Archived: The Beeches

At our last inspection in September 2017 we rated the service as ‘Requires Improvement’, and identified two breaches of regulation in relation to safe care and treatment and need for consent. On this inspection we looked to see what action had been taken to make sure the service had achieved compliance with these regulations.

The Beeches is a care home. People living 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.

The Beeches provides accommodation and personal care for up to 23 older people, some of whom were living with dementia. The accommodation is over two floors, with a passenger lift to provide access. There are communal lounges and a dining room on the ground floor.

There was a registered manager in post when we inspected the service. 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 told us they felt safe living at The Beeches. Premises were well maintained and staff understood how to recognise signs of potential abuse and their responsibilities to report these. The home was clean and well maintained. Improvements had been made to make sure medicines were managed safely.

Staff were recruited safely and received training and support appropriate to their role. People told us there were enough staff available to meet their needs safely and in a timely fashion.

When accidents occurred we saw these were reported and investigated appropriately. The registered manager audited accidents to look at ways in which the risk of reoccurrence could be minimised.

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. Improvements had been made in relation to the process for making decisions in the best interests of people who lacked capacity and conditions on Deprivation of Liberty Safeguards were being met.

People told us they enjoyed the food at the home and had plenty of choice. We saw the food was of good quality and people were supported to enjoy the mealtime experience. Visitors were invited to share a meal with their relative.

People were supported to access health and social care professionals when needed. A visiting district nurse told us they were very happy with the health care provided at The Beeches.

People and relatives were unanimous in their praise of the standard of care provided. Our observations during the inspection confirmed this.

Some care plans required further development to demonstrate the person-centred approach we observed.

People told us they enjoyed the activities provided at the home.

Processes were in place to make sure complaints were managed appropriately. People told us they would not hesitate to speak to staff if they had any concerns.

Systems were in place to monitor and improve quality and safety in the home, including audits, meetings and surveys. The management team had responded well to suggestions made at the previous inspection to improve the auditing process.

People who lived at the home, relatives and staff were complimentary of both the registered and deputy manager.

We found sufficient action had been taken to comply with regulations identified as being breached at the last inspection and did not identify any breaches of regulation on this inspection.

At our last inspection we rated the service as ‘Good’, and did not identify any breaches of regulation.

The Beeches provides accommodation and personal care for up to 23 older people, some of whom were living with dementia. The accommodation is over two floors, with a passenger lift to provide access. There are communal lounges and a dining room on the ground floor.

There was a registered manager in post when we inspected the service. 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 told us they felt safe living at The Beeches. Premises were well maintained and staff understood how to recognise signs of potential abuse and their responsibilities to report these. Premises were well maintained. However, we found medicines were not always managed safely, and identified a breach of regulations.

Staff were recruited safely and deployed in sufficient numbers to provide safe care and support, and the registered manager planned to work with the provider to develop a tool to help calculate safe staffing levels based on people’s needs.

When accidents occurred we saw these were reported and investigated appropriately.

People’s capacity to make decisions was not always well recorded, and where best interests decisions were required there was not always documentation in place. The registered manager was recognising when applications for Deprivation of Liberty Safeguards (DoLS) were needed, however we saw one DoLS had conditions attached to the authorisation which were not being met. We identified a breach of regulation associated with this.

People told us they enjoyed the food, however we saw people did not always receive effective support at mealtimes. We observed the lunchtime meal was not well organised, and the registered manager was candid in raising this with us before we gave feedback.

We saw people were supported to access health and social care professionals when needed.

Staff received an effective induction and had good access to on-going training. Supervision and appraisal meetings were regular and meaningful. People told us they had confidence in the staff’s ability to provide effective care.

People and relatives told us the staff were caring, and we made observations that confirmed this. We saw a good approach to maintaining people’s privacy and dignity, and staff we spoke with knew people well.’

The provider assessed people’s needs before they began using the service, and used this information to write a series of individualised care plans, which were kept up to date. Care plans reflected people’s individual needs and preferences, although we did not see evidence of people or their relatives being involved in this process.

There was a programme of activities and relatives confirmed activities took place.

We saw there were processes in place to ensure complaints were managed appropriately, and people and their relatives told us they would be happy speaking with the registered manager if they had any concerns.

We received good feedback about the registered manager. Staff described them as approachable and said the registered manager regularly worked alongside them providing care.

There were a number of systems in place to monitor and improve quality in the home, including audits, meetings and surveys. Although audits were up to date we discussed some changes which could be made to strengthen this activity.

During the inspection we identified two breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report.

We checked the medicines records and stocks of nine people who used the service. None of these people were able to speak with us about their medicines on the day of our visit, however we looked at a recent resident survey and saw that no-one had expressed any concerns about how their medicines were handled.

At this visit we saw formal applications had been submitted to the CQC to remove Regulated Activities relating to the provision of nursing care to reflect the change to the service provided. There was a Registered Manager in post, and a process was in place to submit statutory notifications about incidents that affect the health, safety and welfare of people who used the service.

We spoke with five of the 16 people living in The Beeches who told us they were happy living in the home. One person commented, 'I'm very well looked after.' We also spoke with two visiting relatives who also said they were happy with the care provided by the home and said they had no concerns. They told us they felt able to speak with staff if they had any issues.

We found all care workers handling medicines had completed certificated medicines training and had been assessed as competent in the homes medicines procedures. However, we found that the action plan had not been fully effective in bringing about improvements in medicines handling. For example, we again found that appropriate arrangements were not in place for recoding the application of prescribed creams. This meant it was impossible to tell whether creams were being used correctly, as prescribed.

Staff told us they had a good working relationship with professionals from other agencies and how they sought advice and support from these specialists to provide appropriate care to meet people's needs. We spoke with a visiting health professional who confirmed this and told us that the staff at the home followed their clinical recommendations to meet the needs of the people in their care.

Care workers administering people's medicines had not completed assessed training in the safe handling of medicines. The manager showed us that a course had been chosen, but care workers had not yet been enrolled onto it.

During this visit we the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We found a programme of redecoration and general maintenance was in place.

The Beeches were not reporting important events that affect the health safety and welfare of people who live in the home to the CQC as required. We discussed this with the manager who acknowledged he had overlooked the submission of statutory notifications. He provided assurance he would comply with this from now on.