Beech Hill Grange

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Requires Improvement.

At this assessment the rating has remained Requires Improvement This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.
 

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.
The provider had a ‘resident of the day’ scheme to review risk assessments and care plans regularly. While this process was in place and followed, we found care plans and risk assessments were not always updated promptly when people’s needs changed or did not reflect the person’s current needs.

For example, 1 person had returned from hospital, and their repositioning charts and care plan had not been updated to reflect the change in their needs. This meant that they were at an increased risk of pressure sores.

People were assessed by the registered manager before moving into the service. However, this was not always effective.

We saw a person who had recently arrived at the service was supported in bed. They did not have a detailed care plan or risk assessments in place to enable staff to provide the appropriate care safely, despite the fact that a 4-week period had elapsed.

Systems and processes to ensure care was personalised to people’s individual needs were not effective.

Care plans were not always updated with relevant information.

During our assessment we noted there were 7 shared rooms. Of these rooms, 5 were occupied by people who were not related to each other. In many cases, there was no evidence people’s individual needs had been considered when placing them in shared rooms. There was no evidence attempts had been made to consider how people’s specific needs and risks may impact upon the person with whom they were sharing a room.
For example, there were people who were supported in bed at all times; however, their care plans did not demonstrate how privacy and dignity were appropriately upheld when receiving personal care or when their loved ones visited.

There was no shared room policy in place which was a requirement from the last inspection to alert staff to things they may need to consider and raise as concerns if they witnessed any changes. There was no continued assessment of ongoing suitability of people to cohabit in a shared room.

People’s relatives told us the staff contacted them to make them aware of any changes affecting their loved ones’ care.”
 

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Most people we spoke with told us they were happy with the overall care they received and how this met their needs.

One person told us, “I’ve gained weight since being here, the food is nice and they weigh me every month.” Another person told us, “I get the care I want. I tell them how I like things. They are very good.”

However, people gave mixed reviews about the food served at the service. We saw this had been discussed at ‘resident meetings’ and that the feedback had been shared with the catering team.

We saw evidence that staff kept daily records of people’s nutrition and hydration intake. These were monitored and that staff were aware of people with special diets and fluid intake requirements, such as the use of thickeners.

However, this information was not always recorded in people’s care plans. There were examples where people had returned from hospital with changes to their dietary requirements, but their care plans had not been updated to reflect this.

Staff told us they were aware of these changes because people had told them about these. This did not reflect a safe or robust approach to meeting people’s individual nutrition and hydration needs.

One relative told us they felt concerned their loved one never seemed to have any fluids next to them when they visited and would forget to drink if they did have fluids within their field of vision.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. Systems were not in place to effectively share information with all staff.

Care staff told us they were not involved in regular daily meetings or handovers to discuss people’s care and any changes in their needs. They said they would relay on any updates on the electronic care records for the people they were supporting that shift.

Staff supporting people in communal areas, such as the lounges, were only able to view full care records for people on the particular unit they were allocated to work.

Whilst staff could see important information flagged on people’s daily records, they were not able to view people’s care plans and risk assessments on the electronic system.

This meant, for example, a member of staff providing support in the lounge could not see how a person from a different unit was supported to mobilise safely.

We discussed this with the registered manager who told us staff would ask the nurses for guidance. Following this conversation, the registered manager took the decision to allow staff access to all records.

Staff we spoke with had worked at the service for a long time and told us they knew people well.

However, care staff did not always attend reviews and assessments of people’s needs as the nurses usually did this along with the registered manager.

This meant the opportunity for staff to share information they knew about the person may be missed.

We observed positive staff interactions between people and staff supported them. Staff appeared to work well together as a team.
 

Systems were in place to identify risk to people’s health and prevent this from deteriorating. However, improvements were needed to ensure these were fully effective and we found issues with monitoring and recording of information.

