Beachville West End

Beachville West End is a residential care home providing personal care to up to 13 people. The service provides support to older people with accommodation over 2 floors. At the time of our inspection there were 13 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The home accommodates 13 people in one adapted building which includes dining and social areas such as a communal lounge area and a seafront garden.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right support: Staff were trained and enthusiastic in their roles to provide the care that people required to live the most independent lives as possible. Staff had received a good standard of training to fulfil their roles. We spoke to a number of people who use the service and their relatives who told us about how their nutritional needs were being met. This was in part due to the positive relationship between carers, the kitchen staff and people who lived there.

Right Care: People’s care plans were person centred and the home recognised the importance of equality and diversity in its policy making. The management team were knowledgeable about their roles and responsibilities and had promoted a culture of respect which focused on individuals’ personal choices. The Registered Manager had carried out appropriate quality checks to maintain a good oversight of the care being provided by their team.

Right Culture: Staff we spoke to were passionate about achieving good outcomes for people who use the service and people felt the home provided a close family like experience. 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

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 21 May 2022)

The provider completed an action plan after the last inspection to show what they would do to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations and action had been taken to ensure people had given consent to their care and treatment was given in line with the law and guidance

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 Beachville West End 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.

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

People were not always engaged and involved with regards to their care and support. An important decision was made about one person’s care and support without any consultation or involvement with the person for their feedback.

Records did not always evidence that best practice was followed. Checks carried out by management staff had not identified these issues. We have made a recommendation about this.

Training in certain areas had not been carried out as planned due to COVID-19. During our inspection, management staff reviewed training intervals and updated their training policy. The registered manager told us that all training would be reviewed with staff in May 2022.

Prior to our inspection, we received a concern about visiting. On the first day of our inspection, records did not fully evidence that visiting procedures fully aligned to government guidelines; however, the relatives we spoke with during the inspection, told us they were very happy with the arrangements in place. During the inspection, management staff updated records and their procedures relating to visiting at the home.

The home was clean and well maintained. Comments from relatives included, “It’s definitely clean, I look out for that and they’re always wearing their PPE” and “They have taken every precaution, they’re spot on.”

People and relatives spoke positively about the staff and the care provided. Comments from relatives included, “It’s like a second family” and “I cannot fault them, my mum gets excellent care.”

There was a system in place to manage medicines safely. We identified several minor issues relating to the recording of medicines and the storage of keys which management staff immediately addressed.

People were supported to eat and drink enough to meet their needs.

People and relatives spoke positively about the “homely” environment of Beachville West End. There was an outside garden area with summerhouse which had been important during the COVID-19 pandemic for visiting.

Staff told us how they had worked together as a team during the pandemic to promote people’s wellbeing. One staff member said, “We all have worked endless hours during the pandemic so that our residents have the care and the support that they need. We all work well together as a team and have very supportive management who work hard putting all procedures and guidelines in place they are always there when we need them and helping us with our residents and it's rewarding to ourselves knowing we have protected our residents throughout.”

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 10 December 2019).

Why we inspected

Prior to our inspection, we received a concern about visiting. A decision was made for us to inspect, to review visiting arrangements in place at the home.

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.

During the inspection, we found that one person had not been involved in an important decision about their care and support. We therefore widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

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 to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the full report below for further details. You can see what action we have asked the provider to take at the end of this report.

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care. Please see the action we have told the provider to take at the end of this report.

We have also made recommendations in the safe, effective and well led sections relating to the review and implementation of best practice guidance. Please see the full report for further details.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

¿ There was a clear process for visitors, which included temperature checks, completion of a health check form and track and trace documentation. Visits were due to recommence in the next few days and were in line with national guidance.

¿ Staff had undertaken additional training in infection prevention and control. This included putting on and taking off personal protective equipment (PPE), hand hygiene and other Covid-19 related training. Further training was currently taking place to refresh staff. Suitable supplies of PPE were available and contingency plans were in place.

¿ The provider supported people and staff as far as possible with social distancing.

¿ People and their relatives were supported to keep in contact using a range of technology including social media, telephone and email.

