Archived: Beechlawn Residential Home

Beechlawn Residential Home is a residential care home providing personal care to up to 35 older people, in one adapted building; some people were living with dementia. At the time of our inspection visit on 14 June 2019, there were 23 people using the service, with one person moving in on the day.

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

There had been changes in the management of the service, since our last inspection. This had caused some instability in the service and improvements identified at our last inspection had not been sustained and embedded in the culture to improve the service’s rating to at least good.

Improvements had not been made in a timely way to improve the service provided to people. The current management team were working to improve the service and were introducing systems to make these improvements.

We were not always receiving notifications from the service, this is important information about certain incidents which we should be informed of.

Improvements were needed in the training provided to staff to ensure they were skilled and knowledgeable about their roles and responsibilities and to provide good quality care to people.

Improvements were needed in how the staff recorded where people received their prescribed medicines that were to be administered externally, such as creams. Other medicines, such as patches and tablets, were administered as prescribed and safely.

People’s care records were being improved, which was ongoing and not yet complete. There were some inconsistencies in the records which did not provide robust guidance to staff about how to meet people’s needs. Not all people’s records included guidance for staff about people’s preferences for their end of life care.

Improvements were needed in how people were provided with stimulation and engagement which were meaningful and reduced the risk of boredom.

Some improvements had been made in the environment to be more accessible for people living with dementia, this was ongoing and not yet complete.

There were systems to keep people safe. However, not all staff had received training in safeguarding.

Despite the shortfalls we identified in the service, we received positive feedback from people using the service and relatives about the caring nature of the staff and the care and support received.

People’s dietary needs were assessed and met. Referrals to health professionals were made, as required.

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.

Improvements had been made in the staffing levels in the service. Staff were recruited safely.

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 requires improvement from our previous inspection of 13 March 2018 (published 14 June 2018). There were no breaches of Regulation.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The service provides residential care in one adapted building for up to 35 older people, some of whom are living with dementia. There were 25 people living in the service when we inspected on 8 and 13 March 2018. This was an unannounced comprehensive inspection.

We last inspected this service on 11 August 2016 and rated the service Requires Improvement in four of the five key questions and Good in Effective. Overall, the service was rated as Requires Improvement. During that inspection, we found that there was not sufficient staff on duty to ensure that people remained safe and that improvements were needed in regards to the management of people’s medicines. It was also found that caring relationships between staff and the people they supported were being developed but improvements were still needed to be made. There were concerns that the environment was not dementia friendly and people did not have full access to outside areas. Care plans needed improvement to ensure that people got consistent support that met their needs.

During this inspection on 8 and 13 March 2018, we found that improvements had been made to help ensure that people received a good quality of care, but some further improvement was still needed in some areas.

Beechlawn Residential Home has a registered manager. 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.

During our previous inspection on 11 August 2016, it was highlighted that the service was not dementia friendly; we were told that the registered manager would take action and put plans into action to rectify this. During this inspection, we saw that little action had not been taken. After our inspection, the registered manger sent us plans of the action they intended to take. This would help people living with dementia to find their way around the building better and to be able to orientate themselves, which would help them to feel less anxious and more relaxed so that behaviours triggered by anxiety would decrease.

Not all of the people who lived in the service told us that they felt safe. We were told that there were people who walked with purpose for most of the day and, on occasion, during the night. People told us that these people had entered their bedrooms and, when asked to leave, sometimes became anxious and responded in a way that was disruptive or worrying to the room’s occupant. During discussions with people, staff members, the registered manager and on examination of the rotas and dependency calculations, it was established that there was not always enough staff on duty to support and keep people safe. The registered manager, in agreement with the provider, immediately took action and increased the number staff on each shift.

Risks were assessed and steps have been put in place to safeguard people from harm without restricting their independence unnecessary. Risks to individual people had been identified and action had been taken to protect people from harm. However, some of the risk assessments were generic and needed to be individualised.

Within the environment there were examples of poor fire safety practices that put people at risk. During the inspection, the registered manager took immediate action in some areas and undertook to take further action in all the areas bought to their attention. The main exit needed more than one action to open the door, which was not considered best practice; there were two locks and a door chain in place. Curtains obscured two of the fire exits and the fire signage did not give clear instruction for exiting the building in emergencies, a fire for example. The provider and the registered manager took immediate action by removing the extra locks on the main door and removed the curtains from the fire exits. We were assured that they would take advice and would take the necessary action to further safeguard people and staff from the dangers of fire throughout the service.

There were arrangements in place to make sure the service was kept clean and hygienic. On our first day’s visit, we found some minor examples of poor cleaning practices. For example, one area behind the washing and drying machines where fluff had collected could be a possible fire safety hazard. On our second day, we saw that action had been taken to rectify the matter and the cleaning schedule had been amended to lessen the likelihood of this practice continuing.

There were systems in place that provided guidance for staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe from abuse. Where people required assistance to take their medicines there were arrangements in place to provide this support safely, following best practice guidelines.

