Beckdale House

Beckdale House is a residential care home providing personal care to up to 9 people. The service provides support to younger adults with mental health needs, learning disability and/or autism. At the time of our inspection there were 7 people using the service.

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.

People’s experience of the service and what we found

Right Support

Systems and processes to manage people's medicines were not always effective. People were empowered to make meaningful decisions and choices. People's needs were assessed, risks were identified, and steps taken to keep them safe, and these systems were being embedded.

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.

Right Care

Care was person-centred and promoted people's dignity, privacy and human rights. People were protected from all forms of abuse and discrimination by the dedicated staff team. The service had enough skilled staff to meet people's needs and keep them safe. Infection control and prevention systems were in place.

Right Culture

Governance oversight and quality assurance systems were not robust enough to identify shortfalls. People and relatives were complementary of the service's compassionate culture. The staff team were well trained and dedicated to meeting people's needs. Staff knew people well and were able to communicate effectively with people using appropriate aids as necessary. Staff supported people to engage in their local community. Care was personalised to people's needs and staff reviewed and adapted support as people's needs or wishes changed.

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 (report published 7 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service, specifically, the time elapsed since the last full inspection.

Enforcement and Recommendations

We have identified a breach in relation to safe care and treatment at this inspection. We have made a recommendation around implementing a support model to promote independence and quality assurances.

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.

There was a registered manager at the service. 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 continued to receive safe care and we found there were enough staff to provide support to people that met their needs. We found that people were consistently protected from the risk of harm and received their medicines safely. The provider had safe recruitment procedures in place to ensure that staff were of a good character and suitable to support people who used the service.

People continued to be supported to make decisions about their care and staff sought people’s consent before they carried out support. 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 the provider had in place supported this practice.

People’s health and wellbeing was maintained and staff sought advice if people were unwell. People were involved in meal planning and preparation and people were able to choose what they wanted to eat and drink. Staff received training to enable them to support people’s needs effectively.

People were treated with dignity and staff were caring and kind. People’s privacy was respected an upheld. Staff encouraged people’s independence and respected people’s choices. Staff understood people’s individual communication needs and supported people to maintain relationships with relatives.

People were supported with interests and hobbies that were important to them. People and their relatives were involved in the planning and review of their care. Staff knew people well, which meant people were supported in line with their preferences. People understood how to complain if they needed to because complaints procedures were in a format that people understood. Complaints that had been received had been acted on.

Effective systems were in place to assess and monitor the quality of the service people received. People and staff were involved in the service and encouraged to provide feedback about the service was run. The registered manager was approachable to both people and staff and the registered manager led the team well.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

During this inspection we were unable to speak with everybody who lived at Beckdale House as they did not want to meet with us. Therefore our judgements are based on the feedback from three people we did speak with, the review of records and feedback from other people we spoke with. We spoke with one relative, three care staff, the manager and the deputy manager. Following the inspection we also contacted two external health professionals. Below is a summary of what we found.

Is the service caring?

The people we spoke with were happy with the care and support provided by Beckdale House. We were told the staff helped them to complete their daily routines such as meal planning and cleaning. People told us their privacy was respected and they liked the staff. Comments included; "The staff are really helpful", and "The staff are really good here you can have a laugh with them. We spoke with one relative who confirmed they were happy with the care and support provided.

During the inspection we looked at three care records. In two of the records we viewed we saw they were not always written in a way that promoted people's independence or dignity, encouraged understanding of the care and support in place or considered the individual communication needs of people who lived at the home. We spoke with two people who told us they did not understand the written information within the records. We considered that improvements were required in this area.

Is the service responsive?

We looked at three care records and saw that when appropriate, people were supported to seek advice from other health professionals such as their GP and that people had individual care packages in place. For example care records suggested some people received three hours support a day and this was used to plan budgets or complete household tasks. We saw recorded that other people received continuous support which was provided on a one to one basis. We were unable to speak with people receiving one to one support on the day of our visit as they did not want to talk with us so were unable to ascertain their views or the effectiveness of the support they received

The people we were able to speak with told us they were happy with the care and support they received. We also spoke with one relative and following the inspection we spoke with two external health professionals who expressed no concerns regarding the care provided by Beckdale House at the time of our visit.

Is the service safe?

We saw that some systems were in place to ensure people were safe. We saw that overall, staff had access to training activities to enable them to maintain their knowledge and competence.

During the inspection we asked for the homes policy on physical intervention and asked two staff members if they had read this. They told us they had not. This was a concern to us as staff should be knowledgeable of policies in order to provide care and support in a way that meets the home's aims and objectives. We considered that improvements were required in this area to assure people's safety and wellbeing.

Is the service effective?

We spoke with three people who lived at the home who told us they were happy with the care they received. One person discussed their care with us and told us they felt they had progressed well. We spoke with one relative who told us they were 'confident that (my family member) is receiving really good treatment.'

Is the service well led?

We looked at a sample of audits and saw there were some systems in place to identify when improvements were required. The staff we spoke with told us if any actions were required, these were discussed with the manager and at supervisions, so improvements could be made. We spoke with one relative who told us they found the manager approachable and they would speak with them if they had any concerns. However we noted that some documentation was not always completed and it was therefore not possible to review incidents effectively to identify any triggers. We considered that improvements were required in this area.

We saw a pictorial easy read 'my plan, my choice, my prospect' had been used in some instances to help people explain their needs and preferences.

We observed staff engaging with people who used the service in a supportive and compassionate manner. Staff spoke to people in a friendly manner and knew each individual well.

We spoke with a visiting social worker who told us; 'I think the care and support is of a good standard".

We saw evidence of formal mentoring of support staff by senior staff in areas such as medication administration.

We found the provider had comprehensive systems in place to monitor the quality of the service they provided.

People were provided with the opportunity to express their views and concerns about the service. We looked questionnaires completed by professionals and relatives. Comments included; 'Excellent staff providing quality support at Beckdale House,'

We sampled five staff personnel files. We found each file was current and fit for purpose and contained detailed records which demonstrated that staff had been safely and effectively recruited.

These instructions provided clear guidance to staff on being pro-active in respect of preventing incidents escalating. Each file contained a 'Service User Daily Entry' record which was up-to-date containing detailed information about the person.

We had some concerns about the number of safeguarding notifications that had been made by Beckdale House to the commission in recent months. We reviewed this outcome to assess if the provider had a proactive approach in managing safeguarding in the home. We spoke with two people who used the service and comments included 'I do feel safe here, I am happy', 'The staff are fair, if you do something wrong, that's fair enough' and 'I like the staff and I feel safe'.

We checked how medicines were handled and recorded. Medicine administration records (MAR) were maintained in an appropriate manner. We reviewed charts and found entries were recorded as required.