Archived: Beechcroft Residential Home

We found the following examples of good practice.

A visiting pod could be accessed by loved ones without entering the home. There was a booking system available and cleaning took place between uses. This meant people could enjoy visits in a safe and comfortable environment.

Staff wore Personal Protective Equipment (PPE) in line with guidance. PPE stations and clinical waste bins were available throughout the home.

Clear signage was displayed throughout the home to prompt with handwashing and correct PPE use.

Carpeted flooring in corridors was being replaced with hard floors. This allowed more frequent cleaning and supported to control the spread of infection.

Staff we spoke to were knowledgeable about infection control practices and felt they would be supported by the manager if they raised any concerns.

Beechcroft Residential Home is a care home that provides personal care, over two floors. The service can support up to 50 people. When we inspected the service there were 46 people living at the home, some of whom had dementia.

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

Risks were not consistently managed. The providers systems and processes were not always effective at mitigating ongoing risk to people. We observed that staff did not always follow best practice and national guidance when administering medication.

Most people told us more staff were needed to meet their needs. Some steps had been implemented to improve staffing. Following our inspection, the provider told us that staffing levels day and night had been increased. This gave us assurance that people’s needs would be met effectively.

Staff knew people's needs and demonstrated a good understanding of the level of assistance people required. Staff were observed to be kind and caring. Staff spoke to people with dignity and respect and took the time to support and encourage people. Relatives and visitors to the home were made to feel welcome and spoke highly of staff.

People's dietary needs were met, and staff had the knowledge and understanding to support those who needed additional support at meal times. People had access to healthcare services where required. People were involved in decisions around their day to day care and were treated with dignity.

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.

The provider had systems in place to identify and support people's protected characteristics from potential discrimination. Protected characteristics are the nine groups protected under the Equality Act 2010. They include, age, disability, race, religion or belief etc. Staff members we spoke with knew people well and they could tell us about people's individual needs and how they were supported.

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 good (published August 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to regulation 12 safe care and treatment and regulation 17 Good Governance. Please see the action we have told the provider to take at the end of this report.

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.

At our last inspection in June 2016 the service was rated as good in three of the five questions we ask: Is the service effective? Is the service caring? Is the service responsive? And requires improvement for the remaining questions: Is the service safe? And Is the service well-led? This was because medicine and recruitment systems were not adequately safe. Additionally although governance processes were in place they had not always been effective to ensure that staff sickness levels and other staff issues had been addressed. This inspection we found that specific issues that we had identified previously had been addressed in well-led and safe but some new issues were evident in safe. As a result the rating for safe remains as requires improvement.

The provider is registered to accommodate and deliver personal care to a maximum of 50 people. At the time of our inspection 48 people lived at the home. People who lived there were elderly and had needs associated with old age and less advanced dementia.

The manager was registered with us and was present on the day. 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.

Although recruitment systems overall prevented unsuitable staff being employed checks needed more diligence. Medicine systems had improved but some further strengthening was needed to enhance safety. People were safe and systems were in place to prevent people from the risk of harm and abuse. Staffing levels were monitored regularly to give assurance that people’s needs could be met.

Staff received induction and other training that they required to acquire the skills and knowledge to provide safe and appropriate care to people. Staff confirmed that they were adequately supported in their job roles. People received care in line with their best interests and processes were in place to ensure they were not restricted unlawfully. People were supported to have the food and drink that they enjoyed.

Relationships between staff and the people who lived at the home were positive. Staff were friendly, polite and helpful to people. People were encouraged to make everyday choices and they were supported to maintain their independence.

People needs were reviewed regularly to ensure that they could be met. The complaints system was well managed and was available for people and their relatives to use. Activities were available each day for people to engage in.

People knew who the registered manager and provider were and they were visible within the service. Quality monitoring processes, the use of provider feedback forms and meetings helped to ensure that service was being run in the best interests of the people who lived there.

The provider is registered to accommodate and deliver personal care to a maximum of 50 people. At the time of our inspection 47 people lived at the home. People who lived there were elderly and had needs associated with old age and dementia.

