Archived: Beechdale Manor Care Home

At the time of our inspection there was no registered manager in post. The registered manager had left the service in September 2016. Interim management arrangements were 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last comprehensive inspection in November and December 2016, we asked the provider to take action in relation to a number of breaches of regulations. During this inspection we found improvements had been made.

People received their medicines as prescribed and medicines were managed safely. People were kept safe by staff who understood their responsibility to protect people from avoidable harm and abuse. Measures to keep people safe, such as equipment and regular observation were in place and safety checks were carried out as required. People were supported by sufficient numbers of staff.

People were supported by staff who had received training and were supported by the management team. People were encouraged to make choices and decisions and had their rights protected under the Mental Capacity Act 2005. We observed that some people required further encouragement to eat but people were supported to drink enough. People were supported to maintain their health and people’s health was monitored and any changes responded to.

People were cared for by staff who were kind and treated them with dignity and respect. People and their relatives were given opportunities to be involved in reviewing the care they received and people had access to advocacy services if they required this.

People told us they received care and support at the time they required it and in line with their preferences. Staff were provided with guidance about people’s needs and preferences in care plans which had been regularly reviewed and updated when people’s needs changed. People and their relatives felt able to approach the management team with any concerns and we saw that action had been taken to address concerns which had been raised.

Systems in place to monitor and improve the quality of the service were not always fully effective. People and their relatives told us the management team were approachable and responsive to concerns visible and staff felt supported and motivated. People and their relatives were kept informed of changes and given opportunities to be involved in the development of the service.

Beechdale Manor provides accommodation, nursing and personal care for up to 65 older people, some of whom were living with dementia. There were 44 people living at the service at the time of our inspection.

At the time of our inspection there was no registered manager in post. The registered manager had stopped working as the manager in May 2016 and had since left the service. Interim management arrangements had been in place until the new manager had commenced working at the service approximately a month before our 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.

At our last comprehensive inspection on 16 and 17 August 2016, we asked the provider to take action in relation to a number of breaches of regulations. Following the inspection the provider sent us an action plan to inform us of planned improvements. During this inspection we found some improvements had been made in line with the action plan, however we identified further improvements were required to ensure people were safe and received care which was specific to their needs and preferences. We also identified further breaches of regulation.

People were not always safely supported when being assisted by staff to mobilise around the service. Potential safety hazards such as unsafe access to medicines and inaccurate information about people who lived at the service had not been identified or responded to. Safety checks to equipment were being carried out on a regular basis.

People were protected from the risk of abuse as management and staff understood their role in keeping people safe from harm.

Staffing levels identified by the provider were being maintained however people told us that their needs were not always responded to in a timely way.

Staff had not always been recruited following safe recruitment practices.

Improvements were required to the administration of medicines to ensure this was safe and that people received their medicines as prescribed.

People were supported by staff who had received training and were supported by the management team to ensure they could perform their roles and responsibilities effectively.

People were encouraged to make choices and decisions however; people’s rights were not fully protected under the Mental Capacity Act 2005. The registered manager had applied for authorisations to deprive people of their liberty if required. However, further advice or authorisation had not been sought when the restrictions on people had changed.

People told us they found the food satisfactory and that people’s dietary requirements were known and catered for. People received support to maintain their hydration, nutrition and healthcare although documentation required improvement.

Staff were kind and people were treated with dignity and respect. People were given information and choices and supported to maintain their independence.

There was some evidence to show that people were involved in decisions about their care and advocacy information was available to people.

People did not always receive care that was responsive to their needs and preferences. Staff were not always provided with sufficient guidance or in some instances the guidance provided was not being followed. This resulted in negative outcomes for some people.

People and their relatives felt able to approach the management team with any concerns and we saw that action had been taken to address concerns which had been raised.

Systems in place to monitor and improve the quality of the service provided were not effective in responding to issues in a timely way. Information and feedback was not used effectively to drive continuous improvements at the service.

People told us that the management of the home were visible and approachable and staff felt supported and motivated. People and their relatives were given opportunities to be involved in the development of the service.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

The overall rating for this service is ‘Requires Improvement’. However, that service has been rated as ‘Inadequate’ in one key question over two consecutive comprehensive inspections therefore will remain in special measures.

The service 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. For adult social care services the maximum time for being in special measures will usually be no more than 12 months.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We carried out an unannounced comprehensive inspection of this service on 16 and 17 August 2016. Breaches of legal requirements were found. We issued warning notices in relation to two of these breaches.

We undertook this focused inspection to confirm that the provider had met the requirements of one of these warning notices. This report only covers our findings in relation to those requirements. We will be following up the other warning notice at a later date once the date of required compliance has passed. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beechdale Manor Care Home on our website at www.cqc.org.uk.

The service did not have a registered manager in post as they had stopped working as the manager in May 2016. An interim manager was in place at the time of our inspection. A new manager had been recruited and was due to commence working at the service shortly after our visit. 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 and associated Regulations about how the service is run.

At our last inspection on 16 and 17 August 2016, we asked the provider to take action to ensure that people were provided with safe care and treatment through the proper and safe management of medicines.

During this inspection, we found that action had been taken to improve the storage and administration of medicines, however further improvements were required to ensure people were given their medicines as prescribed and medicines were managed safely.

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

Accommodation and nursing care for up to 65 people is provided in the home over three floors. The service is designed to meet the needs of older people. Some people were living with dementia. There were 52 people using the service at the time of our inspection.

