Archived: Beechwood - Care Home with Nursing Physical Disabilities

Beechwood is a care home providing personal and nursing care for up to 26 adults with physical disabilities, acquired brain injuries, sensory impairments and learning disabilities in one adapted building. At the time of our inspection there were 17 people living at the service.

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

The providers systems and processes had not been robust, which put people at risk of financial abuse. Once this had been identified these systems had been improved to protect people from harm. A separate review of a specific incident is currently underway and was not reviewed as part of this inspection.

At this inspection we checked and found improvements had been made to audit systems and processes. The provider and registered manager must now demonstrate they can consistently meet the regulation and demonstrate continuity in a well led service.

There was a large number of staff vacancies at the home and the provider relied heavily on agency staff to ensure staff numbers were maintained. Staff recruitment was safe and there were enough staff to provide people with the person-centred support they needed. Staff received the training and support they needed to carry out their roles effectively.

Care plans were person-centred and were reviewed regularly although people and were appropriate their relatives were not always involved. They gave detailed information to staff to guide them on the care and support people needed.

People felt safe living at the home. The home was clean. Risks were managed. Medicines were managed safely. Staff helped people to stay healthy and people had access to a range of health care professionals.

Staff interacted with people in a kind and sensitive manner. People seemed relaxed and comfortable in the company of staff. People spoke positively about the staff who supported them. Everyone was positive about the registered manager and the way the service was organised and run.

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.

There was a range of activities on offer, both in the home and in the community to help prevent people becoming socially isolated and to keep people active. People were supported to have access to work opportunities.

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 (report published 20 July 2018) and there was one breach of regulation. 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.

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.

Beechwood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 22 people in one building.

There was a registered manager in post but they were absent from the service at the time of the 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.

People told us they felt safe living at the home. Staff we spoke with were knowledgeable about safeguarding people and could explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans were in place to reduce the risks and ensure people’s safety. Personal emergency evacuation plans lacked some detail in relation to evacuating people in the event of a fire. Night time staffing levels were a concern and there was no system in place to accurately determine staffing levels.

Environmental checks had not been completed robustly, although the provider had plans in place to recruit additional maintenance staff to improve this. Refurbishments were taking place and the provider was working towards improving the safety of the home in the event of a fire.

Medicines management had improved since our last inspection and there were systems in place to monitor this. We saw people received their medicines in a timely way from staff who had been trained to carry out this role. People managed their own medicines where they had been assessed to do this safely and staff competencies had been assessed in line with good practice.

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. The manager had complied with their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had regular reminders about the principles of the Act and the peripatetic manager had worked hard to enhance staff knowledge to ensure people’s human rights were protected.

Menus had been planned with people at the home to improve their choice and plans were in place to ensure the availability of fortified snacks for people to take without the need to ask during the day. People were sensitively supported at mealtimes, which were a relaxed and enjoyable experience for people at the home. Some improvements in records relating to people’s food and fluid intake was required and the registered provider acted immediately to rectify this.

Staff interacted with people with warmth and respect and we saw the atmosphere in the home was friendly and supportive. Staff were able to spend time chatting and laughing with people.

People felt able to raise any concerns with staff which was an improvement from our last inspection where we found concerns and complaints had not been acted upon.

The provider was in the process of changing all care plans to provide better guidance for staff. Care plans which had not been updated contained person centred information but the sheer volume of records made it complicated for staff to read.

The home had not been well-led and there had been a lack of robust monitoring by the registered provider. However, detailed audits had been carried out by national, regional and the peripatetic manager which had identified where there were issues including the lack of robust audits. There were plans in place to improve the home within a set time-frame to ensure they were fully compliant with the regulations. This included ensuring staff were supported to develop in their roles by in-depth supervision, robust assessment of staffing levels, improved records and more robust audits.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to developing staff skills. You can see what action we told the provider to take at the back of the full version of the report.

Beechwood provides accommodation and nursing care for up to 26 adults with a physical disability. It is located in a large house with an accessible garden. On the days we inspected there were 19 people in the home.

There was a registered manager in post who had been with the home since 2002 and they were available both days of the 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.

People said they felt safe and staff had an awareness of what may constitute a safeguarding concern. Concerns were reported appropriately.

There were still concerns with staffing levels as evidenced during the previous inspection. This meant people were not always able to have a shower or bath when they wished or participate in their preferred activity. Call bell data was not available to look at response times but we saw continued discussion in residents’ meeting minutes and from what people told us that staff were continually busy. There was no evidence staffing was based on the needs or dependency levels of people using the service which meant people’s experiences were sometimes poor.

Risk assessments were in place but did not always address the area of risk identified, such as entrapment or suitable equipment provision. One person had been noted as at risk of falls so had specialist mobility equipment but this had not been considered in relation to their personal care needs.

Medication was recorded and administered in line with requirements but there were minor issues with storage of creams.

The environment needed considerable updating and the home was due further re-decoration.

People’s dining experience was varied with some liking the food but others saying the choices were poor. This was after the menus had been changed to accommodate people’s preferences. Staff did support people to eat and drink but not always in the most sensitive manner, by standing next to them and not engaging with people.

Staff had not received regular supervision and there were significant gaps in training received. Some of this was due to changes in Head Office but it meant staff had not received the current guidance for the day to day support of people in the home.

Knowledge of the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards was poor as people were not accurately assessed in relation to their levels of capacity.

People spoke with us about the lack of choice in relation to care staff, especially in regards to gender and cited some examples of practice which lacked empathy.

Activities were organised for people on a group and individual basis but relied heavily in the input of volunteers as staff did not have time to spend with people. There was a range of activities and people we observed seemed to enjoy them.

Care records were person-centred and written in conjunction with people who helped determine how they wished to receive support.

Complaints were not handled well as low level concerns were not logged, and people told us they had not received acknowledgement or outcomes of concerns they had previously raised.

We found mixed views as to people’s experience of living at Beechwood, some people liked it and others felt it was too institutionalised. There appeared to be a lack of overall quality scrutiny and improvements focused solely on the environment, rather than quality of care provision. Many of the issues raised returned to the same theme of ‘lack of funding’ and there appeared little attempt to consider alternatives.

We found breaches of Regulations 10, 12, 16, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three staff, including the manager and three people who used the service.

We found there was enough permanent qualified, skilled and experienced staff to meet people's needs.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Following the initial evening visit, we also returned to the service the morning of a second day. This was because some of the information we required to make our judgments, was not accessible at the evening visit.

At the time of our inspection we talked with five people who used the service, two relatives and five staff.

Comments from people who used the service about the care they received included:

'The staff here is are A1. It is unbelievably good and we are well looked after.'

'If I had any concerns I would know who to talk to. I would go to the manager and he would sort it out.'

'We get good care, 24 hours a day.'

'(The Manager) keeps people up to date. There have been lots of changes since he has come, which have been good. He keeps it clean. He is hands on.'

'I am really settled here. I have a laptop in my room and the internet.'

'Don't use much agency staff.'

People also told us that during the day there were plenty of staff on duty however, in the evening the staffing levels were reduced and sometimes people had to wait longer for assistance.