Archived: The Beeches

The Beeches is a care home which provides accommodation and personal care for people aged 65 and over. The home is registered to support up to 40 people in a single adapted building. On the day of inspection, 36 people lived at the home, some of whom were living with dementia. The accommodation consisted of a single building, arranged over two floors. There were two communal lounges, a conservatory and a large dining room. There were secure, partially covered outside areas and gardens.

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

Governance processes failed to monitor safety and risks effectively to keep people safe from potential risk of harm. The provider had not learnt lessons from the previous inspection and had not taken appropriate steps to improve the care being provided. Staff deployment and identified hazards, such as hot water were identified during the last inspection, these concerns were found again during this inspection.

Staff were not deployed adequately to meet people’s needs and people waited long periods of time to receive support from staff. The monitoring system for waiting times was insufficient and did not account for the amount of occurrences people needed to wait outside of the providers set maximum waiting time.

Risks to people were not always managed effectively to protect them from potential harm. Window restrictors did not comply with safety standards and several radiators were not safely covered in accordance with Health and Safety Executive requirements.

Staff told us how they could recognise unsafe care practices and the action they would take to report poor practice. People and relatives told us they felt the service was safe.

Staff were recruited safely, the provider sought out references and carried out criminal record checks prior to their employment.

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.

Medicines were administered safely. Staff followed systems and processes to prescribe, administer, record and store medicines safely. Medicines were regularly audited and action was taken to address any discrepancies.

The service used effective infection, prevention and control measures to keep people safe. People told us they felt the home was clean and hygienic.

The provider apologised to people, and those important to them, when things went wrong. Relatives told us they felt involved in the service and felt the management kept them updated on changes.

The service worked well in partnership with other health and social care organisations, to monitor people health and improve their wellbeing.

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 12 May 2020) and there were breaches of regulation. 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 the provider remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

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 how the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We received concerns in relation to infection prevention control practice and staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed following this focused inspection and remains requires improvement, based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report. The provider took effective action to mitigate some of the risks during the

inspection.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing) at this inspection.

We have issued the provider with a warning notice. We will check the provider is taking action to comply with the legal requirements set out in the warning notice.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Beeches is a residential care home providing personal care and accommodation to 37 people aged 65 and over at the time of the inspection, some of which were living with dementia. One person was in hospital at the time of our visit, so only 36 people were present in the home. The service is registered to support up to 40 people in a single adapted building.

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

Quality assurance systems had been introduced and improved since the last inspection, however further improvements were needed to ensure they were fully effective at identifying omissions and areas to improve upon. Despite medicine management improving, there were still some areas that required further improvement to ensure instructions were correct and complete for staff and that storage was always appropriate. Infection control had improved as areas of the home were cleaner, however some food hygiene practices needed improving. People were generally protected from risks although water temperatures were not always within a safe range and had not been rectified. Staff were not always deployed effectively which meant some communal areas were not always supervised and supported when they needed to be.

People had plans of care in place and these were reviewed, however reviews were not always clear. Staff knew people’s needs and preferences. People were supported with their communication needs, but we discussed with the registered manager the need to have the ability to enable people to have access to their care plans in alternative formats if necessary. People had access to a range of activities and were positive about the activity coordinator. No complaints had been received but people and relatives felt able to complain. No one was receiving end of life care at the time of the inspection, but the management team were aware of their responsibilities to support people. Practical details about people’s palliative care were in place, but this did not always encompass people’s spiritual or specific preferences for the end of their life.

People were protected from the risk of abuse, staff understood their responsibilities. Safe recruitment checks were in place to ensure staff were suitable to work with people who used the service. Lessons were learned when things had gone wrong as the provider had acted upon feedback and accidents and incidents were now analysed for trends. People were safely supported with moving and handling.

People were supported to have enough to eat and drink and had a choice. 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. Staff received training to be effective in their role and were supervised to ensure they felt supported. People had access to a range of health professionals and daily meeting had been introduced to ensure people had a regular review encompassing most areas of their support. The home was adapted to the needs of people and equipment was available for use.

People were supported by a kind and caring staff team who knew people well. People were supported to make decisions about their care and were supported to be as independent as possible. People were treated with dignity and respect and were given privacy when needed.

