Beverley Grange Nursing Home

We found the following examples of good practice.

The service was extremely clean, tidy, and well maintained. A cleaning schedule was in place which included additional cleaning of frequently touched areas such as door handles. Windows were open where possible to support good ventilation.

The registered manager had a good understanding about the impact of the pandemic on the people they supported. They recognised the particular difficulties they faced and did all they could to make reasonable and safe adjustments to support people and meet their needs.

Staff wore personal protective equipment (PPE) appropriately and the service had ample stocks of PPE available throughout the service.

Where people had been unable to consent to COVID-19 tests or vaccinations, the provider had ensured the Mental Capacity Act 2005 had been followed.

When we completed our previous inspection on 5th June 2017 we found concerns relating to record keeping processes which were ineffective in monitoring and improving the quality and safety of the service, assessing and mitigating risks and maintaining contemporaneous records of each person using the service. At this time these topic areas were included under the key questions of Responsive and Well-Led. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these topic areas are included under the key question of Effective and Well-Led. Therefore, for this inspection, we have inspected these key questions and also the previous key question of Responsive to make sure all areas are inspected to validate the ratings.

Beverley Grange 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.

Beverley Grange provides accommodation and support to a maximum of 75 people some of whom may be younger or older adults that may have physical disabilities and/or living with dementia. At the time of our inspection there were 59 people using the service. The home is purpose built and split into two areas, the first floor is for those people requiring nursing care and the ground floor for people that are more mobile and independent. There are seven bungalows within the grounds of the home three of which were occupied at the time of this inspection. People could live as independently as they could with support available if needed. A large garden with a greenhouse and raised beds of flowers surrounded the home and parking is available on site. The home is located on the outskirts of Beverley in East Yorkshire.

There was a registered manager in post at the time of this inspection. 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.

Staff had exceptional skills and expertise to empower people and their families to be involved in the care planning process. Management supported staff by offering specialist training which supported them to achieve responsive and effective care outcomes.

Records showed staff were innovative and proactive in their approach. Staff worked above and beyond to support people, they arranged multi agency support frameworks, offered support for those transitioning back into the community and worked tirelessly to ensure nursing care was continuously improved to demonstrate high standards of achievement in areas such as pressure care.

Staff were highly skilled at enabling people to explore different innovative communication methods find those that best suited individuals and their capabilities. Relatives told us that staff were patient, friendly and very kind when facilitating people’s freedom to express themselves. This supported an inclusive environment with equal opportunities for all people living at the service.

Relatives feedback praised staff for their kindness and professional manner towards those people requiring palliative care. Staff spoke passionately about ensuring people were comfortable and meticulously cared for during end of life care. Relatives had thanked staff for their exceptional support, care and attention during difficult times.

Staff took time speaking with people about their life histories and captured this information to support people to achieve their future aspirations. People were encouraged to get involved with activities and event planning that incorporated parts of their life stories. People spoke proudly of their achievements and felt a sense of value and belonging within the home.

Detailed risk assessments had measures in place to mitigate risks such as, choking or falls. Records such as food and fluid intake had been accurately documented to reflect amounts taken each day. Guidance on best practice was readily available should staff need to refresh their knowledge.

The provider had various quality assurance processes in place to maintain good practice and improve quality standards within the home. The registered manager told us they were in the process of updating all their quality assurance systems to maintain good record keeping and monitoring to drive continuous improvements within the home.

People were protected from avoidable harm and abuse. Systems and processes were in place to minimise the risks and guide staff should they need to report a safeguarding incident. Staff were knowledgeable about the signs and types of potential abuse and how to report them.

Staff responsible for administration of medicines received regular training and competency checks. Medicines were administered safely and stored at correct temperatures. Medicines for pain relief were monitored to ensure they were effective.

The provider maintained safe staffing levels and robust recruitment checks were in place to ensure people were of suitable character to work in a care home environment.

Staff were encouraged to develop their skills and knowledge. The provider had employed an external trainer to support them in accessing the right courses to develop staff in their role. Regular supervisions and annual appraisals were in place to support staff. This meant that people received a higher standard of care as the staff team had developed their own knowledge and understanding in terms of caring and supporting people in the right way.

