Beeches Retirement Hotel

We found the following examples of good practice.

There had been an outbreak of COVID-19 which had resulted in people being supported and cared for in their own bedrooms. At the time of the inspection the period of isolation had recently finished and people were able to use communal areas of the home. The registered manager had followed government guidelines relating to visiting throughout the pandemic including the most recent advice allowing one nominated person to visit.

The home benefitted from a large garden and conservatory both of which were used to accommodate visits. Relatives were asked to take a lateral flow COVID-19 test (LFT) and then waiting for 30 minutes for the result. If negative, a socially distanced visit took place.

Staff had a single point of entry and exit from the home and had their temperatures taken on arrival. Personal protective equipment (PPE) was put on at the start of every shift and there were PPE stations throughout the service where used PPE could be safely disposed and replaced. Any visitors to the home went through the same process and had a health questionnaire to complete before entering the home.

The home was clean throughout. A dedicated member of cleaning staff worked full time and was supported on every shift by staff who carried out a routine of regular cleaning of touch points and high reach areas. Some ornaments and wall hangings had been temporarily removed to minimise the risk of infection.

At the time of the inspection all people and staff were taking part in testing. People were being tested monthly and staff were having weekly polymerase chain reaction (PCR) tests and twice weekly LFT tests. All results were logged by the registered manager. All people and staff had received their first COVID-19 vaccine.

The outbreak and subsequent reviews of contingency plans had resulted in lessons learned and preparation for any future outbreaks. This included having a dedicated supply of PPE for use only during an outbreak, a more effective way of delegating tasks in the event of supervisors and managers being taken ill and plans to rapidly increase staff numbers to cover unexpected absences.

Since the beginning of the pandemic all staff have undergone training and refresher training in PPE, infection prevention and control and specifically, training related to COVID-19. The training has been provided internally by managers and by using online training forums.

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

People and relatives were positive about the support provided at Beeches Retirement Hotel. Relatives said the registered manager was very approachable and that staff were caring.

People had a high level of independence and were supported to have choice and control of their lives. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Risks to people’s health and safety had been identified and actions were in place to ensure risk was minimised. Staff were aware of the actions to take if they thought anyone was at risk of harm or abuse. Any concerns identified had been reported to appropriate external professionals.

A complaints procedure was in place and although there were no current complaints, people, staff and relatives were aware of the process.

Staff knew people very well, they treated them with kindness and respect and demonstrated a good understanding of people's individual needs. People were assisted to access healthcare services when needed.

Care documentation included information about people’s care and support needs and personal preferences. People received their medicines when they needed them from staff who were trained to give them out safely.

There were enough staff working to provide the support people needed, at times of their choice. Staff supported people to attend appointments when needed. People were able to continue with hobbies and activities they enjoyed. People chose how to spend their time and some went out alone or with relatives.

Recruitment procedures ensured only suitable staff worked at the home. People told us staff were available when they needed assistance. Relatives and people told us staff knew people well and the care provided was of a high standard.

A system of quality checks and internal audits to monitor care, documentation, safety and quality of the service were completed by the care manager.

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 1 February 2017)

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 previous inspection of the service took place on 15 April 2014. The service met all the regulations we checked at that time.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe at Beeches Retirement Hotel. Staff understood how to protect people from the risk of abuse and knew the procedure for reporting any concerns. Staff understood the provider’s safeguarding policies and procedures in place to protect people from potential harm. Staff had identified and assessed risks to people and had up to date information about how to support them safely. Staff recorded accidents and incidents and put plans in place to prevent a recurrence. There were arrangements in place to deal with foreseeable emergencies.

People’s support was provided by staff who were recruited safely. The provider followed a robust recruitment process to ensure staff were suitable to support vulnerable adults. There were sufficient staff to meet people’s individual needs safely.

People received the support they required to take their medicines safely. Staff administered and managed people’s medicines safely. The registered manager regularly audited the administration of medicines and ensured staff followed the provider’s medicines management procedures.

Staff had the relevant skills and experience to undertake their role. Staff received training and felt supported in their work. Staff received regular supervisions and yearly appraisals to monitor their performance and review their development needs.

People received support in line with the principles of the Mental Capacity Act 2005 and the requirements of the Deprivation of Liberty Safeguards. The service had received authorisations to deprive some people of their liberty in order to provide necessary care and to keep them safe. People gave consent to care and treatment.

People enjoyed the nutritious food provided at the service. Staff ensured people’s dietary needs and preferences were met. People were supported to maintain good health and wellbeing and accessed professional healthcare services when needed. The service was responsive in managing changes to people’s health.

People were treated with kindness and respect. Staff upheld and maintained people’s dignity, privacy and confidentiality. Staff knew people well and understood their individual needs. Staff took into account people’s views and experiences when they supported them. People were supported to maintain relationships important to them.

People’s care records contained sufficient information which staff used to plan and meet people’s individual needs. People, their relatives and healthcare professionals were involved in making decisions around people’s care and the support they received. People’s needs were reviewed and their care plans updated on a regular basis to ensure they remained effective. People’s care was person centred and provided as planned.

People received the support they required to maintain relationships important to them. People took part in activities they enjoyed and received the support to maintain their interests.

The registered manager asked people and staff for their views about the service and responded to any concerns they raised.

Staff were happy to work at the service and felt supported in their work by their colleagues and by the registered manager. There was a positive and transparent culture were people, their relatives and staff were encouraged to give their ideas to improve the service.

There were robust systems in place to monitor the quality of the service. The registered manager carried out checks on the care and support people received and took action to address any shortfalls.

People were provider with information on how to make a complaint and knew how to raise any concerns about their care. The registered manager had responded to complaints appropriately.

The service had close partnerships with the local community and other healthcare professionals to develop the service and to ensure people’s needs were met.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at.

To see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly.

We saw that staff had received appropriate training and demonstrated a good understanding of safeguarding procedures.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Staff gave us an example of their understanding of DoLS and what actions they would take if they identified any concerns. The deputy manager had received training to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from our observations and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us. "Sometimes I wake up at night and soon a head pops round the door. It's so reassuring to know there's someone there'

We saw from training records that staff had received appropriate training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things when they wanted to. Our observations confirmed this. One person told us, 'They are all round caring staff, anything you want they will do; it's so good it's almost embarrassing.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences had been recorded and care and support had been provided that met their wishes. People had been supported to maintain relationships with their friends and relatives.

Where people had been identified as having a health related need we saw that referrals had been made to appropriate external professionals.

Is the service well-led?

The provider of Beeches Retirement Hotel is also the registered manager. The deputy manager was responsible for the day to day running of the home and is referred to throughout this report.

People told us if they had any concerns they spoke to the manager or senior member of staff on duty. They said any issues were dealt with immediately.

Staff told us they were clear about their roles and responsibilities. They said the manager and provider ensured they were aware of any changes that happened at the home. They told us it was an 'open door policy' and their views and concerns were listened to and taken into account.

People told us they were very comfortable. One person said, "This is my home and I like living here". We observed that people were encouraged to make choices, and staff spoke with people in a respectful manner at all times.

We examined four care plans, and found that they included details of people's support needs. They were reviewed by the deputy manager on a regular basis.

We spoke with two of the care workers. They demonstrated a good understanding of people's needs and how these were met.

We examined the systems for the management of medicines. We found that a new storage system had been installed, and a pharmacy inspection had recently taken place.

We looked at staff rotas and training records. Staff told us there were usually enough staff working in the home, and they had received relevant training.

We looked at care plans, handover sheets, daily records and some of the home's policies and procedures. We found that overall the information recorded needed updating and some policies and procedures were not in place.