At the previous inspection on 3 December 2015, we asked the provider to take action to make improvements to the area of good governance. Following the inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. At this inspection we found that improvements were still required and the regulation had not been complied with.

A registered manager was in post but she was not available during the inspection and was no longer working as the manager of the home. An acting manager was in place on a temporary basis and was available during the inspection. However, no application to register a new manager had been received by the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Potential safeguarding issues had not been reported or not reported accurately putting people at greater risk of abuse. Identified risks to people were not always managed safely and accidents and incidents were not well documented to show that they had been appropriately responded to.

Robust systems were not in place to ensure that sufficient numbers of staff were on duty to meet people’s needs and keep them safe. Safe infection control and medicines practices were not always followed. However, staff were recruited through safe recruitment practices.

Not all staff received appropriate induction, training, supervision and appraisal. People’s needs were not fully met by the adaptation, design and decoration of the service. People’s rights were not fully protected under the Mental Capacity Act 2005.

Documentation to show that people received sufficient to eat and drink required improvement. However, external professionals were involved in people’s care as appropriate.

Staff were kind and knew people well. However, there was limited evidence that people and their relatives were involved in decisions about their care and advocacy information was not available to people.

People’s dignity and privacy were not always fully protected. However, we were told that staff encouraged people to be as independent as possible.

People did not always receive care that was responsive to their needs and activities required improvement. Care records contained some information to support staff to meet people’s individual needs but could be further improved.

A complaints process was in place and staff knew how to respond to complaints. However, information on how to make a complaint was not easily accessible to people.

People and their relatives had some opportunities to be involved in the development of the service; however, it was not clear that issues raised were fully responded to.

The registered manager was not working as the manager of the service. Staff views on the quality of leadership was mixed and some staff felt that they did not receive constructive feedback.

Systems in place to monitor and improve the quality of the service provided were not effective.

We found breaches 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 this report.

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.”

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

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

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service. We undertook conversations with six people who used the service and one person's relative. We spoke with representatives from the management team and four care staff. We also spoke with the activities coordinator, head chef, domestic assistant and nurse. We looked at some of the records held at the home which included people's care plans and supplementary documentation.

The home does not currently have a registered manager. A new manager has been appointed and we have been told they plan to have them in place by the end of July 2014. In the meantime, three people were covering the managerial duties, with a Quality Assurance Manager managing the home for four of the seven days per week. In terms of the content of this report, we have referred to this person as the manager. We will monitor this service and the new manager's application to become registered with the CQC.

Is the service safe?

Only nine of the forty three people who used the service had been involved in a review of the care plans. We were told by the manager that plans were in place to ensure the remaining people, and where appropriate their representatives, were involved in a review of the care.

People were cared for an environment that was safe, clean and tidy. Communal and garden areas were well maintained and people spoken with told us they were happy with the cleanliness within the home.

Some of the staff spoken with told us they did not regularly read people's care plans and therefore we could not be confident that people always received care and treatment appropriate to their needs. However we spoke with people who used the service and they told us they felt safe at the home. One person said, 'I feel safe, I have no issues. You couldn't want for a better place. My health has improved so much since being here.' Another person said, 'I am safe here, I feel so happy. I think this is a fantastic home, I wouldn't want to live anywhere else. They [staff] look after me so well, I don't want for anything.'

We could not judge whether staff were suitably skilled or qualified for their role. Staff training records showed gaps in some areas such as moving and handling, dementia and dignity awareness.

The CQC monitors the operation of the deprivation of liberty safeguards (DoLS) in place which applies to care homes. DoLS are part of the Mental Capacity Act 2005. Correctly applied DoLS make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. The manager and staff could explain the principles of the DoLS and how they implement these safeguards into the role. The manager told us they would be assessing each person who used the service to establish whether a DoLS was required for them.

Is the service effective?

Staff gave people choices throughout the day and were patient in their approach.

We saw a person had been assessed as requiring their food and fluid intake to be monitored. However the records did not always reflect that this had been carried out

The food and drink provided for people was readily available, of a good quality and there was a wide range of food to choose from. The head chef requested people's feedback regularly and asked them what they thought of the food and drink.

People who used the service said, "You get plenty of choice of food. There are so many nice things to choose from. You can order your food the day before. It really is fantastic. I don't have to wait a long time for my food, it is there when I want it.'

Is the service caring?

We observed staff interactions with people who used the service and in the majority of occasions they were caring in their approach. However we did see one member of staff talk disrespectfully to a person who used the service, which was reported to the manager.

People who used the service spoke highly of the staff and responded well to them throughout the day.

Is the service responsive?

Staff responded to people's needs in a timely manner. They responded to call bells within a reasonable time frame.

However we saw a person was left for an unacceptable length of time to wait for their lunch as the stand aid required to assist them to the dining room was unavailable. They were left alone, for half an hour, before assistance was provided. We spoke with the person and staff and they assured us that this was a one off and did not happen regularly.

Is the service well-led?

There is not currently a permanent manager at the home, although we were told by the Quality Assurance Manager (QAM) that a new manager had been recruited and was due to commence employment soon.

People who used the service and staff told us they found the current manager approachable and were confident they would deal with any concerns or complaints that they had.

We saw some quality monitoring had taken place throughout the home, although the quality and review of the care plans was not sufficient. Additionally the regular monitoring of staff performance had not always taken place.