People, relatives and staff were complimentary of the registered manager, management team and providers. People, relatives and staff were engaged in the service. People were given the opportunity to discuss and plan for their protected characteristics. The provider had engaged in learning and improving the quality and safety of the service, with much progress being made, although some further improvements were needed. The registered manager was aware of their responsibility to be open and transparent if something had gone wrong. The service worked in partnership with other organisations.

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 (initially published 20 August 2019) and there were four breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the need for consent, safe care and treatment, good governance and the requirement to display performance assessments. The provider completed an action plan after the last inspection to show what they would do and by when to improve. A condition was imposed on their registration, so they had to submit a monthly report to us to update us on action taken.

At this inspection some improvement had been made however there continued to be a breach of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was no longer a breach of Regulation 11 and 20A at this inspection. We also found one other breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service has been in Special Measures since 20 August 2019. During this inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Enforcement

We have identified breaches in relation to the oversight of the quality and safety of the service, managing medicines and risks to people and the deployment of staff.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The Beeches is a residential care home providing personal care and accommodation to 35 people aged 65 and over at the time of the inspection, some of which were living with dementia. The service can support up to 40 people in a single adapted building.

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

Systems were not effective at identifying areas that needed improving and to keep people safe. People were left at risk in the event of an emergency and instructions from the fire service had not all been followed. Some building checks were also not completed. Risks were not always assessed, planned for and mitigated to keep people safe. People were not always protected from the risk of cross infection and lessons had not always been learned. The previous inspection rating was not displayed as required.

People did not always have their mental capacity assessed when necessary although staff did generally ask for people’s consent. The policies and procedures did not support best practice in relation to the Mental Capacity Act (2005). Staff did receive training, however the application of their training was inconsistent. People were supported to have adequate amounts of food and drink, although there was mixed feedback about what people thought about the food. People’s weights were not always effectively monitored.

Staff were not always effectively deployed, although staff were recruited safely. People were protected from the risk of abuse by staff who understood their safeguarding responsibilities. There were occasions when people were not always treated with dignity, but people felt positively about the staff overall. People were supported to be independent and were involved in their care.

People were able to access activities and trips of their choice, although this opportunity reduced at weekends when there was less staffing available. People and relatives felt involved in their care, but reviews of this were not always effective. People were supported at the end of their life. People and relatives felt able to complain and an appropriate procedure was in place.

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 15 June 2018) and there was one breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 about a lack good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made or sustained and the provider was still in breach of regulations, with new breaches also being identified. The service has deteriorated to inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines, risk management, people were not having their mental capacity assessed as necessary and governance system were not effective at identifying areas that needed improvement.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 timeframe. 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.

The Beeches is a residential care home that provides a service to older people and people living with dementia. 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.

The Beeches is registered to provide a service for up to 40 people. On the days of our inspection there were 31 people living in the home.

The home had a registered manager who was present on the days of the inspection. 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 our previous inspection we found that the management of medicines needed to be improved. At this inspection we found that the provider had not taken sufficient action to make improvements. The storage of medicines in the fridge was not monitored. The medication electronic tablet did not provide staff with information about how certain medicines needed to be administered safely.

We found where people had sustained a fall their risk assessment and care plan had not been reviewed in a timely manner to avoid a reoccurrence.

Hygiene standards within the home placed people at risk of cross infection. The environment was unsuitable for people living with dementia and this could add to their confusion.

The provider’s governance was ineffective in identifying the shortfalls we found. The registered manager did not undertake regular training to ensure they had the skills promote good practices.

Staff’s lack of understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards placed people at risk of their human rights being compromised. People’s right to privacy and dignity was not always respected by staff. However, people confirmed staff were kind and friendly. People’s involvement in their care planning ensured they received a service the way they liked.

People were cared for by staff who had received training and were supported in their role by the management team. People had access to a choice of meals and drinks and were supported by staff to eat and drink sufficient amounts. People were assisted to obtain the necessary healthcare services needed to promote their physical and mental health. People were provided with the necessary aids and adaptation to promote their independence safely.

The involvement of other professionals in people’s care assessment helped in ensuring their care and support needs were met. People could be confident their concerns would be listened to and acted on.

