The Beeches

The Beeches is a residential care home providing accommodation and personal care to up to 22 people. The service provides support to older people including people living with dementia and people with physical disabilities. At the time of our inspection there were 21 people using the service.

The service is set across 3 floors and has a mix of both ensuite bedrooms and shared bathrooms. It has kitchen and laundry facilities, a shared lounge and dining room and conservatory space as well as a large garden. There is an office onsite.

The service is also registered to provide personal care to people in their own homes. At the time of the inspection, no people were receiving this service. The provider told us they intend to be resuming this service in the near future.

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

Since the last inspection a new registered manager had been appointed. Changes and improvements to systems, processes and the environment had been made. People told us improvements had been made and this had a positive impact on the quality of care and the environment. Some of the changes were yet to be fully implemented or embedded.

People told us they felt safe living at The Beeches because staff treated them well, were kind and regularly checked on them during the night. Staff knew how to keep people safe and what to do if they had any concerns. Some staff were not sure about what all types of abuse looked like or who they could report to externally such as CQC.

Risks to people’s health and welfare were assessed but accompanying guidance for staff about risks to people’s health or mobility needed to be clearer.

People were mostly supported to safely administer and manage their medicines. However, there were some discrepancies that had not been identified during audits. The registered manager was aware of these and had already put additional measures in place to address this with the staff team.

People were supported by staff who were trained in all aspects of their role. People and relatives felt staff were knowledgeable about how to support them in ways they preferred. People felt there were not always enough staff to spend time with them or to take them out. The provider was in the process of recruiting more staff.

People had access to health professionals who worked closely with the staff and management team to ensure all health concerns were investigated straight away. People with specific dietary requirements had clear guidance for this and all staff were aware of how to support them safely.

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.

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 19 May 2023) 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 improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 19 May 2023. During this inspection the provider demonstrated improvements had 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.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. When we last inspected The Beeches on 20 February 2023 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

We undertook a focused inspection to review the key questions of safe, effective 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 changed from inadequate to requires improvement based on the findings of this 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Beeches is a residential care home providing personal care, it can accommodate up to 22 people aged 65 and over. There were 19 people using the service at the time of the inspection.

The service is also registered to provide personal care to people in their own homes. At the time of the inspection, no people were receiving this service and the provider told us they would not be continuing this service.

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

The provider had failed to ensure improvements were implemented since the last inspection. Governance systems were not effective to identify and prevent risks to people’s safety. The provider had failed to recognise their system for identifying how many staff were needed on duty was not robust.

Risks to people’s safety were not always assessed or mitigated. People were not always supported to take their medicines safely. There were environmental risks to people’s safety with furniture that wasn’t safely secured. One person had not been protected from the risk of choking. The provider had not followed best practice guidelines in relation to infection prevention and control. Staff were not always safely recruited.

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 always support good practice.

Staff were kind and caring and wanted people to achieve good outcomes. People told us they felt safe.

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 requires improvement (published 29 September 2020). This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to provider’s response to incidents, the level of care being provided and risks in the service environment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

You can see what action we have asked the provider to take at the end of this full report. The provider had taken some action to mitigate risks highlighted in this report and some of this was effective.

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 is inadequate. This is based on the findings at this 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 have identified breaches in relation to people’s health and safety, management of the service and staff recruitment.

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

Follow up

We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 providing personal care, it can accommodate up to 22 people aged 65 and over. There were 13 people using the service at the time of the inspection.

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

Systems were in place to regularly audit and review the health, safety and quality of the service. However operational difficulties relating to COVID-19 and historical staff shortages as a result of staff turnover meant that audits were not always completed consistently. The registered manager had plans to address this.

Staff spoke positively about the support they received from the registered manager. Regular opportunities for staff to meet were provided. The views of people using the service were sought and where shortfalls were identified these were followed up.

Some relatives told us they thought communication from the service could improve but were confident in the staff and registered manager.

People's relatives mostly told us they were happy with the care and support people receive . Staff told us they were focused on ensuring people received care which was person centred and treated people as individuals.

Staff knew how to protect people from abuse and report concerns. The provider had a whistleblowing process which staff were aware of. Training records showed some new staff were yet to receive safeguarding training, the registered manager confirmed to us following the inspection that this was now scheduled.

