Beeches

Updated 20 April 2022

The inspection

This was a focused inspection to check whether the provider had met the requirements of the Warning Notices in relation to Regulation 17 (Good Governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Beeches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission as they had recently left their position. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided. Day to day management support was provided by an acting manager, who was also the provider’s deputy operations director. Additional management support was also provided by the deputy manager.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. This information helps support our inspections. We used all of this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

During the inspection we spent time observing how care and support was given to people. We spoke with eight staff, including the acting manager, deputy manager, cook, domestic supervisor, administrator, and care staff. We reviewed a range of records. This included elements of four people's care records, three staff files and multiple medication records.

We used the Quality of Life Tool which is designed to support the corroboration of all sources of evidence gathered during inspection.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We asked the provider to give us additional evidence about how the service was managed. We looked at training data and quality assurance records. We spoke with the local authority adult social care commissioning team and a social worker who was conducting safeguarding enquiries about the service. We received feedback from four relatives of people who live at the service and 10 staff members.

Updated 20 April 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence, and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Beeches is a residential care home providing personal care to 11 people at the time of the inspection. The service can support up to 12 people.

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

People were not always supported by enough staff to meet their care needs. The provider’s assessment of the minimum safe staffing levels did not include some people’s support needs. Staffing issues meant people did not always receive the one-to-one support they needed.

The provider’s safeguarding process was not always consistently applied, and an incident of alleged abuse was not notified to the CQC and local authority safeguarding team by the provider. This is something the provider is required to do.

People’s living environment had improved since the last inspection and was now clean and hygienic. Staff had improved the hygiene and homeliness of some people’s bedrooms, which we had raised concerns about at the last inspection. People were protected by the provider’s COVID-19 infection prevention and control measures.

People’s individual risks were identified by the provider and care plans were personalised and comprehensive. People were supported by the provider’s multi-disciplinary care team who had increased their presence in the care home since our last inspection.

People’s prescribed medicines were managed, recorded, and administered safely. People’s individual risk assessments and care plans had been reviewed and updated to ensure they provided an appropriate guide for staff.

People were supported by staff who had received the necessary training to be able to safely meet their care needs. Staff knew how to support them safely and in line with their individual risk assessments and care plans.

People were supported to eat and drink enough to be healthy. Following a recent death of a person, the provider had reviewed and enhanced their support for people who may be at risk of choking on food.

People had access to various activities within the care home and also access to a vehicle for trips out to activities in the community.

People’s relatives told us that communication with them, from the service, had recently started to improve.

Right Support

People did not always receive person-centred care due to staffing issues; and some people's specific support needs were not always clearly identified in their care plans. The service enabled people to access specialist health care support from the provider’s own in-house multi-disciplinary care team.

Right Care

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

Right culture

The service had recently started to become more open with external agencies and the families of the people they supported. However, that change in approach was not yet fully embedded. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and the provider reviewed those incidents to see how they might be avoided or reduced.

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 (published 5 October 2021) and there were five breaches of regulations. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve.

This service has been in Special Measures since 5 October 2021. During this inspection the provider demonstrated improvements had been made in some areas. Although we found the provider was still in breach of one regulation 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.

Why we inspected

We undertook this focused inspection to check whether the Warning Notices we previously served in relation to Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has changed following this focused inspection and is now rated Requires Improvement.

The inspection was also prompted, in part, by notification of a specific incident; following which a person using the service died. This incident is potentially subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of people’s choking risks. This inspection examined those risks.

We also assessed whether the service is applying the principles of Right support right care right culture.

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 that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that 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.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continuing breach of regulation 18 in relation to staffing levels at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.