People told us they felt safe living in the home and staff were aware of their responsibility of safeguarding them from the risk of potential abuse. People were cared for by sufficient numbers of staff who had been recruited safely.

People were supported to maintain links with their local community. Staff were involved in meetings and they felt listened to.

The inspection took place on 20 October 2016 and was unannounced. The service was last inspected on 7 May 2014 when we found the provider was meeting the regulations.

The registered manager had been in post for the past three years. 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 felt safe living at The Beeches. There were sufficient numbers of suitably trained staff available to keep people safe and meet their needs.

Staff had received training in keeping people safe and understood their responsibility to report any observed or suspected abuse. Staff were knowledgeable about the risks associated with peoples care and support. Risk assessments and management plans were in place to manage the identified risks. We found most risks were managed well.

People told us they received their medicines when they needed them. However, medicines were not always managed safely and we could not be sure creams were applied to people’s skin as directed.

New staff received an induction and recruitment checks were carried out prior to staff starting work at the home to make sure they were suitable for employment.

The home had a friendly and relaxed atmosphere and the registered manager supported staff well to provide good quality care to people. People were encouraged to maintain relationships with people important to them and visitors were welcomed at the home.

We saw staff were caring and responsive to people’s needs. They demonstrated good knowledge of how people preferred their support to be provided. They were patient, attentive and treated people with kindness.

People's records contained information to ensure staff had the guidance they needed to meet people's needs. People had been involved in planning their care to ensure they received care and support that met their preferences, likes and dislikes.

The managers and staff understood their responsibilities under the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom.

People made everyday decisions for themselves, which helped to maintain their independence. Staff respected the decisions people made and gained their consent before they provided care. People told us staff respected their right to privacy and told us how staff supported them to remain independent.

People had access to a range of varied activities which they enjoyed. People enjoyed the food and were encouraged to eat a varied diet that took account of their preferences and dietary needs. People were referred to external healthcare professionals to ensure their health and well-being was maintained.

There were systems in place to gather people’s feedback through annual surveys. The information had been analysed and action had been taken in response to this feedback. People knew how to make a complaint and there were systems in place to manage complaints about the service provided.

People and staff thought the registered manager and the management team were open and approachable. Staff enjoyed working at The Beeches and they spoke positively about their managers. They received training and felt supported by their managers through regular meetings.

The provider ensured the quality of care and services was maintained and continually improved through a range of quality monitoring processes.

We spoke with four people who used the service and looked at their records. We also spoke with four relatives of people, five members of staff, a visiting professional and the provider to help us to understand the outcomes and experiences of people who used the service.

Is the service safe?

People who used the service told us they felt safe and had no concerns regarding the staff that supported them. People told us that the manager was approachable and they would speak with her if they had any concerns.

Staff spoken with had a good understanding regarding the level of support each person required to maintain their safety and well-being. Information within care plans and risk assessments demonstrated that people were supported to maintain their safety and welfare.

We saw that all care staff carried a radio whilst on duty and we observed these being used regularly. One member of staff we spoke with told us, 'We all carry radios to contact one another in the building especially when we are assisting someone'.

Appropriate policies were in place regarding safeguarding vulnerable adults and staff demonstrated a good knowledge of what procedures to follow if they identified any safeguarding concerns or if any information of concern was disclosed to them.

Is the service effective?

Discussions with people using the service and information in care records showed that people's needs and preferences were met. We saw a log that ensured that people's preferences were respected with regards to their bedtime, waking and personal hygiene routines. The provider said, 'It also makes staff accountable in case a service user doesn't look well dressed; then we know who dressed them up that day'.

Relatives of people who used the service were generally complimentary of the care their relatives received. One relative said, 'X receives very good care here. This place is ideal for her needs'.

During the visit, we saw that other healthcare professionals were involved in the care and treatment of people who used the service. One visiting professional told us that they came regularly to carry out health reviews of people who used the service. They said, 'If they've [the staff] got any concerns or queries about medications, they'll ring the clinic for advice. I've never gone back and felt concerned about anybody I have seen'.

People who used the service and their relatives told us that structured activities took place regularly and external providers were often invited to engage in activities with people. On the day of the visit, we observed a volunteer activities person engaging people in a sing-along group and exercises. People we spoke with told us that they enjoyed the activities that took place at the home.

