Beaufort Grange

Beaufort Grange is a residential care home providing regulated activities of nursing care to up to

74 people. At the time of the inspection there were 58 people using the service.

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

People’s care plans did not always contain important information relating to their individual needs such as catheter care and how staff were to use their equipment such as their sling. Staff received training in moving and handling although one person was observed to support someone unsafely and not in line with their training.

We found the service was supporting people with their care and most feedback from people and staff was positive. Some feedback did suggest at certain times of the day it was busy with staff supporting other people. We fed this back to the registered manager so they could review this feedback and the staffing situation.

People received their medicines safely from trained staff. Although some improvements needed to be made to recording medicines such as when and where to apply topical cream and when someone might require their angina spray.

People felt supported by staff who they described as 'nice'. The staff team felt it was a nice place to work with good support from their colleagues, although some feedback suggested improvements could be made to how management dealt with issues when raised with them.

People were supported by staff to make daily decisions although best interest decisions relating to covert administration of medicines were not being documented as being in the best interest decisions.

People were supported with referrals to health and social care professionals when required. People had access to a varied diet and hot and cold drinks were available throughout the day.

People were supported by staff who had checks prior to their employment. Incidents and accidents were completed when required and these confirmed any monitoring undertaken by clinical staff and referrals and actions taken.

Rating at last inspection and update

The last rating for this service was Good (Published 13 September 2022). At this inspection we found the service is Requires Improvement.

Why we inspected

The inspection was prompted in part due to concerns received about people getting safe care and there being enough staff. A decision was made for us to inspect and examine those risks.

We found during this inspection that people could be at risk of harm from this concern. Please see the Safe sections of this full report.

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.

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 Good to Requires Improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified a breach in relation to ensuring staff provide people with safe care.

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

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

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

People and their relatives spoke positively about the service they were receiving. They told us there was enough staff and staff were kind and responsive to their needs. Staffing was planned based on the occupancy of the home and people’s individual needs. Some people were supported on a one to one basis to keep them and others safe. This was kept under review as people settled into the home life at Beaufort Grange.

People were kept safe because risks were assessed and mitigated. Medicines were managed safely. People were able to retain responsibility for their medicines where they were assessed as being safe to do so. Safe recruitment was undertaken to ensure people were protected. Staff wore personal protective equipment in line with national guidance. Relatives and visitors were welcomed to the home.

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.

Beaufort Grange provided a comfortable and a homely atmosphere for people. The home was clean and free from odour. Plans were in place to refurbish some areas of the home such as flooring and replacement of curtains.

There were robust systems in place to monitor the quality of the service and drive improvements. Staff described a team, that worked together to deliver care that was person centred. There was an open, transparent and positive culture and people, their relatives, staff and professionals told us the management team were approachable.

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 4 January 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. 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. This inspection examined those risks and staffing within the home.

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 found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

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 not changed and remains good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beaufort Grange 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.

Beaufort Grange is a residential care home providing personal and nursing care to 74 people aged 65 and over at the time of the inspection. The service was at the time of the inspection supporting 67 people. This was over three floors. Each floor had separate lounges, kitchen and dining areas and seating areas where people could socially distance themselves from other people living at Beaufort Grange.

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

Personal protective equipment was not always stored or being worn correctly to prevent the risk of cross contamination or infection. The registered manager took immediate action to address this following our inspection. Staff had checks undertaken prior to starting their employment and where concerns were identified these were managed by the provider.

People received support from staff who knew them well. Relatives and staff felt people received safe care. Staff knew who to go to should they have concerns for people’s safety and they were able to identify the different types of abuse.

This was a targeted inspection that considered if people were safe and if staff had checks in place prior to working with vulnerable people.

Rating at last inspection; Good (Published January 2018)

Why we inspected

The inspection was prompted in part due to concerns received about people receiving safe care and treatment, safe staffing and recruitment. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern.

Please see the Safe section of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beaufort Grange on our website at www.cqc.org.uk.

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.

We carried out a comprehensive inspection on 15 November 2017 and reviewed the improvements that had been made since our last inspections.

Beaufort Grange is a 74 bedded home that provides accommodation for persons who require nursing and personal care. At the time of our inspection there were 38 people living in the care home.

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.

