Beechill Nursing Home

Updated 16 August 2023

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

One inspector and an Expert by Experience carried out the inspection. 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

Beechill 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. Beechill is a care home with 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 CQC 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 a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service 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 service, 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 8 people who used the service and 4 relatives about their experience of the care provided. We spoke with 9 members of staff including the registered manager, general manager, clinical lead, senior care workers, care workers, chef and activities co-ordinator. We made observations of people’s support throughout the inspection.

We reviewed a range of records. This included 3 people’s care records and multiple medication records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed.

Updated 16 August 2023

About the service

Beechill Nursing Home (known as Beechill) is a nursing home providing personal and nursing care for up to 31 people with a range of needs. This included both younger and older adults needing support in relation to physical disability, the misuse of alcohol or drugs, mental health and dementia. At the time of the inspection 26 people were living at Beechill.

There are 23 single rooms and four double rooms across two floors. Each floor has shared bathrooms and toilet facilities.

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 the Care Quality Commission (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.

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

There had been a vast improvement in the relationships between the home and the local authority, commissioning and NHS teams. Beechill had taken part in a pilot project with a range of local authority teams and professionals to complete audits and work together to make improvements. All parties said this had worked well.

The home could not evidence the safe recruitment of staff. References were not in place and there was no evidence of these being requested or chased up. A generic risk assessment was used where there were no references, but this did not evidence additional support for the new staff to ensure they were suitable for working with vulnerable adults.

Assessments of people’s capacity to make their own decisions were completed when they moved into Beechill. Applications for a Deprivation of Liberty Safeguards were made where applicable. However, people’s capacity to make decisions was not regularly reviewed. This meant people were not always supported to have maximum choice and control of their lives. We have made a recommendation for formal capacity assessments to be regularly reviewed.

From our observations, and feedback from people and relatives, staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported support this practice.

There were enough staff to meet people’s needs. People and relatives were complimentary about the staff and said communication with the home was good. Staff received the training they needed for their roles. Staff felt well supported by the management team. A new activities coordinator had been appointed and was starting to develop a range of activities within the home and out in the local community.

Risk assessments and care plans were in place and were regularly reviewed. Staff knew people and their needs well. People received their medicines as prescribed. Some guidance for when ‘as required’ medicines should be administered needed to be more personalised. The home was clean throughout and PPE was used appropriately.

People were supported to maintain their health and nutritional intake. Referrals to medical professionals were made appropriately. Where appropriate, people were supported to manage their drug or alcohol misuse.

An electronic quality assurance system was now in place. Audits were regularly completed, and actions identified. Action following the local authority pilot visits had been completed or were in progress. We have made a recommendation for the staff file audit to be reviewed.

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 23 December 2021) and there was 1 breach of regulations. 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 this regulation. However, a different breach was identified at this inspection.

This service has been rated requires improvement for the last 5 consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a breach in relation to the safe recruitment of staff at this inspection.

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

We have made recommendations for capacity assessments to be regularly reviewed and for the staff file audit to fully take in to account the information required in Schedule 3 of the Health and Social Care Act 2008 for the safe recruitment of staff.

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.