All inspections: Beechdale Manor Care Home

We spoke with two relatives. Both of them told us they were happy with the care and support that was provided to their relatives. One relative said 'I would recommend this place to anyone. The carers and management are what makes the place good. We are very happy with the care our relative gets here.'

We spoke with three people about how the staff supported them. One person said, 'The staff are very kind, they help me when I need them. They look after me well.' Another person said, 'The staff are lovely, they look after me.'

We found there had been an improvement in respect of care planning and risk assessments and people's care and treatment was now delivered in line with their individual care plan.

During this inspection we found that people were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We spoke with one person living in the service who said, 'The staff are nice, they're alright. I'm happy here, I feel safe.' Another person told us they felt safe and well cared for.

One relative told us they felt that staff did all they could to make sure their relative was safe. Another relative said, 'I feel [my relative] is very safe here. '

We found there were mixed experiences in respect of people being able to make their own choices and decisions about their care. One person said, 'They get me up at about 6.30 am in the morning and then wait for my breakfast. I don't choose when I get up. Sometimes I could do with lying in bed a bit longer.' Whereas another person said, 'I go to bed when I'm ready and get up when I want. I got up at 10 this morning.'

People told us that the staff respected their privacy and dignity and they treated them with respect. We saw staff were respectful throughout our visit.

We saw there was varying degrees in which the provider considered people's capacity to consent and they therefore did not always act in accordance with legal requirements.

We spoke with 18 people and four relatives in respect of their care and welfare needs. The responses were mainly positive and people felt that they needs were met. One person said, 'Carers are excellent. I'm quite independent and I like it that way. They come and help me if I need it.'

We found the activities provided in the home had improved and people told us they were pleased with these.

We found people were not always protected from the risk of abuse.

There were mixed responses in respect of the amount of staff available to support people. We found there were not always sufficient staff available.

We spoke to four people's relatives who all commented positively about the home. One person said, 'I'm happy with the home, It's running smoothly now and I have no concerns regarding [their relative's] care and treatment.' However we found although quality monitoring systems were in place these were not fully effective to ensure people received a quality service.

We found there had been some improvement in record keeping, but further improvements in regard to this and the security of people's personal information were needed.

We talked to some of the people living in Beechdale Manor. They told us that they were given their medicines when they needed them. If they were in pain they could ask for pain killing medicines and staff would get them for them.

We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Last time we visited Beechdale Manor we asked the provider to make improvements. This visit was to see if these improvements had been made.

We found there had been improvements in respect of the support that people received to ensure their health and wellbeing was maintained. Although there were still some improvements required the manager had improved upon the documentation to assist in this process.

We saw that staff were kind and caring and they supported people in line with their plans of care.

Two people told us they were well cared for and all their needs were met.

The expert by experience found people were now enjoying a wider range of activities and stimulation and they spoke positively about care delivery. They also spoke with two people about the food provided. One person said, 'The food is alright' and the breakfasts are 'really good ' egg and bacon.' Another person told them the breakfasts were good, stating that poached eggs were good and 'they even cut the toast into small squares to make it easier'.

When we last visited this home we had continuing concerns for the care and welfare of some people using the service. We had undertaken enforcement action against the registered provider. These visits were to check to see if improvements had been made. Whilst we found that some improvements in respect of the care planning, care delivery and staffing levels had been made further improvements were still required.

During our first visit of 14 February people we spoke with had varying views in respect of their experiences. Some people spoke positively about the care and support they received whereas others felt improvements were needed. One person said, 'The carers are kind to me. I sit all day and occasionally speak to staff. I can look after myself. My bed is made and is tidy, the food is good, so I can't complain,' another person said, 'Some carers are kind, but sometimes grumpy. Sometimes they rush around and I do not get a shower but a quick wash with a flannel. I don't like to complain because they are always so busy. '

During our visit of 18 March 2013, again there were varying views in respect of people's experiences; however it was acknowledged that further improvements had been made. One relative said, 'My relative is much more alert and responsive recently.' Whereas one person said, 'Communication could be improved. We have not been told what is happening with the management changes or what plans are in place for the future. It is unsettling.'

There were mixed views in respect of the support that people received to meet their needs. Four people were happy with the support they received, whereas two people were unhappy. One person said, 'I could be in a worse place. The staff are very good.' The other told us, 'I am very happy here. Best three star hotel in Nottingham.' Whereas those who were unhappy told their needs were not always met and they did not always feel supported by the staff.

People were generally satisfied in respect of the support they received with their medicines. One person said, 'They look after me, they give me mine 7 in the morning and 10 o'clock at night, just right before I go to bed." Another person said 'Satisfactory and better. When I have niggles I ask for painkillers and they don't get upset about it. I check it, as I know the shape. If something changes I query it.'