A manager was registered with us as is required by law and was present on the day. 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.

Staffing levels needed further consideration to ensure that they would consistently meet people’s needs and keep them safe.

Most people and their relatives told us that the quality of service was good. Governance processes were in place but had not always been effective to ensure that staff sickness levels and other staff issues had been resolved.

Monitoring methods were used but they had not always checked that people’s likes, dislikes and preferences were current.

People were generally given their regular medicines as they had been prescribed. However, protocols were not in place for medicines prescribed on as needed basis to ensure that people also received those medicines safely.

Recruitment processes ensured that most of the checks had been undertaken on staff to prevent people being placed at risk of harm or abuse. The provider had not always however, gained enough information to ensure that all staff were in full good health.

Staff knew how to keep people safe which prevented them being placed at risk of harm or abuse. Processes were in place to prevent people being placed at risk of sore skin and accidents.

Staff received induction training and support to ensure they did their job safely in the way that people preferred.

Staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had met the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

People were provided with drinks and meals that they generally enjoyed in sufficient quantities to prevent them from a risk of dehydration and malnutrition.

People’s health was assessed to ensure that their health care needs were met by a varied range of external healthcare professionals.

People were cared for and supported by friendly, helpful and kind staff.

People were supported to retain their independence and undertake the tasks that they could do themselves.

People were glad that visiting times that were flexible and that their family and visitors and were made to feel welcome by the staff.

People made decisions about their care and support and they and their families were involved in how their care was planned and delivered.

Recreational activities were offered for people to participate in and enjoy but these needed to be further considered for all people’s recreational needs to be met.

A complaints procedure was in place for people and their relatives to raise their concerns or complaints if they had a need to.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well lead?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with eight people who used the service, three relatives, six staff supporting them and looking at six people's care records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service and their relatives told us they felt they were safe. Safeguarding procedures were in place and generally staff understood their role in safeguarding the people they supported.

We found that staff asked people for their permission before supporting them with their care needs.

Staff knew about risk management plans and we saw that they supported people in line with those plans.

The provider had robust recruitment systems in place to ensure that care staff had received the appropriate checks about their suitability to work with people.

Rotas were planned in advance but the number of staff available was not sufficient to meet the needs of people who used the service and keep them safe. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced staff employed for the purposes of providing care.

Systems were not in place to make sure that managers and staff learn from events such as accidents and incidents, complaints and checks made on the service. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety.

Is the service effective?

People's health and care needs were assessed. Relatives told us they were involved in the care planning and reviews of care. We saw that care plans were regularly updated.

Visitors confirmed that they could visit when they wanted to and spend time alone in privacy if they wished.

Is the service caring?

People were supported by staff that were generally kind and caring. We saw that care staff gave people encouragement and were patient with them. One person told us, "The staff are very caring".

People's preferences, interests and diverse needs had been recorded and care and support was usually provided in accordance with people's wishes.

Is the service responsive?

We saw that people's views were sought by the provider about the care they received. We found that the provider did not always respond to comments made.

People and their relatives were aware of the home's complaints procedure and knew how to raise concerns.

Is the service well led?

The service had a quality assurance system. Records seen by us indicated that shortfalls in the service were not addressed promptly.

Staff told us they were clear about their roles and responsibilities but were not aware of plans in place to manage risk and improve the quality of care people received. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and managing risks relating to the health, welfare and safety of service users and others who may be at risk.

Staff told us the home was well organised and they felt supported by their manager.

Staff knew how to support people to meet their needs and ensure their healthcare requirements were met. One person living there told us, 'I'm very, very happy here. I was surprised how I have settled in to living in a care home.'

People had been given their medicines as they had been prescribed by their doctor to ensure their health and wellbeing.

The home's environment was comfortable and well maintained so it was safe for people to live in.

Staff were supported to ensure they had the skills and knowledge to meet the needs of the people living there. One person said, 'The staff are very good.'

People were asked for their views about the home and audits of the quality of care that people received were completed.