Beeches Care Home

Beeches Care Home is a residential care home, providing accommodation for persons who require nursing or personal care. The service provides support for up to 40 people including older people, younger adults and people living with dementia. At the time of our inspection there were 27 people using the service.

The property was set over 2 floors with lift access to the upper floor. There was a communal dining room and lounges, a shared shower room and accessible rear courtyard.

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

The provider did not have adequate systems and processes to monitor and manage fire safety, health and safety or infection prevention and control (IPC). Staff deployment was not always effective. We received feedback about low staffing levels and the impact this had on safety and quality of care. Recruitment and medicines were not managed safely. The provider failed to learn from incidents, accidents and safeguarding concerns.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care records were detailed, though we found some inconsistencies with information and people did not always get the care they needed. Records we reviewed raised concerns around people’s fluid intake, and we received mixed feedback about the food. Staff had an induction and training was refreshed annually, but they did not receive periodic supervision to monitor competence. The home required maintenance and refurbishment and was not fully adapted to meet people’s needs.

People and their relatives were not always consulted when planning or reviewing care and treatment. We observed caring interactions and staff spoke about people with dignity and respect, but staff did not have time to talk with people and care could be task focused. A person living at the home told us, “The staff are a lovely group of people, but they don’t always have enough time to give us their full attention.”

There was a lack of meaningful activities, and people did not always receive personalised care in a way that met their preferences. People had limited opportunities to express their views around the quality of care and appropriate action was not always taken in response to concerns. Complaints were not analysed to help prevent reoccurrence. Staff did not receive training around end-of-life care and information about people’s advanced wishes was missing from care records.

The provider and registered manager had not maintained good standards. Systems to monitor the quality of care were not utilised and audits had not picked up some of the issues identified during inspection. Action was not taken in a timely manner to resolve issues or drive improvement. Systems and processes failed to engage people, their relatives or staff and promote good outcomes. Staff worked hard as a team and people generally spoke about them positively.

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 21 April 2021)

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk and safe care and treatment. This inspection examined those risks.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

Enforcement and Recommendations

We identified breaches in relation to person-centred care, safe care and treatment, premises and equipment, good governance and staffing. We made recommendations in relation to learning lessons when things go wrong, receiving and acting on complaints and consent.

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

Follow up

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.

We found the following examples of good practice:

Staff wore appropriate personal protective equipment (PPE) in line with the Government guidance and supplies of PPE were available throughout the home. Used PPE was disposed of safely. Staff had received training in infection control and how to put on and take off PPE safely.

We found that the home was clean and hygienic. Enhanced cleaning was being completed regularly throughout the home, to ensure people were protected as much as possible from the risk of cross infection.

There were clear processes in place for visitors to the service. They were screened for COVID-19 symptoms on arrival and were required to wear appropriate PPE and maintain social distancing during their visit. The

provider was facilitating visits in line with the Government guidance and had a designated room where visits could take place safely.

Staff and people living at the home were being tested regularly, to ensure that appropriate action could be taken if anyone contracted the COVID-19 virus.

Further information is in the detailed findings below.

At the last inspection carried out in December 2015 the service was rated Good. At this inspection we found evidence continued to support the rating of ‘Good’. 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.

There was a registered manager in place. 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.

During the inspection visit we observed many examples of staff being kind, sensitive and attentive to people in their care. They were caring, patient and respectful. This was confirmed by our observations and relatives and people who lived at the home we spoke with.

People who lived at The Beeches received their medicines as required. Care records we looked at contained a medication care plan and risk assessment to inform nursing staff about medication details for each individual.

There was a safeguarding procedure document on display in the reception area of the home. This gave people who lived at the home, visitors and staff information about who to report any concerns to. Staff informed us they had received training in safeguarding vulnerable people and records confirmed this.

The registered manager completed risk assessments to guide staff about the mitigation of risk to people who lived at The Beeches. Completed accident and incident documentation with instructions about any injuries and measures introduced to reduce their reoccurrence were kept. In addition, the registered manager would look for any patterns or trends that they identified and addressed them to ensure people were kept safe.

The layout of the premises was appropriate for the care and support provided. We found facilities and equipment had been serviced and maintained as required to ensure The Beeches was a safe place for people to live.

Staff had been recruited safely, appropriately trained and supported. They had skills and experience required to support people with their care and social needs.

The management team had sufficient staffing levels in place to provide support people required. We saw staff showed concern for people’s wellbeing and responded well when people required their help. This was confirmed by talking with people who lived at the home and our observations during the inspection visit.

All people who lived at the home were highly complementary about the quality and quantity of food and comments included, “All the food is good.” Also, “I have not ever had a bad meal.”

People had been 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.

The management team used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys to seek their views about the service provided. In addition, daily ‘handover’ meetings were held to discuss the day’s events and any issues in relation to people who lived at the home.

The Beeches had a complaints procedure which was made available to people on their admission to the home and their relatives. People who lived at the home and relatives we spoke with were aware of the process to follow should they have any concerns.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

We spoke to staff regarding safeguarding procedures at the home. All the staff we spoke to were aware how to recognise and report potential safeguarding issues internally. Some staff were unclear what happened after a safeguarding issue was reported. We discussed this with the registered manager who agreed that staff would find it beneficial to know how safeguarding issues were handled following them reporting it to senior members of staff and who they could report issues to if they felt they could not do internally.

Is the service effective?

We looked at care plans for four people living at the home. People's needs were assessed and care and support was delivered in line with their individual needs. We saw that care assessments had been carried out and daily

monitoring records had been completed. Care plans were easy to follow and it was evident that regular reviews of people's needs were carried out. Risk assessments were in place covering areas such as moving and handling, falls and nutrition. Evidence was in place showing that monthly reviews of all risk assessments were carried out.

Is the service caring?

We spoke with five people who lived at the home and four visiting relatives. All the people we spoke with were happy with the care they or their relatives were receiving Beeches Care Home. All the people we spoke with who lived at the home had varying degrees of dementia therefore not many people were able to give a balanced view and responses were mainly limited to a 'yes' or 'no'. One of the relatives we spoke with said, "I think I have found the best home for (name) here. I hope it doesn't change. We looked at a lot of homes in this and other areas, this was easily the best". Another relative we spoke to told us, "I wanted to speak to you as you always hear the bad things about care services. My sister was in another home before she came here and they could not cope with her. Here they are so thoughtful. I come every week and I have never seen or heard anything that concerns me. I never worry about her when I go home, everyone is very caring here".

Is the service responsive?

Records of visits from professionals were kept on file and we could see that people saw district nurses, GP's and chiropodists as they needed to.

Is the service well-led?

We saw that staff meetings took place regularly. We found evidence that a meeting for all housekeeping staff had taken place a few weeks prior to our inspection. We saw notes from meetings for health care assistants (day and night staff) and for nursing staff. Some of the topics covered within these meetings were; raising safeguarding alerts, Deprivation of Liberty Safeguards, medication and duty rotas. Staff we spoke to felt that they had the opportunity to raise issues at staff meetings. Resident and relative meetings also took place.

We saw that a number of audits took place at the home including, safeguarding, nutrition, infection control, activities and medication.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop.

The premises were clean and tidy and the design, layout and security of the premises was fit for purpose to meet the needs of the residents.