Beacon House

Beacon House is registered to provide residential and nursing care for up to 40 older people with physical disabilities and those who may be living with dementia. At the time of our inspection there were 34 people using the service.

Accommodation is provided over the ground and two upper floors with various lounges, a dining room, and an accessible garden.

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

There were shortfalls in the assessment of risks to the health and safety of people living at Beacon House. People who had been assessed as having swallowing difficulties and were on a modified diet to ensure they were able to eat and drink safely did not have a choking risk assessment in place.

Nurses practice needed to align with best practice guidance in relation to wound care. Correct procedures were not taking place which meant essential information about people’s pressure wounds was not recorded to ensure the healing process was taking place or not.

Pressure mattress settings did not always match people's weights. We observed 8 mattresses that were not set correctly according to people’s weights. Repositioning charts for pressure area care and food and fluid charts had significant gaps.

Where PRN (as needed medicines) protocols were in place there was no guidance regarding variable doses. For example, when to give 1 tablet and when to give 2 tablets.

We have made a recommendation about the management of as needed (PRN) medicines.

Quality checks and audits needed to be strengthened to ensure areas for improvement were identified and acted upon swiftly. Quality checks had failed to identify the gaps in monitoring charts, incorrect mattress settings, risk assessments not in place, incorrect recording in risk assessments and inconsistencies in recording.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

The registered manager had not always considered or investigated some adverse incidents or reported these to the Local Safeguarding Authority and CQC as required by law.

People were safe because staff knew how to recognise the signs of abuse and how to report it. People and staff felt they would be listened to if they raised any concerns. People received support from staff who had undergone a robust recruitment process. They were supported by regular, consistent staff who knew them and their needs well.

People, relatives, and staff were positive and about the leadership of the service and praised the registered manager. Staff felt well supported and said the registered manager was open and approachable. The service worked in partnership with outside agencies.

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 (published 28 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We inspected and found there was a concern in relation to ensuring consent to care and treatment in line with law and guidance, so we widened the scope of the inspection which included the key questions of safe, effective and well-led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report.

Please see the action we have told the provider to take at the end of this report.

Enforcement and Recommendations

We have identified breaches in relation to assessing risks, monitoring and management of pressure area damage, nutrition and hydration monitoring, the Mental Capacity Act and quality monitoring of the care people received.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

at this inspection.

¿ Beacon House provides accommodation, support and care, including nursing care, for older people, some of whom may be living with dementia. The home was clean and airy. All areas in the home were thoroughly cleaned each day with some additional cleaning procedures for `high traffic areas` taking place several times a day. Infection control audits were completed daily, weekly and monthly. These were effective in identifying any shortfalls and actions were taken promptly.

¿ Staff were provided with Personal Protective Equipment (PPE) and a designated PPE champion on each shift ensured staff were wearing their PPE in line with national guidance. Staff we seen were wearing their PPE the correct way.

¿ The provider’s admission and visiting policies were robust and staff adhered to these. Visits from family members were booked in advanced and facilitated outdoors or indoors. The room used for indoor visits was next to the front entrance and a transparent plastic shield separated visitors from people.

¿ When people were admitted into the service, they were accommodated on the top floor in the isolation unit for 14 days after which they could move into their permanent room. People and staff were regularly tested and contingency plans were in place in case any of the test results came back positive COVID-19.

¿ Risks to people and staff in relation to their health, safety and wellbeing had been thoroughly assessed. There was support for staff in place which included provision of training and regular supervisions.

¿ A robust package of policies, procedures and guidance had been developed which the registered manager had successfully implemented at the service.

Further information is in the detailed findings below.

This inspection was undertaken by one inspector and an expert by experience who had experience of people living with dementia. At the last inspection on 1 December 2015 the service was rated as ‘good’. At this inspection we found the service remained ‘good’.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 understood what was important to each person and worked closely with each other and other professionals to promote people’s well-being.

People had care plans in place. These recorded people’s individual choices, their likes and dislikes and any assistance they required. Risks to people who lived at the service were identified, and plans were put into place by staff to minimise these risks and enable people to live as independent and safe life as possible.

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 support this practice.

People and relatives said staff were kind and caring. Staff treated people with dignity and respect. People were confident to raise any concerns they had and felt that they would be dealt with appropriately.

Staff understood their roles and responsibilities and were supported by the registered manager to maintain and develop their skills and knowledge by way of supervision, observations, and appraisals. Staff were trained to provide safe and effective care which met people’s individual needs and knew people’s care requirements well. Staff had the necessary training and used recognised distraction techniques to lessen people’s anxiety.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. We found that people who lived at the service and their relatives were encouraged to share their views and feedback about the quality of the care and support provided.