There were mixed views in respect of the staffing levels. Four out of six people told us they felt there were enough staff to meet their needs. Two people told us there had been improvements lately and one person was aware of the improvements we had told the registered provider and manager to make. Whereas two people did not feel there had been any significant changes in the staffing levels and they still felt there were insufficient staff to meet their needs.

We visited the location on 23 July 2012 to carry out a planned review. During this time we also checked to see if the registered manager and registered provider had made improvements to the service since our last visit.

We then revisited the location on 2 August and 3 August following additional concerns being raised in respect of the staffing levels in the service.

During our visit on 23 July 2012 we used the Short Observational Framework for Inspection tool (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We carried out this observation for a period of one and a half hours.

During our first visit we also spoke with eight people using the service, seven relatives and six members of staff.

During our second visit we spent time observing the care and support that people received. We also spoke with five people using the service and five members of staff.

During the visit on 23 July 2012 our observations were more positive and we received feedback from people using the service telling us they felt there had been improvements. One person told us; 'It is very good, I am more than satisfied' and another said, 'Staff are helping me to compile a book of my life and I am really enjoying that, we have had some laughs. Nothing in life is perfect but it is pretty good here.'

We visited the service again on the evening of 2 August following the receipt of concerning information in relation to the level of care people were receiving. During this visit we found that people were not always supported as needed.

We arrived on the unit designated for people with a dementia related illness at 7.45pm and spoke with a member of staff on duty. The member of staff told us 15 of the 23 people using the service on this unit had been assisted by staff to go to bed. We looked around the unit and were able to speak with some people who we could see were in bed and awake. One person told us, 'I am not sleepy' and when we asked them why they were in bed they said, 'I don't know.'

During our visit on 23 July 2012 we found staffing levels had increased by one member of staff on each shift on the unit specifically designated for people with a dementia related illness.

Six people using the service did not express any concerns about the staffing levels and they offered the following comments; 'The staffing has improved, I ring my buzzer, I do not have to wait long,' and 'The staff pop into see me every hour, I am happy with this.'

Whereas two people said they felt that more staff were needed. Both of these people were based on the second floor.

We spoke with two relatives who were visiting on the unit designated for people with a dementia related illness. They both told us they knew staffing levels had been increased lately and said there seemed to be a better staff presence. Whereas two other relatives expressed concern about the staffing levels impacting on the care their relatives' received.

During our visit on 2 August 2012 our observations on the ground floor showed that one person had to wait for two members of staff to be available to assist them with their continence needs.

There were two members of staff on the unit designated for people with a dementia related illness. We found staff were task orientated and were unavailable at times to give assistance and support to people when they needed it.

One person said, 'Staff usually come within 10 minutes, but if it was an emergency I would need to shout my head off. The length of time I have to wait depends on the time of day. You have to ring the buzzer in the morning to get into the queue.' They also said, 'It doesn't work if there are only two staff, some people need two staff to help them. That leaves no one left to help anyone else.'

Another person said, 'I can go to bed and get up when I want. I do have to wait sometimes as the staff are too busy. I have been waiting now for the staff to come and change me, it was only about 10 minutes though. The staff do seem rushed off their feet.'

We made a safeguarding referral to Nottingham City Councils safeguarding vulnerable adult's team following this visit.

We visited the location to carry out a planned review. We also looked at the compliance actions that had been set following the inspection in May 2012 to see if these had been addressed and improvements made.

Due to the complex needs of some people living at Beechdale Manor they were unable to talk with us. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We carried out this observation for a period of one and a half hours.

We also spoke with eight people using the service, seven relatives and six members of staff.

Everyone spoken with felt they were able to make their own choices and decisions.

One person said, 'I am happy here, the staff ask me what I like and I can say. They listen to me and respect what I say.'

All eight people felt that their privacy and dignity was valued and maintained and that staff were respectful towards them. All seven relatives felt staff respected their relative's privacy and made sure they supported them to maintain their dignity.

We spoke with several relatives of people using the service. One of them expressed frustration that they wished to be shown their relative's care plan and be involved in decisions about how their relative's care was being delivered. They told us they had made this request several times but had not yet been given the opportunity to be involved.

We spoke with three people in the unit designated for people with a dementia related illness. They all told us they felt safe in the home and one said, 'The staff are very kind to me.' All of the other people we spoke with also said they felt safe living in the home.

All relatives spoken with said they felt that their relatives' were safe living in the home and three of them said they felt confident in approaching staff if they had any concerns.

Everyone spoken with felt that they would be able to complain if they need to.

