Beechy Knoll Care Home

We found the following examples of good practice.

The provider was supporting people who used the service and staff to access regular testing for COVID-19, to try to limit any potential outbreak in the service. For example, staff were required to complete a lateral flow device (LFD) test prior to the start of each shift.

Appropriate checks were undertaken before people moved into the home to reduce the risk of infection being introduced to the service. The service obtained evidence that any person being admitted to the service had recently tested negative for COVID-19, prior to their arrival.

There were systems in place to support people to access the community regularly. The risk of doing so had been assessed and measures had been introduced to manage the risk of people contracting COVID-19 through the use of regular LFD tests.

Staff had received training about how to keep people safe from the risk of infection and how to use personal protective equipment (PPE) correctly. The provider ensured there was enough PPE available for staff at all times.

Beechy Knoll is a residential care home that provides accommodation for older people, people living with dementia and people with a learning disability who require personal care. The home can accommodate up to 40 people in one adapted building over two floors. At the time of this inspection there were 34 people using the service.

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

People told us they felt safe living at Beechy Knoll. They told us staff usually responded to them quickly. We found some improvements were needed to the deployment of staff to ensure they were always available when people needed support. Most people received their medicines as prescribed, however improvements were needed to some medicines records to ensure people received the correct support from staff. The risks to people were assessed and minimised and people were protected from the risk of abuse.

People received appropriate nutrition and hydration, however we found improvements could be made to the dining experience. People were supported by staff who had received a range of training to ensure they had the right skills to care for people. 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 told us staff were kind and caring. People said they felt well-treated by staff and they were involved in decisions about their care. Staff supported people to maintain their independence. People’s privacy was respected.

People felt able to complain about the service, if they had any concerns. An activity coordinator arranged a varied programme of activities and entertainment for people, within the home and local community. People were happy with the programme of activities, but said they became bored if the activity coordinator was not there.

People and their relatives told us the home was well-run. People were supported by a team of staff who were happy in their jobs and well-supported by their managers. An experienced registered manager completed a range of regular checks on the quality and safety of the service. People and their relatives told us the home had improved since the registered manager had started working there.

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 25 July 2018) and we found a breach of one 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.

Why we inspected

This was a planned inspection based on the previous rating.

Thematic review

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement. As part of thematic review, we carried out a survey with the deputy manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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 checked progress the registered provider had made following our inspection on 25 January 2017 when we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in; Regulation 9; Person-centred care, Regulation 11; Need for consent, Regulation 12; Safe care and treatment, Regulation 15; Premises and equipment, and Regulation 17; Good governance.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led. We found improvements had been made and the registered provider was no longer in breach of regulations.

Beechy Knoll Care Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Beechy Knoll Care Home is a care home providing accommodation and personal care up to 40 older people with a range of support needs, including people living with dementia. There were 24 people living at Beechy Knoll Care Home at the time of this inspection.

There was a registered manager employed at 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.

Staff had not been provided with supervisions and appraisals at the frequency identified in the registered provider’s policy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.

People’s care records contained detailed information and reflected the care and support being given, but we found there were no records of best interest decisions for the use of restrictive equipment, such as bed rails.

There were systems in place to monitor and improve the quality of the service provided and make sure full and safe procedures were adhered to.

People spoken with were very positive about their experience of living at Beechy Knoll Care Home. They told us they were happy, felt safe and were respected.

We found systems were in place to make sure people received their medicines safely so their health needs were met.

Staff records showed staff were provided with relevant training, which gave them the skills they needed to undertake their role.

The service employed a part-time activities coordinator and we saw a stimulating programme of activities was offered at the service. We received positive feedback from people who used the service about the quality of activities provided.

Beechy Knoll Care Home is a residential care home based in Sheffield. The home provides care for older people and people living with dementia. The home is situated close to local amenities and transport links. The home is registered to provide accommodation and personal care for 40 people and on the day of our inspection there were 26 people using the service.

It is a condition of registration with Care Quality Commission that there is a registered manager 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. There had not been a registered manager at the service since September 2016. The current manager was recruited in October 2016 and was in the process of applying to CQC for registration. The manager was present on the day of our inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People told us they felt safe living at Beechy Knoll. Comments included, “I feel very safe here” and “[Staff are] Nice people now and they look after me now.”

People living at Beechy Knoll and their relatives told us staff were mostly caring, and their privacy and dignity were respected. We saw and heard positive interactions between people and staff throughout the day of our inspection.

We found effective systems were in place to ensure medicines were managed, stored and administered in a safe way. However, improvements were still required in the administration of topical medicines, such as prescribed skin creams and with ‘as and when required’ medicines.

Staff knew how to protect people from harm and what they would do if they had any safeguarding concerns. They were confident any concerns would be taken seriously by management.

Safe recruitment procedures were followed to ensure that all the required information and documents were in place before staff commenced employment. Staff received regular supervision to support them in their job.

There were enough staff employed to meet the needs of people living at Beechy Knoll. The manager reviewed staffing levels regularly and reassured us she would be able to increase staffing levels as and when required.

The service did not always follow the requirements of the Mental Capacity Act 2005 Code of Practice and Deprivation of Liberty Safeguards as not all people’s care plans clearly recorded whether the person had the capacity to make significant decisions about their care and treatment.

People were provided with a nutritious diet. People told us they enjoyed the food served at Beechy Knoll.

Some activities were provided. An activities co-ordinator was in the process of being employed. People living at Beechy Knoll told us that more activities were being made available to them and this was an improving area.

