Beechcroft House Residential Home

Beechcroft House is a residential care home providing personal and nursing care to eight people aged 65 and over at the time of the inspection. The service can support up to 25 people in one adapted building.

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

The provider had not ensured there was an effective fire safety risk assessment in place. Policies were not consistently up to date. The governance arrangements in the home were not consistently effective in identifying areas for improvement or capturing when action had been taken.

We have made a recommendation about window restrictors.

People were supported safely; risks were assessed, and plans put in place to reduce them. Staff understood how to protect people from abuse. There were enough staff to support people safely. Medicines were managed safely, and staff were following guidance for infection prevention control. When things went wrong there was a system in place to learn from this.

People, relatives and staff spoke positively about the home and the management team. There were systems in place to seek people’s views and the registered manager took opportunities to work in partnership with others and learn about new practices.

Rating at last inspection

The last rating for this service was good (published 06 August 2019).

Why we inspected

We received concerns in relation to risk management and building safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe 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 Beechcroft House Residential Care Home on our website at www.cqc.org.uk.

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.

We found the following examples of good practice.

• Visits from relatives took place in a safe way. Temperature checks of visitors were completed and Personal Protective Equipment (PPE) was supplied by the service to ensure people were protected from the risk of cross transmission.

• When visits were restricted other methods were used to ensure people continued to have contact with their loved ones such as, video and telephone calls. The registered manager kept in regular contact with relatives to ensure they had up to date information about their relative’s wellbeing.

• The environment was well maintained and clean. Additional cleaning had been implemented to lower the risk of cross transmission.

• Staff were supported by the registered manager during periods of anxiety and staff had been signposted to external wellbeing services where needed.

• The registered manager had acted on advice received from professionals to ensure staff followed up to date infection control guidance to keep people safe.

Beechcroft is a residential care home providing personal care to 17 people aged 65 and over at the time of the inspection. The service can support up to 25 people. The home is split over two floors and people have access to two lounges, a dining area and hair dressing suite. Two of the bedrooms could be used for shared occupancy and three bedrooms have en-suite shower rooms.

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

The provider had an audit system in place however, it could not demonstrate the system was reflective of best practice in social care. The provider did not actively connect with health and social care groups and could not demonstrate that they were continuously learning to improve care. People told us they knew who the manager was and felt that they were approachable. Feedback from people using the service was requested on an annual basis. The provider met the requirements under the duty of candour to share information as required.

People were safeguarded from abuse by staff who had received the appropriate training. Risks to people’s safety were assessed and plans were in place to mitigate identified risks. People were supported by sufficient numbers of staff and people received their medicine on time by staff trained to administer. Effective infection control procedures were in place and lessons were learnt when things went wrong.

People’s care needs were assessed on admission and care plans were created and reviewed on a regular basis. Staff received compulsory training to meet the requirements of their role. People were supported to maintain a balanced diet and provided with regular drinks and snacks. People were supported to have a smooth transition into the home and had good access to health care. The home was adapted to meet the needs of the current group. 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.

People were well treated by staff and shown kindness throughout their day. Staff involved people in decisions about their care. People’s dignity and independence was maintained.

People received care that was personalised to their needs and information was made accessible. People were enabled to maintain and develop their relationships with others. Any complaints received were investigated and feedback was given. At the time of inspection there was no one in receipt of end of life care however people’s advance wishes were recorded.

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 14 December 2016).

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.

Beechcroft Residential Home provides accommodation and personal care for up to 25 people. There were 16 people using the service at the time of 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.

People were safeguarded from abuse as the registered manager and staff knew what to do if they suspected a person had been abused. Staff told us they knew the provider’s whistle blowing procedure and who to contact if they thought the registered manager and provider had not acted upon allegations of abuse.

Risks of harm to people had been assessed and plans had been put in place to minimise the risk. Staff knew people’s individual risks and followed people’s risk assessments to keep them safe.

There were sufficient suitably trained staff to keep people safe. Senior staff were trained to administer people’s medicines and people’s medicines were stored and administered safely. The registered manager regularly checked that people were receiving their medicines as required. Staff were employed using safe recruitment procedures.

The principles of the MCA 2005 were being followed as people were consenting to or being support to consent to their care at the service. DoLS referrals had been made for people who lacked mental capacity to agree to their care.

People were cared for by staff who felt supported and had been trained to fulfil their role effectively. People told us that staff were kind and treated them with dignity and respect.

When people became unwell or their health care needs changed, health care support and advice was gained. People were encouraged to eat and drink sufficient amounts to remain healthy.

People’s choices were being respected and they received care that reflected their individual preferences. People had their own private space where they were able to spend time alone or with their friends and families.