None of the people we spoke with had received questionnaires or been aware of any meetings taking place to enable them to have a say and put across their views in relation to the service they received.

Three out of five relative' said they had received questionnaires from the home asking them their views and opinions of the care their relative was being given.

None of the relatives' knew about meetings taking place that they could attend to offer feedback about the quality of the care provided to their relative's. Four out of the five relatives' said they would welcome the chance to attend meetings in the home so they could give their opinion on the care delivered.

Although relatives spoke positively about the care staff gave, three relatives' commented on poor communication between the staff on occasion.

We visited the location due to concerns in respect of people's health, safety and welfare needs being met.

We spoke with seven people using the service to establish their views and experiences. Due to some people's complex needs we were unable to communicate with them. We therefore spent time observing how people spent their time and the support they received from staff. We also spoke with nine relatives to gain their views about the service.

We also consulted with three members of staff in respect of their job roles and the support they offered to people using the service.

The views of people using the service were varied in respect of their needs being met. Two out of seven people spoken with told us they liked living at the home. They said, 'I am happy and settled here, I am looked after well and my needs are met.' Another person said, 'I feel safer here than anywhere else.'

However three people expressed concerns; one person told us, 'I am very unhappy here, I am hoping my family will move me. The building is lovely and it is very clean. It's what they don't do which makes me unhappy. Some of the carers are OK and some are not.'

One person using the service said, 'I am worried about expressing my concerns, I do feel safe but things could be better. I am scared to talk about things that are wrong as I don't want any trouble or to get people into trouble.'

Four out of the nine relatives spoken with expressed concern in respect of the care and support their relative received. Two relatives said they had previously raised concerns in respect of their relative's health care needs and nothing had been done to address these issues. Another relative also did not feel listened to and they expressed concerns in relation to their relative being kept safe.

We observed that during the day people were frequently left for periods of time in communal areas without any staff presence. The atmosphere appeared fraught at times during the day with people shouting for help from staff. Some people using the service were shouting and swearing at each other and other people using the service were shouting at them to be quiet.

We observed lunch being served in the unit for people who had a dementia related illness. There were 20 people using the service in the dining area and one member of staff assisting one person to eat. Some people needed help to eat but there were no other staff available to give this assistance.

People told us they liked living at Beechdale Manor and the care was good. One person told us, 'My carers are lovely and very helpful and look after me so well.' Another said, 'I'm fortunate I've ended up here, I love it. The care is excellent.' People who were unable to give their views due to their mental health appeared calm and settled and staff were attentive to their needs.

Relatives also commented positively on the care at the home. One said, 'I am over the moon with my relative's care here. They are much more content since they arrived, their mood has improved, and they always look immaculate when I visit.' Another relative said, 'I can't fault the care ' the staff do everything they should. My relative seems very well-cared for and is looking much better than when they first came in.'

Both group and individual activities were on offer if people wanted them. One person told us, 'There are lots of activities like baking and relaxation. The activities lady is a star.' A relative said, 'The activities lady comes and sits with my relative and does hand massage with her. She uses rose scented hand cream which my relative loves.'

People told us they felt safe in the home and knew who to speak to if they had any concerns. One person said, 'I'm fine here and have no worries. But if I did I would tell the staff and if they didn't sort it out I would tell the manager.'

People's views on staffing levels were mixed. Some people were satisfied with the number of staff on duty. One person told us, 'I've got a call bell in my room and when I ring it the staff always come.' Another said, 'The staff are there if you need them, you don't have to wait for long.'

Others thought there should be more staff. One person told us, 'The staff are very willing but they are run off their feet.' A relative told us, 'On this floor (in the dementia unit) there are usually either three or four carers but I think we need four as they are under a lot of pressure at times.'

Two relatives thought the number of staff on duty had increased and were now satisfactory. One relative said, 'The staffing has improved since my relative came here. It's ok now.' Another commented, 'There have been more staff in the last few weeks so I think the staffing problem has been resolved.' A visiting professional told us, 'The staffing levels here are good. I've never seen people unattended when they needed help.'

Archived: Beechdale Manor Care Home

All Inspections

2 December 2013

During an inspection looking at part of the service

10 September 2013

During an inspection looking at part of the service

9 April 2013

During an inspection looking at part of the service

4 June 2013

During an inspection looking at part of the service

14 February and 18 March 2013

During an inspection looking at part of the service

13, 14 September and 18 October 2012

During an inspection looking at part of the service

3 August 2012

During an inspection in response to concerns

23 July 2012

During an inspection looking at part of the service

14 May 2012

During an inspection in response to concerns

22 December 2011

During an inspection in response to concerns