Overall, we found there had been significant improvements and the legal requirements had been met. Further work was needed to ensure that improvements were consistent, embedded and sustained.

Sufficient numbers of staff were deployed at the time of our visit when the home was only 51% occupied. Staff performance was effectively monitored. Staff had received supervision and training to ensure they could meet people’s needs.

People’s medicines were managed safely and audits and checks were completed. Actions were taken when errors were identified.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.

Staff were kind and caring. We found people were being treated with dignity and respect and we found people’s privacy was maintained.

Systems were in place for monitoring quality and safety and actions were taken where areas for improvement and shortfalls had been identified. Further improvements were needed to make sure shortfalls were promptly recognised and acted upon.

We undertook this focused inspection to ensure that people living in the home were safe, and that there were sufficient staffing and management arrangements in place to make sure people’s care needs were being met. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for Beaufort Grange on our website at www.cqc.org. The current overall rating for the home is ‘Requires Improvement.’

Beaufort Grange is registered to provide accommodation for up to 74 people who need nursing or personal care. At the time of our visit, 45 people were living in the home.

There was a manager who was registered with the Care Quality Commission to manage this service. However, they were no longer in post at the time of our visit. Their deregistration process had not been completed. ‘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.

People who used the service and their relatives provided mixed feedback about staffing. Staff turnover and significant reliance on agency staff meant that people could not always be confident their care needs would be met.

There were sufficient management arrangements in place. However, these were temporary arrangements. People and staff were not confident the improvements that had been made would be sustained and embedded in the home.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During January 2016 and February 2016, we received a significant number of concerns about staffing levels and care provision at Beaufort Grange. This information of concern was received from people living at the service, their relatives, staff and from healthcare professionals who had visited the service. As a result of this information we undertook a further comprehensive inspection of Beaufort Grange on 23 February 2016. During this inspection we followed up on the breaches we identified during the inspection in August 2015. You can read the reports from our last comprehensive inspections, by selecting the 'All reports' link for ‘Beaufort Grange, on our website at www.cqc.org.uk.

During the inspection in February 2016, we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of this the service was rated as ‘Inadequate’ overall, the service was therefore in ‘Special measures’. Services in special measures are kept under review. In addition to being placed in special measures, we imposed a condition on the provider’s registration around the assessment of people’s personal care, treatment and medicine needs, internal governance arrangements and recruitment progression.

We carried out a comprehensive inspection of Beaufort Grange on 4 October 2016 to review what improvements had been made at the service since they were placed into special measures following our inspection in February 2016.

Beaufort Grange provides accommodation for people who require nursing or personal care up to a maximum of 74 people. At the time of our inspection, 47 people were living at the service. Following our inspection in February 2016, the provider had placed a voluntary cessation on the admission of new people to the service. The current general manager told us this cessation remained in place and that the Commission would be contacted prior to any people being accepted at Beaufort Grange.

There was a not a registered manager in post during this inspection. 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. The current general manager had submitted all necessary application documentation to the Commission and was awaiting an interview as part of their registration process to become the registered manager.

During this inspection, we found that although governance arrangements and systems had been improved, there was still no effective system in operation to monitor daily records made by staff. We identified that some people’s medicines records, food and fluid charts and repositioning records had not always been completed accurately. Care records did not consistently reflect people’s needs. Despite staff being able to demonstrate an awareness of people’s care needs and risks, people were still not fully protected against the risks associated with poor record keeping.

Through conversations with people and their relatives it was evident they were experiencing a better quality of living than they were during the previous inspections of this service. People and their relatives said they felt safe at the service and commented positively on the staff that supported them. Care records had been updated and reflected the risks associated with people’s care, however we have made a recommendation about the planning of diabetes care. Incident and accident analysis had been completed to reduce risks to people. We found the service was clean and cross infection risks had been reduced. There were sufficient staff to keep people safe, however we did receive some negative comments about the absence of management at the weekends. Recruitment procedures were safe and there were systems to monitor environmental risks.

Staff received supervision and appraisal, however the manager acknowledged the current completion rate was below expectations and informed us this would be addressed. The service understood their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS), and we found that staff knowledge in DoLS was good and that people’s conditions were understood, where applicable. DoLS is a framework to assess the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. Staff had an understanding of how the Mental Capacity Act 2005 impacted on their work.