¿ The provider was following national guidance for anyone moving into the service. Staff worked closely with healthcare professionals to ensure appropriate and safe admission procedures were being followed.

¿ Infection control audits and checks were carried out and these were being further reviewed. The registered manager spoke positively about the dedication and hard work of the whole staff team. They said staff commitment had helped to minimise the impact of the pandemic on people's health and wellbeing and keep the service Covid-19 free.

Further information is in the detailed findings below.

Beachville West End provides personal care and accommodation for up to 13 people. Accommodation was spread over two floors. At the time of the inspection, 12 people were living at the home, some of whom had a dementia related condition.

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

People were complimentary about living at the home. One person told us, “It’s like home from home.”

Systems were in place to safeguard people from abuse. People told us they felt safe.

People were cared for by a consistent and stable staff team. Safe recruitment practices were followed. Staff were suitably trained and supported to enable them to meet people’s needs.

People lived in a homely environment that met their needs. The home overlooked Newbiggin Bay. The fantastic views out to sea and passing ships were a constant source of conversation between people throughout our inspection.

People were supported to eat and drink enough to maintain their health and wellbeing. There was an emphasis on home baking. Staff assisted people to access healthcare services and receive ongoing healthcare support.

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 received personalised care which reflected their needs and preferences. People were supported to continue their hobbies both within and outside of the home.

A complaints procedure was in place. No complaints had been received.

There was a cheerful atmosphere at the home. Staff told us they felt valued and said morale was good.

A range of audits and checks were carried out to monitor the quality and safety of the service.

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 18 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At this inspection we found the matters related to these previous breaches of regulations had been addressed and the requirements of the regulations met.

Beachville West End is a residential care home based in Newbiggin-by-the-sea, Northumberland which accommodates up to 13 older people, some of whom are living with dementia or a cognitive impairment. There were 13 people living at the home at the time of our inspection.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since October 2010. 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.

Checks were undertaken on the safety and security of the home. We saw there were appropriate testing of small electrical items, lifting equipment, assessments for legionella risk and an assessment of any asbestos risk at the home. Regular fire drills and checks on fire safety equipment had also taken place.

The home was clean and tidy. We noted the soaking of commode pots was taking place in a shower area, but the registered manager told us infection control staff had not raised an issue about this, when they had visited the home as part of the last local authority review. We have made a recommendation about this.

The home had a safeguarding policy in place. There had been no recent safeguarding incidents at the home. Accidents and incidents were recorded and reviewed. Staffing and staff recruitment continued to be managed in an effective manner. We found some minor issues with medicines and the deputy manager said these would be addressed immediately.

The home continued to work within the requirements of the Mental Capacity Act and where people did not have capacity to make their own decisions best interests processes had been undertaken. Staff continued to have access to a range of training and development opportunities and there was regular supervision and an annual appraisal.

People continued to be supported to access health and social care services to help maintain their health and wellbeing. There was good access to a range of food and drinks and people told us they were happy with the meal choices offered.

People told us they were happy with the care they received and we saw there were good relationships between staff and people who lived at the home. People and their relatives were involved in determining their care needs, as appropriate. An annual questionnaire sent to relatives of people living at the home was overwhelmingly positive. People were supported to maintain their independence.

Care records contained good information about people as individuals. Care plans were in place that addressed people’s needs, had good information for staff to follow and were reviewed on a regular basis. Some of the reviews of care plans lacked detail. People had access to a range of activities and were supported to follow their own interests. Staff understood about the risk of social isolation. There had been no formal complaints received by the provider in the last 12 months.

A range of audits and checks had been put in place since the previous inspection. When we first arrived at the home the current quality rating was not displayed, although this was rectified by the registered manager. The registered manager confirmed the home had not notified the CQC about people who had a DoLS authorisation in place, as they were legally obliged to do so. Arrangements were made to immediately address this.

Staff told us they felt well supported by the management of the home and said they enjoyed their jobs. With the exception of care plan reviews, records were up to date and daily records contained good detail.

There is a condition on the provider's registration of this service that a registered manager must be in place. At the time of our inspection there was a registered manager in post who had been managing the service for many years and been registered with the CQC since October 2010. 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 were assisted at our inspection by both the registered manager and provider, both of whom were present on the days that we visited the home.

