Two Beeches Nursing Home

Updated 11 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection completed on the 6 November 2018 and was unannounced. One adult social care inspector, a specialist advisor in nursing and an expert-by-experience completed this 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.

Prior to the inspection we looked at other information we held about the service such as notifications and previous reports. The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. At our last inspection of the service in April 2016 we did not identify any concerns with the care provided to people.

During the inspection we met all the people who lived at the service and spoke with some in details about their care. Some people living at the service were living with dementia which meant they had limited ability to communicate and tell us about their experience of being supported by the staff team. Therefore, staff used other methods of communication, for example by providing visual prompts. Others were able to tell us about the care and support they received. As some people were not able to comment specifically about their care experiences, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people living in the service.

We also looked around the premises. We spoke to the registered manager, ten staff and three relatives. We also received feedback from two professionals via email. We looked at records relating to individual’s care and the running of the home. These included four care and support plans and records relating to medicine administration. We also looked at the quality monitoring of the service.

Updated 11 December 2018

We carried out an unannounced comprehensive inspection on 6 November 2018.

Two Beeches Nursing Home is a care home with nursing for up to 25 people. On the day of our inspection there were 20 people living at the service.

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.

There was a registered manager in post. 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.

At the last inspection on the 18 and 19 April 2016, the service was rated Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good:

People remained safe at the service. People when asked said they felt safe. Professionals and relatives said people where safe living in Two Beeches. Some people were not able to fully verbalise their views therefore they were not able to tell us about their experience of living there. We spent time with people seeing how they spent their day and observing the interactions between people and the staff supporting them. However, one person when asked if they felt safe living at Two Beeches they said; ‘Yes’ they did.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff, relatives and professionals said the registered manager was approachable and had made many improvements since being in post. Staff said the registered manager was involved in the day to day running of the service. One relative commented; ““The company is exceptional.” One staff member said; “I love my job here!”

People received their medicines safely from suitably trained staff. People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people. People, relatives and staff agreed there were sufficient staff to keep people safe. Staff said they were able to meet people’s needs and support them when needed.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible. Robust systems were in place to assess risks and ensure measures were put in place to further reduce those risks to protect people.

People lived in an environment that was clean and hygienic. Areas of the environment continued to be updated and refurbished, considering people’s individual needs.

People received care from a staff team who had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company.

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. People's healthcare needs were monitored by the staff and people had access to a variety of healthcare professionals.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. People’s safety and liberty were promoted.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought.

People’s care records were personalised to meet their individual needs. Staff understood people’s needs and met them. People were not all able to be fully involved with their support plans. For example, due to living with dementia. Therefore, family members or advocates supported staff to complete and review people’s support plans in their best interests. People’s preferences were sought and respected. Care plans held full details on how people’s needs were to be met, taking into account people’s preferences and wishes. Information held included people’s previous history and any cultural, religious and spiritual needs.

People were observed to be treated with compassion by the staff who valued them. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

The service was responsive to people's individual needs and provided personalised care and support. People’s equality and diversity was respected and people were supported in the way they wanted to be. People who required assistance with their communication needs had these individually assessed and met. People were able to make choices about their day to day lives. The provider had a complaints policy in place and records showed all complaints had been fully investigated and responded to.

People had access to organised and informal activities which provided them with mental and social stimulation.

People’s had their end of life wishes documented. People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained. The staff worked with other organisations to make sure high standards of care were provided and people received the support and treatment they wished for at the end of their lives.

All significant events and incidences were documented and analysed. The evaluation and analysis of incidents was used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback to assess the quality of the service provided was sought from other agencies and the staff team.

The service continued to be well led. People lived in a service where the provider’s values and vision were embedded into the service. People, relatives and staff said the providers and registered manager were approachable. One staff member said; “They will always listen to what I have to say.”

People lived in a service which had been designed and adapted to meet their needs. The service was monitored by the management team to help ensure it’s ongoing quality and safety. The provider’s governance framework helped monitor the management and leadership of the service. The provider listened to feedback and reflected on how the service could be further improved. The provider had monitoring systems which enabled them to identify good practices and areas of improvement.

The registered manager and provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.