People were supported to eat and drink where required, however we found records were not consistently completed. The dining experience was significantly improved since our last inspection. People received the required intervention when needed from healthcare professionals and the service benefitted from a regular attendance from the relevant GP. People told us that staff were caring and we made positive observations of care being provided and a good relationship between staff and people was seen. Staff we spoke with understood the needs of the people they cared for and spoke of the desire to provide a high standard of care. We saw the service had received compliments from people’s relatives.

Care records reflected people’s preferences and in general had been written in a person centred way. Most of the care plans we reviewed clearly reflected the needs of the person to whom they referred, however we found some examples of where this was not always consistent. There were activities for people to partake in if they wished and we observed people engaged in activities during the inspection. We received very positive feedback from people and their relatives about the activities co-ordinators employed by the service. There was a complaints procedure in operation and where required this had been followed when a complaint had been received.

There were some effective governance systems in operation to monitor the health, safety and welfare of people at the service. People and the relatives we spoke with were aware of the new management structure in the service. Meetings had been held with people and their relatives to communicate key matters in the service and to explain what improvements were being made within the service.

Staff we spoke with were positive about the new management at the service and told us they felt listened to. They told us they were happy in their employment and expressed how they wished to provide a high standard of care. The manager had received support from the provider in relation to quality monitoring and governance.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During January 2016 and February 2016, we received a significant number of concerns about staffing levels and care provision. This information of concern was received from people living at the service, their relatives, staff and from healthcare professionals who had visited the service. As a result of this information we undertook a comprehensive inspection of Beaufort Grange on 23 February 2016. As part of this inspection, we checked to see if the service was meeting the legal requirements for the six regulations they had breached at our inspection in August 2015. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘Beaufort Grange, on our website at www.cqc.org.uk.

Beaufort Grange provides accommodation for people who require nursing or personal care to a maximum of 74 people. At the time of our inspection, 67 people were living at the service.

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.

The provider had not ensured there was enough staff on duty to meet people’s needs. There was inconsistency in undertaking an accurate assessment of the risks to people’s health and safety. This placed some people living at the service at risk of receiving unsafe or inappropriate care or treatment. We also found there were issues of concern around the management and safe administration of medicines. The service was not consistently clean and appropriate systems were not in operation to reduce cross infection risks.

The provider had not implemented sufficient measures to ensure that people’s nutrition and hydration needs were consistently met. We made observations that the dining experience for some people was not enjoyable due to insufficient numbers of staff being available to support people. The service had not fully complied with the requirements of the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. This placed people at risk of being unlawfully deprived of their liberty. In addition to this, the provider was not providing care in line with people’s consent and with mental capacity legislation.

Not all staff put into practice their knowledge of promoting people’s privacy and dignity. We observed good interactions between people and staff. However, we made observations where people’s dignity was not properly maintained and communication between staff and people was not caring and reassuring when people were distressed or anxious. The provider had not been consistently responsive to people’s needs and we saw examples of poor care being provided and other care not being given in line with people’s assessed needs. We saw that some care provision had not been designed in line with people’s preferences. There were insufficient governance systems to monitor the health, welfare and safety of people. Inaccurate records also placed people at risk of receiving inappropriate or unsafe care or treatment.

Staff we spoke with were knowledgeable about procedures around safeguarding and whistleblowing. The permanent staff we spoke with understood the needs of the people they cared for and the provider had safe recruitment procedures for new staff. Care records showed that people accessed health professionals as required. The provider had a clear complaints policy and the complaints currently being investigated by the provider and registered manager had been responded to in accordance with policy. The equipment and environment in which people were cared for was monitored to ensure it was safe.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During this inspection we looked at the arrangements being made for gaining people’s consent. This helped us to answer the question Is the service safe? And is the service effective?

At the previous inspection of Beaufort Grange on the 28 and 29 April 2014 we had found that procedures were not always followed to ensure that consent was gained from people using the service and it was not recorded in their documentation, before receiving care and treatment. The service had not been complying with the regulation in relation to consent. We told the provider and the manager that they must take action to ensure that improvements were made.

We visited Beaufort Grange again on the 29 July 2014 order to check on the action that had been taken. Below is a summary of what we found.

