported to attend a range of in house and external activities. Staff had positive working relationships with other agencies involved in providing support to people. People were supported to see their friends and be active within their community. Care files were reviewed and updated regularly. The provider had taken action to sensitively explore people’s end of life wishes.

We saw people were comfortable and confident in the company of the management team. The provider had taken appropriate action to address our previous concerns and there were now clear structures in place to monitor the quality and safety of the service. There was a person-centred culture in the home that was embedded across staff of all grades.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

Rating at last inspection and update.

The last rating for this service was requires improvement (published 26 July 2018)

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

This was a planned inspection based on the previous rating.

When we completed our previous inspection in July 2017 we made a recommendation about supporting people to plan for the end of their lives. At this time this topic area was included under the key question of Caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area is now included under the key question of Responsive.

Beechwood Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal 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.

Beechwood Residential Home is a terraced house where adaptations have been made to give one bedroom en-suite bathroom facilities. Beechwood Residential Home can accommodate up to five people, at the time of our inspection four people were living in the home. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager 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.

During the inspection we found medicines information, care plans and risk assessments had not been kept up to date and were missing important information about how to support people in a safe way. The registered manager updated the records during the inspection to ensure information was available to all staff involved in providing support to people.

Staff had information about how to prevent and control the risk of infection, and had access to personal protective equipment to support them to mitigate the risks. However, bathrooms had not been appropriately maintained to fully mitigate the risks. The provider had not identified the style of window restrictor in use could be over-ridden.

There were enough staff working in the service to meet people's needs and they had been recruited in a way that ensured they were suitable to work in a care setting. Staff received the training and support they needed to perform their roles.

People were supported in line with the principles of the Mental Capacity Act 2005. The provider had submitted requests for appropriate authorisation to deprive people of their liberty. However, they had not notified us when these had been granted.

People were supported to access healthcare services. However, records were not well maintained and staff had not consistently recorded monitoring information about people’s health, or escalated when people’s information changed.

Care plans contained information about people’s preferences and goals.

People were supported to attend a range of activities and other services. We saw staff from the home liaised with other services supporting people.

People were supported to be involved in choosing the menu and records showed they were supported to eat a balanced and varied diet.

People had developed positive relationships with staff who were knowledgeable about people’s emotional needs and communication. People were supported to maintain their dignity. People were supported to practice their religious faith if they wished to do so.

The provider had not followed our recommendation about supporting people to plan for the end of their lives. Care plans had not consistently been updated to reflect changes in people’s needs.

There was a clear policy regarding complaints and people were given the opportunity to raise complaints in meetings.

The service completed health and safety checks to monitor the service. However, these were not consistently completed. The registered manager had introduced audits in March 2018, but the provider was not completing any checks on the work of the registered manager. This meant issues with the quality and safety of the service were not identified or addressed ahead of the inspection. There were no plans in place to improve the service.

People and staff appeared relaxed with the registered manager, who they could approach easily. They told us the registered manager had introduced changes since our last inspection. The registered manager attended local networking events to stay up to date with best practice.

We found breaches of two regulations regarding notifications of incidents and good governance. 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 the service is Requires Improvement. This is the second consecutive time the service has been rated Requires Improvement.

Beechwood Residential Home is a five bedroom care home for adults with learning disabilities. It is based in an adapted house in a residential area. At the time of our inspection four people were living in the home.

The home was last inspected in May 2015 when it was rated ‘Good.’

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. The previous registered manager had left in November 2016. The provider was in the process of recruiting a new registered manager.

People’s care plans and risk assessments were detailed and personalised. There was detailed information about people’s communication and preferences within the care plans. Care plans and risk assessments had been reviewed annually. However, parts of the care documentation had not been updated and there were discrepancies including about people’s end of life wishes.

People told us they felt safe in the home. Staff were knowledgeable about safeguarding adults from harm. Incident records showed the provider had taken appropriate action when incidents happened.

Recruitment records did not show staff had been recruited in a safe way.

Staff received the training and support they needed to perform their roles.

The home supported people to take their medicines. The home completed regular audits of people’s medicines to ensure they were correct. However, the home was not always following the prescriber’s instructions for when medicines should be taken.

The home was working within the principles of the Mental Capacity Act 2005. Where people lacked capacity to make decisions appropriate best interests processes had been followed. Staff supported people to make their own choices where they were able to do so.

People told us they liked the food. The home encouraged people to be involved in choosing the menu and supported people to eat a healthy, balanced diet in line with their preferences.

Records relating to people’s health and the support they needed to access healthcare services was old and out of date. They had not been updated since 2015.

People and staff had developed strong, caring relationships with each other. Staff supported people to maintain their dignity and respected their privacy.

Care plans contained details of people’s religious beliefs and people were supported to practice their faith if they wished to do so.

People were supported to maintain their friendships and relationships. Care plans considered people’s sexuality and their support needs in relation to their sexuality.

People attended regular one-to-one and house meetings where staff listened to and responded to their feedback about the service. The home had a complaints process in place that was accessible to people who used the service.

The provider had not identified that health and safety checks were not being completed as required, or that some records were no longer being maintained. The provider had not identified that some information in staff and care files was out of date, incomplete or inconsistent.

We found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we asked the provider to take at the back of the full version of this report. We also made two recommendations about supporting people to have their healthcare needs met, and identifying and recording people’s end of life wishes.

We observed during our visit that people engaged in various activities such as attending day centres and shopping with staff. On the day of our visit three people were out of the home and one was taken out during our visit.

We were not able to speak with people who used the service as they were not able to verbalise their needs. We tried to make contact with the relatives of people who used the service, but did not receive any response.

The provider had two policies regarding managing medicines. One was dated as last reviewed in 2010 and the other had been reviewed in 2013. We noted that the policies provided conflicting information to staff.

We found that staff did not receive supervision and appraisals in line with the provider's supervision policy.

We found that each person who used the service had a care file which contained details of their care plan, finances and other professionals involved in their care.

We found that the provider had not notified us of a change to the registered manager.

Staff told us they were well-supported and happy to work at the home. They received ongoing training and knew how to look after the people who used the service.

We found that people's individuality was recognised, their needs were met and their well-being was monitored. They were involved in a range of activities both in the home and in the community.