The provider had a complaints procedure and people told us they would speak to the registered manager if they had any concerns and they would act upon them. People who used the service and staff told us that the registered manager was supportive and approachable.

Systems to monitor and improve the quality of service were effective in ensuring a quality service was delivered. People were regularly asked their views on the service to ensure they were happy with their care.

Beechcroft Residential Home provided accommodation and personal care to up to 25 people. There were 21 people using the service at the time of the 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.

People were not fully safeguarded from abuse as although staff knew how to report abuse internally they did not know the safeguarding procedures if they suspected institutional abuse.

Action was not always taken to minimise the risk to people when a risk of harm had been identified following an incident or a change in people’s needs.

Staffing levels had not been assessed based on the individual needs of people. Staff felt there was not enough staff to keep people safe during the evening.

People’s medicines were not managed safely. Some medication was unaccounted for and safe systems for administering medicines were not being followed.

The guidance of the Mental Capacity Act 2005 (MCA) was not being followed when people’s mental capacity had changed to ensure they were supported to consent to their care and support.

People’s dignity was not always supported and maintained.

People, liked being at the service. However, restrictions were in place which did not demonstrate that people’s individual preferences were being respected.

The systems the provider had in place to improve the quality of the service were ineffective as people’s views were not listened to or acted upon.

People liked the food and their nutritional needs were met. People received support from a range of health care professionals when they needed it.

Staff were supported by the registered manager and received training to be able to fulfil their role effectively.

Safe recruitment procedures had been followed to ensure they were fit to work with people prior to employing new staff.

We found four breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the report.

During the inspection we spoke with some of the people who used the service and a representative of a person who used the service. We also spoke with the registered manager and the staff who were on duty during the inspection.

We considered our inspection findings to answer the questions we always ask:

Is the service safe?

People who used the service had their needs assessed and risk assessments had been completed to reduce any risks to people's health and well-being. Records were accurate and had been reviewed to ensure they were up to date.

There were procedures in place to protect people in an emergency.

Staff had been appropriately trained to meet the needs of people who used the service.

The provider identified and managed risks to the health and safety of people who used the service, staff who worked there and people who visited.

Is the service effective?

People's health and social care needs were assessed and plans were in place to provide the support they required. People's needs were regularly reviewed and updated to ensure that care plans remained effective.

People were referred to health care professionals as required and were supported to maintain their physical and mental health care needs.

People were encouraged to be involved in their care.

Is the service caring?

The staff knew people well and the people who used the service looked relaxed and comfortable in the company of staff. We observed positive interactions between the people who used the service and staff. Staff were patient with people and encouraged them, with support, to take responsibility for their daily living tasks. A person who used the service told us: '10 out of 10 here. It is a very good home".

Is the service responsive?

The home had a complaints procedure. People we spoke with said they would tell the staff if they were worried about anything. A person told us: "You can approach the manager or any of the staff about anything. They will always listen".

People living in the home and/or their representatives were enabled to share their opinions with staff, as the provider regularly sought their views and suggestions.

Is the service well led?

Staff who worked at the home felt well supported by the manager. One person said: "This is the best home I have worked in. The manager here is really good".

There was clear, comprehensive and detailed information to support staff in caring for people.

Staff training was provided and staff received regular individual supervision. This meant that staff had the opportunity to discuss their own personal development.

There was evidence of quality monitoring having taken place to monitor, audit and improve the services provided.

During the inspection we spoke to people who used the service, a relative, a visiting health professional and staff members who were available on the day.

We looked to see if people who used the service consented to their care, treatment and support. We found that the service had systems in place to show that people had consented to their care.

We looked at care records and observed people's care being delivered and found that the service was meeting the care and welfare needs of people who used the service.

We checked that equipment within the service was safe and available for use. We found that equipment was well maintained and appropriate for its intended use.

Staff we spoke with told us they liked working at Beechcroft House and felt they were supported to fulfil their role effectively.

We found that the service had a complaints procedure to receive and respond appropriately to any complaints made by people who used the service or their representatives.

Beechcroft House was compliant in the five outcome areas we looked at.

We spoke with people who used the service who told us they were no longer being got up early.

We looked at care records and spoke with the managers.

We spoke with relatives of people who used the service who told us they were happy with the care their relative received.

We found the service was now compliant in Outcome 4 Care and Welfare of people who use services.

People who used the service told us they were happy with their care and they liked the staff.

Relatives of people who used the service told us that they were happy with the care their relative received.

People who used the service looked smart and tidy and dressed appropriately and appeared relaxed and comfortable.

At lunch time people were singing to the old time music playing in the dining room and we observed the food looked healthy and appetising.

The service was decorated for Halloween.

We have concerns over the routines within the home which people who used the service told us meant they had to get up unnecessarily early.