Is the service safe?

We found that improvements had been made and we found the service was now complying with the regulation. People who used the service were now better protected against the risks associated with medicines. This was because the provider now had appropriate and robust arrangements in place for the recording and safe administration of medicines.

Is it effective?

We found that improvements had been made and we found the service was now complying with the regulation. People’s documentation now demonstrated how people had given their consent to their care and treatment decisions. This was because their care documentation detailed people's consent or best interest decisions. Documentation also evidenced the involvement of family members and other professionals as required.

At the time of our inspection 37 people were living in the home. We observed the care being provided to people in the communal areas of the home and examined the care documentation and supporting records. We spoke with nine people that used the service who were able to tell us of their experiences. We also spoke with eight members of staff to gain their understanding of how they met the needs of people living in the home.

Below is a summary of what we found.

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

Is it safe?

People told us they felt safe and well cared for. They told us “it’s a very lovely home I feel safe here”. We saw that people’s care needs were met in a safe way as moving and handling equipment was used appropriately.

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. One person we spoke with told us they felt safe living in the home and observations that we made evidenced that staff supported people in a safe manner with their moving and handling needs. People who used the service were cared for by staff who knew how to protect them from the risk of abuse.

Staffing was maintained at safe levels. The registered manager set the staff rotas; they took people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. The registered manager told us extra staff could always be provided across the home if required. We viewed this during our inspection. Extra staff were provided in the Memory Lane area of the home. We were told this was because more people required one to one support at this particular meal time. This ensured that people’s needs were met safely.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to ensure that unsafe practice was identified and people were protected. Staff understood the procedure in place to report unsafe working practice.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). The registered manager confirmed no one currently living in the home was subject to a Dols application. However relevant staff had been trained to understand when an application may be required and the registered manager told us about times when they had sought advice in the past from the Dols team. The organisation was introducing a new system of assessment in relation to Dols. This meant that people would be safeguarded as required.

Medicine management systems were not robust in relation to the recording and safe administration of medicines. We have asked the provider to tell us what they are going to do to meet the requirements in relation to medicines.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helps the service to continually improve people’s safety.

Is it caring?

People were supported by sensitive and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. Not everyone was able to verbally tell us of their experience of living in Beaufort Grange. Therefore we spent a period of time observing interactions between staff and people that used the service.

The observations we made demonstrated staff supported people in a calm unhurried manner, using communication methods conducive with their individual assessed needs. People were consulted before staff undertook their care routines. A member of staff was heard to ask a person “would you like me to help you with X”. “Would you like to try something else to eat as you didn’t eat a lot of that”.

Staff were respectful of people’s privacy and were heard knocking on people’s doors prior to entry.

Is it effective?

People living in the home were positive about the care they received. Comments included: “they are fabulous here”, “I am extremely happy here”, “It’s nice, they do their best” and “Food choices are very good”.

We found people’s health and care needs were assessed, but some documentation lacked evidence of how or if people were formally consulted in their care and treatment decisions. This was because some care documentation lacked details of people’s consent or best interest decisions. We have asked the provider to tell us what they are going to do to meet the requirements in relation to consent.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. This was confirmed by observations that we made and discussions we had with members of staff.

Is it responsive?

People's needs had been assessed before they moved into the service. The registered manager told us people met with their key workers monthly to discuss their care plans as part of a system called ‘resident of the day’. This was a system that ensured staff from all departments met with the person to discuss the service provided.

People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. People we spoke with confirmed they had access to a GP as and when they required one. One person told us “I just tell the staff and they will ring for me”.

People knew how to make a complaint if they were unhappy. One person told us “Oh yes my dear I would happily tell the manager”. We looked at the complaints procedure and found it to be robust. Therefore people could be assured that complaints would be investigated in a timely manner.

Is it well-led?

People that used the service and their relatives completed a satisfaction survey once a year and posted testimonials on the organisations website. The registered manager told us if any concerns were raised these would be addressed promptly with the person on a one to one basis. Comments received from people included: “I have a real say in how staff care and support me”. “I cannot fault the home, the atmosphere is a very happy one, and more importantly the staff appear happy in their work”.

Some people we spoke with were able to tell us their experience. They confirmed they felt listened to by staff and knew how to raise a complaint if they needed to.