Beech Hill Grange

Beech Hill Grange is a residential care home providing accommodation, nursing and personal care to 71 people at the time of the inspection. The service can support up to 74 people. The accommodation is provided in one adapted building with bedrooms on the ground, first, second and third floors.

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

Whilst we found quality checks of medication records had not always been completed in a consistent way by senior staff and managers, we found people were supported by trained staff to take their medicines when needed. Medication records were accurately completed and there were no missing entries.

Staff were recruited safely and there were enough staff to meet people's needs. Staff received on-going support, training and supervision to be effective in their roles.

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.

Staff understood who to report concerns to as well as any new risks to people’s health. People's support needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. Staff followed the infection control procedures the provider had in place. People were comfortable, relaxed and happy around care staff and staff understood how to keep people safe.

The environment was clean and staff observed and followed infection control procedures in line with national guidance for reducing the spread of COVID-19.

People's individual communication needs were considered to support them to be involved in their care. Staff had the necessary skills to carry out their role. Staff had regular training opportunities and training specific to people's individual needs was provided. Staff had very good knowledge and understood people's health conditions and the support they required.

Staff spoke positively about working for the provider. Systems and processes in place promoted a positive culture in the home. Staff worked with a wide range of stakeholders involved in people's care. These included occupational therapists, health professionals and safeguarding authorities. Staff understood their responsibility to be open and honest when things had gone wrong. The registered manager operated an ‘open door’ policy which enabled people, their relatives and staff to approach management to discuss any concerns they had.

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 21 December 2018)

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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 found the following examples of good practice.

The provider maintained good levels of personal protective equipment (PPE) and staff were wearing PPE correctly.

There was a clear process in place to monitor staff vaccination status and the registered manager explained the process when recruiting new staff.

There were safe measures in place for visitors, health professionals and other professionals who come to the service. They had to show a negative lateral flow test, a Covid-19 pass if needed, sign in electronically and when entering the service PPE was available.

The service was clean and odour free. Tables in the lounge had been recently replaced which were easier to clean.

Beech Hill Grange Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. A maximum of 74 people can live at Beech Hill Grange and at the time of our visit 73 people were living there.

We last inspected Beech Hill Grange Nursing Home on 20 June 2017 when we rated the service as 'Requires Improvement' in all the key questions. This meant the overall rating of the service was 'Requires Improvement'. We found that the provider was not always meeting the legal requirements set out by the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and were rated as Requires Improvement. The provider was failing to meet regulation 17 of the HSCA which related to the governance systems had not all been effective, and had not ensured that people would receive a consistently safe service that met their needs. After our inspection in June 2017 the provider provided us with an action plan outlining what they would do to meet legal requirements in relation to the breach. At this inspection we found improvements had been made and the service is now rated as ‘Good’ overall.

There was a registered manager in post. 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.

The provider had systems in place to check and improve the quality of the service provided. We saw that where areas required improvement action had been taken in response.

The home was well-led by an experienced management team who were enthusiastic about the service and committed to providing good standards. Staff received appropriate training and support, understood their roles and responsibilities and had confidence in the management team.

People felt safe living at the home and were protected from the risk of abuse. The provider had systems in place to minimise the risk of abuse and staff had a good knowledge and understanding of the signs of abuse and who to report concerns to.

Staff were available to meet people’s individual needs and demonstrated good knowledge about people living at the home.

People were protected from environmental risks within the home. People received good healthcare and were referred to external healthcare professionals when a need was identified to maintain their health.

Staff were caring and treated people with respect. People were relaxed around staff. Staff showed us that they knew people’s likes, dislikes and interests.

Staff who gave people their prescribed medicines demonstrated a good knowledge and understanding of how to do this safely.

The registered manager was aware of their responsibilities in line with the Mental Capacity Act 2005. Staff offered people choice and respected the decisions they made. Where restrictions on people had been identified, Deprivation of Liberty Safeguards authorisations were in place to lawfully deprive people of their liberty for their own safety.

People were encouraged and supported to eat and drink enough and were positive about the quality of their meals. People were supported to take part in a range of activities in and outside of the home.

