Beaufort Hall Nursing Home

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

People and relatives spoke positively about the care and support that was in place. People told us they felt safe and staff were attentive to their needs.

There had been workforce pressures within the service when on occasions the home was staffed below expected numbers due to staff absence. The registered manager and the team had tried to cover the shortfalls including contacting staff agencies.

Staff received training on how to keep people safe and what to do if they had concerns. Medicines were administered safely. Since the last inspection, the provider had made improvements to their recruitment processes to ensure appropriate checks had been carried out before staff were employed.

The provider was following government guidance to prevent people and visitors to the home spreading COVID-19 infection. The provider kept in touch with relatives through regular emails, telephone calls and newsletters. Visits to the home were promoted and in line with government guidance. We observed good infection control measures were in place. The home was clean and free from odour. Staff were wearing appropriate personal protective equipment (PPE).

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. People were involved in their care and consulted on how they wanted to be supported. Regular meetings were held with people to gain their views on the service and make improvements. People were consulted about what they wanted to eat.

There were systems in place to monitor the quality of the care and support. The provider regularly visited the service to drive improvements and support the registered manager and the staff. Improvements had been made to ensure incidents, accidents and allegations of abuse were reported in a timely manner in response to a breach of regulation found at the last inspection.

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 12 August 2020) and there were breaches of regulation in respect of ensuring robust recruitment processes were followed and failure to notify the Commission of safeguarding concerns.

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 inspection was prompted by a direct monitoring review we held about this service, concerns were raised about staffing, risk management, accuracy of records and governance arrangements. 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.

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.

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 requires improvement to 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 Hall Nursing Home 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 Hall Nursing Home provides accommodation, nursing and personal care for up to 33 people; some of whom are living with dementia. It is also registered to provide the regulated activity of treatment of disease, disorder and injury. At the time of this inspection there were 25 people living in the service.

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

People were not always protected from the risk of unsuitable staff being employed. The provider had not ensured that references were sought in line with their policy.

The manager had investigated any safeguarding concerns, however, had failed to notify CQC of these as required by the registration regulations.

There was a system in place to monitor the running of the service, however this was not always operated effectively. Systems in place had not identified the shortfall in references before employing new staff. Systems had also failed to identify the lack of required notifications to CQC.

We observed staff interactions with people; due to Covid-19 we did not talk with people in order to minimise any risk. We observed very positive staff behaviour in supporting people. Staff spoke warmly, kindly and appropriately with people. It was evident staff knew people well and people felt relaxed and comfortable with staff. Staff spoke with us about their roles and demonstrated a clear understanding of, and commitment to, treating people as individuals.

There were enough staff employed on each shift to look after people according to their assessed needs. Systems were in place to provide cover should there be shortfalls in staffing.

Risks to the health and welfare of people living at the service were assessed and guidance was in place to reduce or manage these risks. People had individualised care plans that supported their needs and preferences. Environmental risks were assessed, and action taken to rectify these. Regular maintenance was undertaken.

Medicines were managed safely.

The provider had systems in place for ongoing refurbishment and routine maintenance.

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 14 November 2018).

Why we inspected

We received concerns in relation to people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm in respect of their nursing care needs, however we identified two breaches of regulation. Please see the safe and well-led sections of this report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

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 breaches in relation to safe recruitment and failure to notify CQC of significant events.

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

At the last inspection in October 2017, the service was rated 'requires improvement' in the areas of safe and well led. At this inspection, we found the service had made improvements under the questions is the service safe and well-led? The service is now rated as good. Beaufort Hall Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People's medication was now well managed by staff that had received training and have been assessed as competent. People were given their medicines in a safe manner.

Quality monitoring procedures were now in place and action was taken where improvements were identified.

There was not a registered manager in post at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. However, there was an interim manager in post and a new permanent manager was due to start. 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.

Care plans did not all provide detailed guidance to staff to ensure that people were receiving the appropriate care at all times. People felt safe and staff knew how to respond to possible harm and how to reduce risks to people.

People were looked after by enough staff, who were trained and supervised to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service.

Lessons were learnt about accidents and incidents and these were shared with staff members to ensure changes were made to staff practices and to reduce further occurrences. People were looked after by enough staff, who were trained and supervised to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service.

People's privacy and dignity was promoted and maintained by staff. People received a caring service as their needs were met in a considerate manner and staff knew the people they cared for well. People were involved in their care and staff encouraged people's independence as far as practicable. Activities were offered to support people's interests and well-being. Equipment and technology was used to assist people to receive care and support which included the use of call bells.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People's confidential records were held securely. Systems were in place to promote and maintain good infection prevention and control.

People received a choice of meals, which they liked, and staff supported them to eat and drink. People were referred to health care professionals as needed and staff followed their advice. The registered manager and staff team worked with other health and social care organisations to make sure that people's care was coordinated and person centred.

Compliments were received about the service and complaints investigated, responded to and resolved where possible to the complainants' satisfaction. Staff worked well with other external health professionals to make sure that peoples end-of-life care was well managed and this helped ensure people could have a dignified death. There were clear management arrangements in place. Staff, people and their relatives were able to make suggestions and actions were taken as a result.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Medicines management were not consistently managed safely.

The provider did not have consistent effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. The registered manager took immediate actions to address the identified shortfalls in the inspection.

Recruitment procedures ensured all pre-employment requirements were completed before new staff were appointed and commenced their employment. Staffing numbers were sufficient to meet people’s needs and this ensured people were supported safely.

Environmental checks had been undertaken regularly to help ensure the premises and equipment were safe.

The provider had met their responsibilities with regard to 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.

People received effective support from staff that had the skills and knowledge to meet their needs. Staff said they felt well supported and all had regular supervision sessions. Supervision is where staff meet one to one with their line manager.

People told us that staff were kind and caring. We observed that people's privacy and dignity was respected at all times. The service had received a number of compliments from relatives and visitors.

Care plans contained details of people’s preferences and choices regarding the care and support they needed. Plans in relation to people’s health needs were detailed. Care plans had been regularly reviewed. People and relatives felt that the service was responsive to people’s needs. People had access to a range of activities and held the activities coordinator in high regard.

Staff felt well supported by the registered manager and the provider. People were encouraged to provide their views through surveys and regular meetings. Actions were taken in response to people’s feedback.

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 this report.

People told us they were happy with the care and support they received. One person said "I am very happy here and the staff are wonderful". Another person said "You are always asked what you want to do and I really enjoy the art classes". A relative told us they had taken great care in choosing a nursing home for their family member. The person said "I am very pleased with the care and support that my relative receives at Beaufort Hall".

We reviewed ten care plans and saw they contained risk assessments that were regularly reviewed and updated. This ensured that the care that was delivered, was safe. We noted that care was planned and delivered in line with people's individual care and support needs and met their personal choices.

We observed throughout the day that staff sought consent from people in a kind and gentle manner and used a variety of communication styles when seeking consent.

We observed the home was clean and tidy, well maintained and free from noxious odours.

People told us they enjoyed their meals and there was plenty of choice. We observed throughout the day that people were supported to eat and drink well. People had up to date food and fluid charts. We noted that food and fluid intakes were not calculated daily. This meant there was no system in place to monitor whether the food and fluid intake was adequate for each person's needs.