Risk assessments were in place to ensure people were protected from known risks associated with health conditions. Staff were aware of these and described how risks were reviewed and acted upon. Risks associated with the building were managed, issues we identified at the previous inspection had been resolved.

Staffing levels were meeting the care needs of people living in the service. Some staff and relatives told us that an increase in staffing levels would be beneficial but stated that people’s health and personal care needs were met. Recruitment records showed staff were recruited safely and in line with current legislation.

People received their medicines as prescribed. A clear policy was in place and staff receive training and their practice was observed.

Systems were in place to ensure risks associated with infection control were managed. Staff were following national guidance in relation to COVID-19. Cleaning schedules were in place and the service appeared clean and was free of malodour.

A system was in place to ensure accidents and incidents were recorded. Staff described confidently how accidents were reported and responded to.

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 20 June 2019). Following this focused inspection, the rating has remained the same.

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

People’s experience of using this service: Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe and Well-Led to at least good.

During the last inspection the provider was in breach of two regulations. The registered persons had failed to assess risks to people's health and safety and to do all that was practical to keep people safe in the care home. We also found that the registered persons had not suitably assessed, monitored and improved the quality and safety of the carrying on of the regulated activity that was delivered in the care home.

At this inspection, we found the provider had taken some action to rectify some issues; fire safety and the safety of the electrical wiring had been addressed, as well as some environmental hazards. However, although action plans were in place to address issues in the environment, including subsidence and window repairs, limited improvement had been made since these issues were highlighted during the last inspection. We also found a number of other shortfalls in the safety of the environment of the care home.

During this inspection, we found improvements had been made to some systems to assess and monitor the quality and safety of the services. However, systems failed to identify some of the safety issues. Therefore, improvement was not being driven.

You can see what action we told the provider to take at the back of the full version of this report.

Systems were in place to recruit staff safely. Staff supported people to manage their medicines safely.

Some areas of the home needed redecoration. Plans were in place to address this. We have made a recommendation about following best practice guidelines when decorating, to ensure it is suitable for those living with dementia.

People were supported to maintain a nutritious diet, but menus were not displayed to promote people’s choices. On one occasion we saw hot drinks were not provided readily.

People within the care home had care plans which reflected their needs and were kept up to date. We found shortfalls with a person’s receiving support in the community.

There was an activity coordinator within the care home, but when they were absent staff did not make the best use of their time to facilitate activities.

People were 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. Staff were supported through on-going supervision and they accessed training relevant to people's needs, to ensure these could be met.

People were relaxed in their surroundings and felt comfortable around staff. Staff were kind and promoted people’s independence and treated them with dignity and respect.

People and staff felt the registered manager was approachable and people knew how to raise a complaint.

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

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 17 April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

The Beeches is registered to provide accommodation and personal care for 22 older people. There were 20 people living in the service at the time of our inspection visit. The service was also providing care calls for two people who lived in their own home to provide assistance with tasks such as washing and dressing, promoting continence and managing medicines.

In this report we refer to the two services as being the ‘residential provision’ and the ‘care at home provision’. In addition, when we speak about issues that affect the staff working in both parts of the service we refer to them as being, ‘care staff’.

The service was run by a company who was the registered provider. There was a registered manager in post. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 1 February 2016 the service was rated, ‘Good’.

At this inspection the service was rated, ‘Requires Improvement’.

We found two breaches of regulations. This was because the registered persons had failed to suitably assess risks to the health and safety of people who used the residential provision and had not done all that is practical to keep them safe. As a result people had not always received harm-free care and had not been safeguarded from the risk of avoidable accidents and other untoward events.

We also found that the registered persons had not suitably assessed, monitored and improved the quality and safety of the carrying on of the regulated activity that was delivered in the residential provision. This was because quality checks in relation to this part of the service had not always resulted in shortfalls quickly being quickly put right. In addition and in relation to both parts of the service, the registered persons had not made robust arrangements to ensure that the service complied fully with a number of regulatory requirements. You can see what action we have told the registered persons to take at the end of the full version of this report.

Our other findings are as follows. We found that background checks on new care staff had not always been completed in the right way. However, in both parts of the service most of the necessary arrangements had been made to manage medicines safely. In addition, people were safeguarded from the risk of abuse and sufficient care staff had been deployed. Furthermore, in most instances lesson had been learned when things had gone wrong.