Further information is in the detailed findings below.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

The people we spoke with told us they felt safe living at Beacon House. One person said, 'I really do like being here. Everyone is so caring; they all make me feel very safe.' We observed that care plans included risk assessments to promote people's safety such as assessments for malnutrition, the risk of falls and movement and handling. We also observed staff used safe movement and handling techniques.

Staff told us that they involved other health and social care professionals to support people with their needs. We saw evidence to confirm this in the care records, with evidence of engagement with mental health professionals and GPs.

We found that the premises were well maintained with no risks to people's safety. We saw windows were fitted with appropriate safety equipment such as window restrictors and that call bells were accessible throughout the home. We found no evidence of trip hazards and saw that people had easy access to the outside of the home.

We found that there was enough staff on duty to support people safely and to meet their needs appropriately.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DOLs). We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.

Is the service effective?

We found that people or their relatives were involved in their care planning. It was evident that people had stated their preferences, and this meant steps were taken to involve people in making decisions about their care and support. We observed that staff we spoke with had a good understanding of people's needs and knew how they preferred to be supported. This meant people were supported appropriately in relation to their needs.

The records we reviewed evidenced that the risks around people's nutrition and hydration and other specific needs were monitored and managed.

Is the service caring?

We observed that staff had a good understanding and knowledge of people's needs and preferences and supported them appropriately. People told us that staff were all very caring. One person said, 'I know that people look after me and care for me.' We saw that staff were respectful and promoted the dignity of the people who used the service.

Is the service responsive?

During our inspection we found that call bells were responded to in a timely manner. The staff team had regular updates of their training to ensure they had the skills and knowledge to meet people's needs. This ensured that people were cared for, at all times, by staff that had the appropriate training.

The home had an activity coordinator in place to provide stimulation for the people who lived at Beacon House. A variety of internal activities and visiting entertainers provided entertainment for people, who told us they enjoyed this.

We found that a variety of stakeholders had been requested to give their views on the care provided as part of satisfaction questionnaires. The manager confirmed these had been evaluated and we reviewed a copy of the improvements that needed to be actioned.

Is the service well- led?

At the time of our inspection we found that the service had a registered manager in place. A previous registered manager had yet to apply to deregister and we discussed this with the provider who advised us they would make the appropriate application.

Staff told us they felt able to speak with the manager and were confident the manager would address any issues they raised.

We found that there were effective procedures in place to monitor and improve the quality of the service provided. Systems were in place to ensure that staff had the right skills to care for people safely and individual plans of care reflected people's health care needs and personal preferences.

Prior to this inspection the Care Quality Commission (CQC) received information of concern about the care and welfare of people at Beacon House. Although we had no information to suggest that harm had been caused, it was alleged there had been issues in respect of possible poor care and neglect. We found no evidence to substantiate these allegations.

We spoke with four people and one visitor and found that people were content with the care and support they received. Some people we met had dementia care needs and exhibited variable behaviour. We reviewed their care records to ensure the care they received was documented and agreed by them or their representatives.

People we spoke with told us they were happy. One person said, 'Staff are always kind to me and listen to what I want.' Another said, 'I'm happy, it's ok here.' A visitor told us, "I am always greeted by friendly staff." We observed staff providing care and saw they were responsive to the needs of people. During our observations we noted that one person appeared cold. Staff offered them a blanket and ensured they were comfortable.

At the time of our visit, 30 people were living in the home. We spoke with seven people, although due to some people's dementia needs, not everyone was able to tell us about their experiences at Beacon House. We therefore used a number of methods to help us understand the experiences of people using the service, including observation and talking with people's relatives and care staff.

One person's representative said they were happy with the care provided. They told us, "I visit on a regular basis and staff are always really very kind to me and .... Although they are busy, they take time to talk." People who were able to speak with us told us they felt well cared for and were always supported by staff. Two people said that staff were "lovely", and one person said, "I like being here. The home is nice and I get the care I need."

We observed staff respecting people's privacy and dignity and providing respectful care and support to people. We observed this was delivered in line with the care records we reviewed in order to meet people's needs.

We saw that clear processes were in place to manage any concerns or complaints made. The home had received a number of compliments which were displayed for people to read.

Three people told us the staff were 'wonderful' and 'very caring', and other people told us they 'couldn't fault anything about the care or home'.

One person had recently been admitted to the home and said they were 'very happy' and enjoyed living there.

We observed a relaxed, friendly atmosphere, with good interactions between all staff members and people within the home.