The heating and hot water system was not consistently effective throughout the building. People told us there was not always hot water and some windows were draughty. Some rooms were intensely hot.

Some parts of the premises were not clean and this increased the risk of cross infection.

More quality assurance systems needed to be introduced to look at the quality of the service provided. Those that were in place were not fully effective at identifying shortfalls in order to improve practice.

The service did have a policy and procedure file, a statement of purpose and a service user guide. However, all were out of date. This meant they may not reflect current legislation and good practice guidance.

People living at Beechy Knoll and staff working there told us the manager was approachable and supportive. We saw there were plans in place for on-going improvements, including more training for staff and introducing a quarterly questionnaire to gain feedback.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 12; Safe care and treatment, Regulation 15; Premises and equipment, Regulation 11; Need for consent, Regulation 9; Person-centred care and Regulation 17; Good governance. You can see what action we told the provider to take at the back of the full version of the report.

Beechy Knoll Care Home is a residential care home based in Sheffield. The home provides care for older people and people living with dementia. The home is situated close to local amenities and transport links. The home is registered to provide accommodation and personal care for 40 people and on the day of our inspection there were 35 people using the service.

The home had a registered manager in place and they were present on the first day of 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.

We spoke with a range of different team members; the deputy manager, care staff, kitchen staff domestics and maintenance staff who gave us mixed reviews about the registered manager.

From looking at people’s care plans we saw they were written in plain English but not in a person centred way. The care plans did not all contain people’s personal history and information on care needs was task orientated. These were not regularly reviewed by staff or updated by the registered manager.

Individual care plans contained risk assessments. Some were individualised but others were generic. The risk assessments identified risks but did not describe the measures and interventions to be taken to mitigate risks and ensure people were protected from harm. Some of the care plans we viewed showed us that people’s health was monitored and referrals were made to other health care professionals where necessary but others indicated this was not always the case.

On the day of our inspection people who used the service were not supported by sufficient numbers of staff to meet their care needs. We could see in the staffing rotas that there had been recent staffing issues and people who used the service had not been supported by enough people on a regular basis.

When we looked at the staff training records they showed us that staff were not always supported to maintain and develop their skills through training and development opportunities. We found that some training had expired and staff needed to attend refresher training.

When we looked at supervision and appraisal records we saw that these had been carried out, however they were ineffective and did not address staff wellbeing or performance.

We also viewed staff recruitment records which showed us recruitment practice was not always robust.

We observed how the service stored and administered medicines. We looked at how records were kept and spoke with the management team about how staff were trained to administer medication. We found that medicines were not stored safely and numerous medication errors had taken place. Audits had not identified these issues and staff did not all have the knowledge and skills to appropriately administer medicines.

During the inspection we witnessed some positive interactions between staff and people who used the service. However staff did not always respect people’s dignity when communicating and supporting people.

Activities were not always provided. We saw that some activities took place and also saw evidence that people were being supported to go out but this was not regular or consistent.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We saw people enjoying their meals however the daily menu was not developed with the people who used the service to incorporate their likes and preferences.

We saw the service had a complaints and compliments procedure that was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. We saw evidence that this complaints procedure was not adhered to.

We found a quality assurance survey had taken place previously and we looked at the results. Relatives told us that they had been asked to take part in the surveys. There were no actions identified that were in place to make improvements to the service as result of peoples suggestions.

The program of audits carried out by the registered manager were ineffective and not carried out regularly.

We found that the service didn’t provide an environment suitable for people living with dementia.

The service was unable to provide people with a choice of bathing or showering as there were no working showers on the premises.

During the inspection we found 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.

We observed games taking place in the home. The staff facilitating this took time to ensure that everyone taking part was included, and led the game in a way that meant everyone was involved and benefited from the activity. The people we spoke with told us that they enjoyed this activity. One person said: 'They do look after me, and we always have a laugh.' Another person told us they thought that the staff had 'hearts of gold.'

People were protected from the risk of infection because appropriate guidance had been followed. There were hand wash points throughout the home, and guidance at each point for staff and visitors. We observed staff carrying out care tasks and saw that they used the appropriate personal protective equipment (PPE) for each activity. PPE was available throughout the home.

Staff were provided with a range of training opportunities to ensure that their skills and knowledge remained up to date and that they understood the needs of people they were supporting.

We checked care records. We saw that records were not all completed to a sufficient standard to ensure the provider held appropriate information about people or the care provided to them.

At this visit we saw the provider had addressed the shortfalls we identified at our last inspection by introducing new forms and audit tools. These had helped to make sure things like the amount of food people were eating and changes in their weight was being monitored and acted on as necessary.

On this occasion we did not speak to people who used the service. However their experiences were captured through information received from the provider, checking records and speaking with the manager.

People's needs were assessed and care and treatment was planned and delivered mostly in line with their individual care plan. We found staff turnover at Beechy Knoll Care Home was very low. Therefore staff knew people who lived at the home well and were familiar with their changing needs. We observed people receiving appropriate care in line with their needs.

People were supported to be able to eat and drink sufficient amounts to meet their needs. Our observations at meal time confirmed that all staff including the cook got involved during meal time. They made sure all the people who were able to eat had a choice at meal time and received support where needed.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. All the people who lived at the home had access to the complaints procedure. Three people said they knew how to make formal complaints. One person said, 'I don't like to complain. They have a hard enough job to do. I tell them if I am not happy about something. They soon put it right.'