Some parts of the residential provision were not designed, adapted and decorated to meet people’s needs and expectations. However, suitable arrangements had been made in both parts of the service to promote positive outcomes for people including seeking consent to care and treatment in line with legislation and national guidance. Although in practice care staff knew how to care for people in the right way, some of them had not received all of the training that the registered persons considered to be necessary. However, in both parts of the service arrangements were in place that were designed to assess people’s needs and choices so that care was provided to achieve effective outcomes. Also, in both parts of the service people were helped to eat and drink enough to maintain a balanced diet. In addition, suitable arrangements had been made to help people receive coordinated care when they moved between different services. Furthermore, people using both parts of the service had been supported to receive on-going healthcare assistance.

People who used both parts of the service were treated with kindness, respect and compassion. In addition, they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. Furthermore, confidential information was kept private.

Although in practice people who used both parts of the service received responsive care, information was not always presented to them in an accessible manner. However, people using both parts of the service had been offered sufficient opportunities to pursue their hobbies and interests and to engage in social activities. Furthermore, suitable arrangements had been made in both parts of the service to promote equality and diversity. This included the registered persons recognising the importance of appropriately supporting people who chose gay, lesbian, bisexual and transgender lifestyles. In addition, records showed that complaints and concerns had been properly managed and resolved. In the residential provision, suitable steps had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a registered manager who had established a positive culture in both parts of the service that was focused upon achieving good outcomes for people. In addition, care staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. Furthermore, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

We did not speak with any people who used the service on this occasion but we spoke with the manager and staff.

Since our last visit the provider had reviewed how they were checking on the quality of the service provided. A number of audits had been put in place to check different systems, gather the views of people who used the service and took into consideration staff views.

Any actions had been completed and signed by the manager when this had taken place.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, their relatives, the staff supporting them and from looking at records. We spoke with people who used the service during a site visit on 9 May 2014 the care home and by telephone on 12 and 14 May 2014.

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

There were no systems in place to make sure that managers and staff learnt from events such as accidents and incidents. This could put people at risk if actions were not learnt from incidents and breakdowns in the service,. Regular checks were undertaken to ensure the environment was safe and an action plan was in place for the general maintenance and refurbishment of the premises.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly. Therefore people were not put at unnecessary risk.

The registered manager ensured staff were supervised and received adequate training to enable them to do their job. This was a new system and needs time to be sustained and embedded into the system.

There was no method in place to ensure that staffing levels were maintained to ensure people's current needs were being met.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing their care plans and they reflected their current needs.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. People told us they could express their views at group meetings and at meetings on a one to one basis.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, "Staff are so kind" and "All my needs are being met."

People who used the service, their relatives, friends and other professionals involved with the service attended meetings throughout the year. Where shortfalls or concerns were raised these were addressed. People told us they felt their opinions were valued.

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

Is the service responsive?

People told us they could speak with staff each day and share their concerns. They told us staff acted quickly to meet their needs. Relatives told us they could speak with staff about their family member's needs, when that person could not make decisions for themselves.

Various quality checks were completed by staff each month but no analysis of the outcomes were required to see whether the quality standards were being maintained. This could people at risk of a poor standard of quality being available to them.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We spoke with five people who lived at the home and the relatives of one person who lived at the home.

One person who lived at the home told us 'There is enough staff to look after us but the activities coordinator has been off sick for a month and we haven't been doing anything since.'

Another person told us 'There have been considerable changes since I first came to live here. We don't have any meetings to discuss how we would like things to be done.'

We also spoke with two members of care staff. One member of staff told us she had not undertaken an induction programme and that she had not been given any training in care related issues.

During our visit we found that the provider was not meeting the required standards in relation to consent, care and welfare of people who use services, the safety and suitability of premises, supporting workers, and records.

The provider had commenced a maintenance programme since our last inspection. We saw work in progress such as replacing carpets and curtains. Staff told us they liked the new purchases.

Audits had commenced to ensure the provider was monitoring the quality of the services being provided.

The people we spoke with told us their care was personalised to their needs. People's preferred names were used. All but one person living there, who we spoke with, told us they knew staff kept records on them and had seen those records and discussed their content.

People told us they felt safe and if they were concerned about anything they would discuss it with a member of staff. One person said, "All the staff are pleasant and approachable." Another said, "I feel safe in their hands." People confirmed their views were sought through regular meetings with staff, quietly in the privacy of their rooms and by group meetings and questionnaires. This was confirmed by the records reviewed.