Both the registered manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required. 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 support this practice.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

We saw examples of positive and caring interactions between the staff and people living in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People received care that was personalised and responsive to their assessed needs. The service listened to people’s experiences, concerns and complaints. Staff took steps to investigate complaints and to make any changes needed.

People using the service, and the staff, told us that the registered manager had made positive changes in the service and that they were open and had good management skills. There were systems in place to monitor the quality of service offered people.

Further information is in the detailed findings below.

Since our last inspection the manager has registered with 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.

Beechlawn Residential Home provides care and support for up to 36 older people, some of whom may be living with dementia. At the time of our unannounced inspection on 11 August 2016 there were 16 people living in the service.

We found mixed views from people as to whether there were sufficient staff to meet people their needs. There was not a system in place to ensure the number of staff was sufficient to meet people’s assessed needs. The registered manager told us they were researching a suitable method to do this. We have made a recommendation for the service to seek guidance on appropriate staffing levels. Staff had received appropriate training to meet people’s needs.

There were procedures and processes in place to protect people from abuse and minimise the risks to their safety. There were procedures to ensure people received their medicines as prescribed. However, protocols regarding medicines which people were prescribed ‘as required’ were not in place.

The service was up to date with the Mental Capacity Act (MCA) 20015 and Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and met. Since our last inspection the service had re-located the dining area to make the dining experience an enjoyable experience. People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People had mixed views about their relationships with staff. This was an area which was being addressed by the registered manager. We observed staff interacting with people in a respectful manner and respecting people’s privacy and dignity. Care plans had been revised since our last inspection and the service was consulting with people and their relatives to improve these.

The environment of the service was not dementia friendly and did not support people to be as independent as possible.

The provider and registered manager were working towards improving the culture of the service. Communication with people and relatives was being improved and their views taking into account when planning improvements. Quality assurance systems had been put in place and these were also supporting the service to identify where further improvements were needed.

We spoke with seven people who used the service. We also spoke with the provider, the registered manager and five staff members. We observed the care and support provided to people to check that staff interactions were effective and caring. We looked at four people's care records. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member looked at our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager and the provider told us that they were aware of the changes relating to DoLS following a supreme court judgement in March 2014. They told us that they knew the actions to take if a person using the service was at risk of having their liberty deprived.

Is the service effective?

People told us that they were happy living in the service and that the ways that the staff supported them were effective. One person said, "I don't think you will find any problems, I am happy here." Another person said, "I have got nothing to grumble about, I am quite happy."

We saw that the staff responded to people's requests for assistance, including call bells, in a timely manner.

Is the service caring?

People told us that the staff treated them with respect. One person said, "They (staff) are kind." Another person said, "I have no problems with the staff, they are nice."

We saw that staff interacted with people in a caring, respectful and professional manner.

Is the service responsive?

We were concerned because people's care records did not reflect people's needs accurately, how these needs were met and any changes in people's needs and preferences. Therefore we could not be assured that staff were provided with the information they needed to meet people's needs and that people were provided with the care and support that they required. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The quality assurance systems in place were not robust enough to ensure that the service identified shortfalls, addressed them and continued to improve. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The service had notified us (CQC) of incidents that they were required to tell us about, such as when people had developed pressure sores.

This is a summary of what we found;

Is the service safe?

When we arrived at the service the registered manager asked to see our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), which were updated every year. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

The service was safe. We saw records which showed that the health and safety in the service was regularly checked. This included regular fire safety checks, this meant that people were protected in the event of a fire.

We saw the staff rota and dependency levels assessment which showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them. One person said, "They (staff) come when I ring (the call bell)."

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "I get everything I need." Another person said, "I can't fault it here." Another person said, "I am very happy here."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "I get on well with all of them." Another person said, "They are all very kind and they work so hard."

People using the service, their relatives and other professionals involved with Beechlawn Residential Home completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People told us they were given a choice of menu and that they had enough to eat. One person told us, "There is plenty to eat and I get a choice." Care staff told us that people were offered a choice for meals and that snacks such as crisps were available between meals.

We looked at how the service administered and recorded medication. We found that there were significant gaps in the recording of the application of prescribed creams.

We checked the service's staff rota and found that during the day the number of staff on duty met the numbers assessed as being required by the provider. However, we found that on 13 occasions in the morning there was only one member of care staff on duty. This fell below the assessed need and was not sufficient to ensure the safety and welfare of people living in the service.

People who used the service and their relatives were satisfied with the standard of care they received. One person told us, "I only have to press my bell and someone comes to help." Another person said, "The carers are all very kind."

We saw that people were asked for their consent before care was provided. People told us that they knew how to complain if the need arose.

People benefited from a service that was clean and hygienic throughout.

We found that since our last inspection the provider had revised the format of the care plans. We saw that people's needs were assessed and care planned in line with the assessment. Risks relating to the care provided were assessed and monitored.

The provider had put into place a number of new ways of assessing and monitoring the quality of service provided which included a monthly managers audit and a quality development programme.

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We found that the service did not plan and deliver care to the necessary standard. People's individual needs were not always met. Care records were not updated when a person's needs changed which could lead to care not being delivered correctly