People knew how to raise concerns and felt confident they could raise any issues should the need arise and that action would be taken as a result.

The design and decoration of the premises promoted people's wellbeing and supported staff to use

equipment safely. The home was clean and tidy and staff followed the provider's policies and procedures to ensure people were protected from the risks of infection.

Beech Hill Grange Nursing Home is registered to provide nursing care to up to 62 older people who may also be living with dementia. At the time of our inspection there were 58 people living at the home. The home has a registered manager and they were present throughout 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.

Feedback from people living at Beech Hill Grange and their relatives was that they felt safe. While we observed many practices and systems that promoted safety we found that people were not always supported to move safely. Staff did not always follow good practice regards their nails and jewellery and this had possibly caused some people to be injured. The fire safety risk assessment had not been fully responded to, or updated and we could not be certain the fire safety arrangements were adequate. People did not always experience timely support from the staff team, and people and their relatives shared examples of the impact this had on them.

Medicines were well managed, and people could be confident their medicines would be stored and administered safely and as the doctor had prescribed.

Risks people lived with, that were related to their health conditions or age had been assessed, and plans developed to minimise the impact of the risk on people.

People did not always have a pleasant mealtime experience. People gave us mixed feedback about their enjoyment of the food. The food we saw looked and smelt appetising. Adjustments people needed to their food and drinks to ensure they could eat and drink safely had been made. Systems were in place to ensure people ate and drank enough to maintain good health.

Most staff had received training in the specific needs of the people they were supporting, as well as safe working practices. Some of this knowledge needed to be updated and some staff required this training.

People were offered the opportunity to make a wide range of every day choices. We saw and heard people being asked about what they would like to wear, to do, to eat and drink for example. Processes to help people make bigger decisions were established. However the lack of knowledge demonstrated by some direct care staff may mean people’s human and civil rights would not be protected.

People could be confident their healthcare needs would be well met. There were good relationships between the staff working at the home and local health care professionals. Changes in people’s healthcare were noted and the relevant support was sought for people.

People were not consistently treated with kindness or compassion. Staff did not always knock before entering people’s bedroom. People were not always referred to respectfully. People were not always offered comfort or reassurance when they were distressed.

People and their relatives told us that they could share concerns or complaints at any time. However people told us they were largely happy with the service provided and that this had not been necessary.

Activities were provided for people throughout the day and at weekends. Some people really enjoyed and benefitted from these activities. The activities were not well suited to people living with complex dementia or people who needed to stay in bed. These people were at a greater risk of social isolation.

Most people, staff and relatives we spoke with described the home manager as being approachable and involved in the day to day running of the home. We found that the governance systems (Processes to ensure the safety and quality of the service) had not all been effective, and had not ensured that people would receive a consistently safe service that met their needs.

Some people had dementia and were not able to tell us about the care they received. To get a view of the service they received we observed staff interactions with people. We saw that generally interactions were friendly and polite.

We found that people's needs were assessed and planned to ensure the care people received was safe and appropriate. One person who lived there told us, 'This is a good home'. A relative told us, 'I am pleased with the home and have no concerns'.

People received a good choice of well-presented and nutritious food and hydration and were protected against the risks associated with poor nutrition and dehydration.

We saw that the environment was clean safe and well-presented and offered people a pleasant place to live.

Satisfactory recruitment procedures ensured that people were protected from the risk of unsuitable staff being employed.

There were systems in place to monitor the quality of the service. The service was well led.

The home had recently been extended so the number of people who could live there had increased from 36 to 55. We saw that the homes environment had been improved for people and further work was taking place.

We saw good interactions between people lining there and the staff team. The atmosphere was friendly and relaxed. We saw relatives visiting people and different activities taking place for people to join in with, if they wished to.

People we spoke with told us positive things about the home and the care and support they received. One person said 'I am settled and happy here' and another person told us 'The staff are nice'.

Staff had been trained so they would understand the procedures to follow if they needed to report any concerns.

Recruitment procedures in place ensured the risk of unsuitable staff working at the home was reduced.

There was information for people about how to make a complaint. People we spoke with told us they knew who to if they were unhappy about anything.