The service had failed to ensure risks to people’s health, such as managing the risk of pressure sores and the risk of falling, were assessed and monitored effectively. This meant the provider could not be assured people were supported safely in a way which minimised further impact on their health and wellbeing.

People were encouraged to make healthy choices. People who were at risk of losing weight received fortified meals and supplements to help them gain weight and improve their appetite.

We saw people were weighed on a regular basis and where people had specialised diets, including diabetic, low-fat and vegetarian diets, were offered suitable choices.

People who were at risk of being isolated due to being cared for in bed were visited by the activity staff on a regular basis and offered activities in their rooms by visiting entertainment, such as people playing musical instruments. People and their relatives reported this had a positive impact on people’s mental health and wellbeing.

We saw a variety of activities on offer during our assessment which included gentle exercise to keep people physically well, sing-a-longs and quizzes. Most people we spoke with told us they enjoyed the activities offered at the service.

People saw their GP and other healthcare professionals, such as physiotherapists, dentists and chiropody services, on a regular basis.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and
consistent, or that they met both clinical expectations and the expectations of people themselves.

People’s care was not consistently monitored or delivered in line with their risk assessments or the guidance provided by healthcare professionals.

Staff did not always complete monitoring records to demonstrate that people had received appropriate support with repositioning to reduce the risk of pressure sores.

This issue had been identified at our previous assessment, and although additional checks had since been introduced, these measures had not led to sustained improvement.

Care records were not consistently updated to ensure staff had accurate and up-to-date information on the people they were supporting. For example, we saw 1 person’s care plan stated they were “supported in bed”, whilst their risk assessment provided contradictory guidance that the person, “walks with a frame.”

Whilst staff knew people well, they told us recently there had been an increase in new people moving into the service which meant they may not know them as well as people who had been at the service for a while.

We saw evidence referrals were made to healthcare professionals as needed, and people saw their GP, and other relevant healthcare professionals, such as specialist nursing and physiotherapy services. Doctors and other health professionals we spoke with felt staff were caring and people’s overall care needs were met.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff understood how to identify when people lacked mental capacity to give consent and took action to ensure decisions were made in people’s best interests. For example, we saw a staff member supporting a person with a meal who was not eating trying several different ways to encourage them to have some food by offering different things to eat, in recognition this was in their best interests.. However, people’s care records did not show how people were supported by staff to make day-to-day decisions. Instead, records focused on what had been done rather than how right to make decisions about their care had been promoted, or how they had consented to the care delivered.

In some cases, where people lacked capacity to make some decisions, records showed relatives were involved in best-interest decision-making and the relevant records of these meetings and decisions were made. However, these records did not always demonstrate how people’s wishes and preferences had been considered and did not fully reflect the Mental Capacity Act Code of Practice.

Evidence of how people were supported to understand decisions about their care was limited. People who shared their bedrooms had not signed consent forms agreeing to this arrangement. Further, for those people sharing rooms who lacked capacity, there was no evidence to demonstrate the sharing of rooms was in their best interest.

We found CCTV was in use in communal areas of the home. While the provider told us this was to promote people’s safety, they were unable to demonstrate how the system was used in a way that protected people’s rights to privacy and dignity. People have a right to know when and why they are being monitored, and the provider must ensure CCTV is used proportionately and only for a clearly defined purpose. We had raised this as a concern at our last inspection.

We saw people who needed assistance to eat their meals were supported by staff in the conservatory rather than the dining room. Care plans did not explain how this decision had been made, and it appeared to be based on what was easier for staff rather than the person’s own preference.

This meant people were not supported in a person‑centred way, and their right to choose where they ate their meals was not always considered. This could impact their dignity, comfort and overall mealtime experience.

This concern about people’s choice of where they ate was also identified at our previous inspection.

Despite this, people were supported by a consistent staff team who knew them well.

Staff were familiar with people’s routines and preferences through experience, which helped ensure care was delivered in a way that met their immediate needs, even though this was not always clearly documented.