Acacia Bank Care Home

Updated 14 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 3 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Beeches Care Home is a ‘care home.' People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Beeches Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A manager had been in post over 3 months, but the Care Quality Commission had not received an application from the manager to register.

Notice of inspection

This inspection was unannounced. Inspection activity started on 6 December 2023 and finished on 13 December 2023. We visited the care home on 6 and 11 December 2023.

What we did before the inspection

We reviewed information we had received about the home since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their home, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 11 people who were using the service and 1 relative of a person who used the service about their experience of the care provided. We spoke with 12 staff members in total, including 8 care staff, the regional lead, manager, the deputy manager, head of care and cook.

We reviewed a range of records. This included 8 people's care records, 11 people’s supplementary charts, multiple medication records, and we looked at 3 staff recruitment files. A variety of records relating to the management of the home, including some policies and procedures, were reviewed. We also carried out a visual inspection of the premises and carried out observations of people's care and support.

After the inspection

We continued to seek clarification from the provider to validate evidence found. This included premises and equipment records and training data.

Updated 14 February 2024

About the service

The Beeches Care Home is a care home providing personal care to older people, some of whom were living with dementia. The service is registered for 60 people, at the time of our inspection there were 23 people living at the home. The home has two floors however the provider had moved all people to the first-floor unit, with the ground unit remaining empty.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

Risks were not being well managed for people, and where risks had been identified staff were not keeping contemporaneous care records. We were not assured the provider had effective systems for safeguarding vulnerable people. Recruitment processes were not consistent and staff deployment was not safe or effective. Medicines were not well managed, and the provider's governance systems had not identified the shortfalls we found on inspection.

People and relatives told us they felt safe in the service but they often had to wait for support and staff did not have time to spend with them. One person told us, “Most staff are alright, some can be short with me if I don’t do things quickly enough.”

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.

We were assured staff and the provider were following and promoting safe infection prevention and control practices.

Right Care:

Care plans were inconsistent in detail. Some lacked relevant information such as appropriate risk assessments, and some care plans failed to capture people’s choices, wishes and preferences. The provider did not have effective oversight of personal care records which did not capture when people had received baths or showers. Nutritional requirements were not being well managed and care staff failed to keep accurate records of people’s food and fluid intake, in line with their requirements.

People’s feedback regarding the provision of food and snacks was mixed. Some people told us they had cooked dinners and enough fluids. Other people told us the quality of the food varied and not everyone reported receiving offers of snacks between meals.

The provider was working well with other professionals such as GP’s district nurses, occupational therapists, relatives confirmed the involvement of these professionals in people’s care.

Right Culture:

The provider did not have effective systems to monitor the quality of the care provided and therefore had failed to drive improvements. There had been inconsistent leadership and management in the service which had resulted in poor governance and oversight. Despite activity coordinators being employed, and some activities taking place, during both days of inspection we found there were many examples of missed opportunities for staff to meaningfully engage with people outside of a planned activity.

People told us staff did not have time to engage with them, and one person told us, “I think they could do with more staff. The staff are always busy.”

Staff felt supported by the new manager and provided positive feedback for being approachable and supportive.

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 inadequate (published 19 June 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve promoting dignity and respect and good governance. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 4 and 6 April 2023. A breach of legal requirements was found. We initially undertook this focused inspection on safe, caring and well led, to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there was a concern with adhering to the principles of the Mental Capacity Act 2005, and person-centred care planning, so we widened the scope of the inspection which included the key questions of effective and responsive.

We have found evidence the provider needs to make improvements. Please see the safe, effective, responsive, and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Beeches Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person centred care, safe care and treatment, safe administration of medication, nutrition and hydration, good governance and staffing at this inspection.

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

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures.' This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.