Although the provider had made improvements to ensure that people were protected from the risks of unsafe medicine administration, they needed to ensure that their system for recording medication stored at the premises was effective.

Is the service caring?

We observed a positive working relationship between the staff and the people they supported. We observed that staff were caring and sensitive when they supported people with their personal care needs.

People using the service said that they liked the staff and confirmed they were helpful. A person who used the service told us, 'The staff are polite and nice'. One relative said, 'Staff are pleasant and friendly. I'm perfectly happy he's [relative] here. I wouldn't mind being in care here myself'. Another relative told us, 'The staff are very caring. They've just thought of things that are very good for people'.

We observed that people were treated with dignity and respect by staff. Some people required support during meals and we observed that staff were professional and demonstrated care when they supported these people.

Is the service responsive?

People we spoke with told us that if they had any concerns or worries they would tell a member of staff or a family member. One person said, 'You've only got to talk to X [the manager] and you'll be alright'.

From our observations we saw that people using the service appeared relaxed and comfortable with the staff on duty and were able to openly express their opinions and preferences.

We saw that staff responded promptly to ensure people's needs were met, for example when people requested support to use the toilet staff responded in a timely manner. We observed staff treating people respectfully, ensuring their dignity was maintained.

We saw that staff responded to the changing needs of people. A visiting professional said, 'I've seen a gentleman who was quite breathless and they told me he was waiting to be seen by the GP'.

At the previous inspection, we told the provider that they needed to make improvements because they did not have appropriate arrangements in place to manage medicines safely and accurate and appropriate records were not being maintained to protect people from the risks of unsafe or appropriate care. We saw that the provider had made improvements to ensure that medicines were managed, stored and audited appropriately. People's personal records were stored securely and care plans had been updated to reflect the care people received.

Is the service well-led?

People told us that the provider was always around to respond to any concerns. One relative said, 'The provider is very good and the staff are very good. I go to X [the Registered Manager] or X [the provider] if I have any problems'.

The provider was present on the day of the visit and we saw that relatives approached him to obtain information about their relatives. We spoke with the provider and he demonstrated a good knowledge of the people who used the service. He said, 'We have an open door policy and I love to meet and greet the relatives and get feedback from them'.

People who used the service told us that the registered manger was always available, approachable and friendly. The registered manager told us, 'I go round and ask them [people who use the service] how they are. It's something I've always done. Families just come to us if they've got a problem and we solve it there and then if possible'.

We saw that the provider carried out audits of the service to ensure that people received safe and appropriate care. We saw that the views of people who used the service, their relatives, staff and other professionals were obtained, recorded, analysed and actions taken to address any concerns raised.

Staff were clear about their roles and responsibilities and spoke positively about the management support they received. Staff told us that they were being provided with regular team meetings. A member of staff told us, 'X [the provider] is constantly drilling into all of us about the paper work, that if it's not written up, then it hasn't been done'.

We saw that people were treated with dignity and respect. People were given choices about their care, and the choices they made were respected by the staff.

People were treated with care and compassion and people received assistance with their personal care needs in a timely manner.

Effective systems were in place to ensure that people could access health and social care advice and support when they needed to. We also saw that important information about people's needs was shared with other professionals when required.

We identified that improvements needed to be made to ensure that people were protected from the risks associated with medicines. Effective systems were not in place to ensure medicines were stored safely and given when people required them.

We saw that information about people's needs and their finances was not stored securely. Improvements need to be made so that people can be assured that information about them is kept safe.

We observed a lunch time meal service, staff offered choices and encouraged and enabled people to eat a balanced diet. People told us that they liked the foods and choices they were given.

Staff told us that they were enabled to develop their skills by completing NVQ (national vocational qualifications). We were told that the manager of the home was helpful and supportive. We saw records that showed staff had been trained in safeguarding and staff when asked knew how to raise concerns about poor care.

We were told by a regular visitor to the home that they were happy with the care that their mother received. The staff had always been kind and caring. They told us that they had a positive relationship with the home staff and they had been able to raise any care issues with them when ever they wanted to. They felt that the care delivered to their relative was good.

The Beeches had systems in place to monitor and improve things when required these Included relative and user feedback, audit schedules and staff meetings