People were 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.

We observed staff promoting people’s dignity and privacy. Staff were knowledgeable about how they could ensure people maintained their independence. This included supporting people’s diverse needs and promoting equality in the home.

Systems and processes were in place to support people should they need to raise a complaint. Relatives told us that the registered manager was proactive in dealing with any concerns.

The provider sought feedback from people and their relatives to improve the service and lives of people living at the home. Staff and relatives told us the registered manager was approachable and supportive. We observed both people living at the service and their relatives speaking to staff without prior appointment throughout the day.

Management were always visible and the owner had a hands-on approach which made staff feel supported. The atmosphere was warm, jovial and welcoming.

Beverley Grange Nursing Home provides accommodation and care for a maximum of 75 people over the age of 18. The service provides support for people who may be living with dementia or who may have a physical disability. At the time of our inspection there were 56 people using the service.

The provider is required to have a registered manager as a condition of their registration for this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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, the service did have a registered manager and we have referred to them as 'the manager' throughout this report.

Quality assurance and record keeping within the service needed to improve. There was a lack of effective auditing within the service. We found that care plans, risk assessments and food/fluid charts were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm. This is a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of this report.

People told us they felt safe and were well cared for. The provider followed robust recruitment checks, to employ suitable people. There were sufficient staff employed to assist people in a timely way. Medicine management practices were being reviewed by the manager and action was taken to ensure medicines were given safely and as prescribed by people’s GPs.

Staff had completed relevant training. We found that the care staff received regular supervision and yearly appraisals, to fulfil their roles effectively. However the frequency of supervision for new starters and the trained nurses needed to be more consistent.

People were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment from external health care professionals when necessary, such as the district nursing team and speech and language therapists.

People had access to adequate food and drinks and we found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals.

People were treated with respect and dignity by the staff. People and relatives said staff were caring and they were happy with the care they received. They also confirmed they had been included in planning and agreeing the care provided. People had access to community facilities and most participated in the activities provided in the service.

People and relatives knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with.

People told us that the service was well managed and organised. People and staff were asked for their views and their suggestions were used to continuously improve the service.

We did not speak directly with people who lived in the home as we were following up on the previous inspection when people's views had been incorporated into the judgments at that time. No comments had been received in relation to documents or paperwork.

We found that the provider had taken action and previous issues in relation to care files had been addressed. Records were more person centred, care plans included all areas of need and monitoring forms were on the whole up to date. With only minor work now required to ensure that all details were recorded.

Staff files were more detailed and information recorded in the staffing matrix cross referenced with that held in individual files.

We saw some documents in relation to the management of the home and these were up to date.

Records were stored securely with only minor improvements required to help ensure that data was fully protected.

People who lived in the home told us 'I am very satisfied' and ' I am glad I came here' when asked about life in the home. They confirmed staff were polite and we observed appropriate support being offered to people. One person confirmed they had been asked to complete a questionnaire about life in the home.

We found that the provider, manager and staff had undertaken a large amount of work in response to our concerns. However additional work was still required.

A new system of care planning had been implemented to help ensure that all of a person's needs were recorded and supported.

New staff training records both for individual staff and an overall matrix had been updated and supervision sessions had taken place.

Maintenance records were now in place; as were risk assessments.

However improvements continued to be required as care plans did not all contain all of the relevant information and staff training record details did not match the matrix.

There was little evidence that people had consented to their care plans or that people were involved in the development of their packages of care. There was some information in relation to people's choices, although we observed two instances when peoples choices were restricted. One person told us, ' I felt like I was being told off.'

Staff were aware of maintaining people's privacy and we observed this in practice.

We found that there were discrepancies in the recording of people's information which could have a negative impact on the care provided in the home.

We found that safeguarding issues had been reported appropriately although there was a need for an improved policy and improvements in staff training in this.

Staffing levels appeared adequate although staff training required some improvements.

Systems were in place to audit the home and to find out people's opinions of their care. However there were some omissions in records for maintenance.