People told us they were happy with the care and support they received and they felt safe. Staff were knowledgeable about what constituted a safeguarding incident and confirmed how they would handle any safeguarding matters should they arise. Staff had been trained in safeguarding and we saw that historic safeguarding incidents had been handled and reported appropriately and in line with protocols and procedures. People were supported to meet their nutritional and hydration needs and staff monitored people's weights to ensure they remained healthy, seeking input from GP's and dieticians where necessary.

Risks that people had been exposed to in their daily lives had been assessed and these were regularly reviewed. Accident and incident monitoring took place and where necessary risk assessments were amended to prevent repeat events. Care records were personalised and highlighted how people should be supported safely and in line with their needs, likes, dislikes and preferences. They were regularly reviewed and up to date. Care was person-centred and there was evidence that people and their relatives were involved in their care. No person had a formal advocacy agreement in place but the manager was aware of how to arrange this should it be necessary.

People, staff and our observations confirmed that there were enough staff on duty to meet people's needs. Staff confirmed they were not rushed when delivering care. They had received training in key areas and supervisions and appraisals were carried out regularly. Recruitment processes were thorough and medicines were managed well.

Our observations confirmed people experienced care and support that protected their privacy, dignity and staff promoted people's independence. Staff displayed caring and compassionate attitudes towards people and they enjoyed good relationships. Activities were available to stimulate and occupy people. Choice was evident throughout the service; for example, people chose where they spent their time and the foods they liked to consume.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ and it also ensures that unlawful restrictions are not placed on people in care homes and hospitals. The MCA was appropriately applied and applications had been made to the local authority for those people who required assessment for a deprivation of liberty safeguard to be put in place. There was evidence within people's care records that their consent was sought before care was delivered.

Some systems were in place to monitor the service provided and care delivered but these were limited and did not identify and address environmental risks within the home. A legionella risk assessment and control measures were not in place and there was no evidence that an electrical installation check had not been carried out. We also identified some fire safety issues within the home which we referred to Northumberland Fire and Rescue Service, Fire Safety Department. By the end of our inspection the provider had taken steps to address all of the issues and shortfalls that we had identified and informed them of.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 12, Safe care and treatment, and Regulation 17, Good governance. You can see what action we told the provider to take at the end of the full version of this report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we have found.

Is the service safe?

The provider had effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw risk assessments had been completed for people who were assessed as being at risk of falls.

We saw the provider had effective systems in place to manage medicines.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No applications have needed to be submitted at the service. We saw policies and procedures were in place and all staff had received training in the Mental Capacity Act 2005 (MCA) and DoLS.

Is the service effective?

People were treated with respect and dignity. People who used the service were asked about the support they received and if they understood their rights. One person said, 'I am aware of my rights. The staff explain what they are doing and why. They always ask my permission before doing anything'.

Is the service caring?

People's preferences, interests and needs were recorded and staff were able to give examples of these when we spoke to them.

People's health and care needs were assessed with them and they were involved in this process.

People we spoke with were positive about the care they received from the service. Comments included, 'I am happy here. The girls (care staff) are lovely. They do everything for me' and 'I have everything I need'.

Is the service responsive?

There was an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined an immediate referral was made to the correct medical professional for advice and support.

Is the service well led?

The staff we spoke with were all aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service.

We concluded that people's care and support needs were appropriately planned and their individual care needs were met. People told us the staff were very caring and looked after them well. Comments included, "This is the best place to be" and "We are all very well looked after and the staff are wonderful".

We found the premises were clean, comfortable and suitable to meet the needs of the people who used the service. There were systems in place to ensure the premises were safe and well maintained.

We concluded the staff were well supported, they received the appropriate training for their professional development and were able to obtain further relevant qualifications.

We found the provider had an effective system to regularly assess and monitor the quality of service that people receive.

We talked to three care staff employed by the service and looked at two staff records. The staff we observed during our visit provided person-centred care and this was reflected in the feedback we read and heard from people during our visit. We found that care staff were trained and supported to meet people's needs safely and effectively.