Beech Hill Grange

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.
At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant people’s needs were not always met.
 

This service scored 50 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

While people were treated as individuals and had choice in their day-to-day care, they were not always involved in the planning of the care or included in discussions about changes needed in their care.

We saw in some people’s records, staff had not included them in their care plan reviews and, in some records, recorded ‘not applicable’ where it asked if a person had been consulted as part of the review without explanation for this.

During our assessment we raised concerns with the registered manager about the lack of consultation and consent for people sharing a room. This included where people who did not have capacity to make an informed choice were sharing without an appropriate risk assessment.

Further, there was no policy to guide staff with ongoing monitoring and reviewing of the arrangement and how to raise concerns where people were at risk of harm, for example a breakdown in the relationship between people who shared the same room.

The registered manager took an immediate decision to move everyone who was not related into single rooms whilst they assessed people’s compatibility.

However, this in making this decision they did not consider the impact on people’s health and wellbeing including some people who were sharing a room and had a diagnosis of dementia.

We were told by staff and relatives this change had a negative impact, and people had become disorientated by the change of environment.

We discussed this with the registered manager who told us they had taken the decision to safeguard people whilst they were assessing compatibility. They acknowledged that this decision had been reactive rather than with consideration of the impact on people.
 

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

People’s care files did not provide appropriate information about their health conditions and the impact of these had on their daily lives and care, such as what a good and bad day looked like for a person.

People generally received consistent care from staff who knew them well. However, members of the nursing team told us they were rotated between different units every 3 months. Whilst this provided variety, it could also limit their ability to develop relationships and a deeper understanding of people’s longer term health conditions and to recognise subtle changes that may indicate a shift in their needs. The service advised that this is a business decision and there have not been any adverse outcomes because of this.

Relatives told us staff helped support people with health appointments. We saw a GP did a weekly round at the service, and the nursing staff contacted other healthcare services such as, the tissue viability nurses, when people required more specialised advice.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider did not always consider people’s individual communication needs and provide accessible information in line with the Accessible Information Standard (AIS) or have systems in place to support this.

For example, menus displayed were in small font and did not have pictures to support people living with dementia to fully understand them.

Staff told us they asked people what they would like to eat; however, this would be more difficult for people with limited verbal communication.

The provider displayed literature about the service which was out of date and did not show the service’s current rating from the last inspection and details of the current registered manager.

We spoke with the provider who told us they would remove the relevant leaflets and that new ones would be made available.
 

The service required improvement in how it listened to and involved people in their care.

People were given some opportunities to share their views, and the provider carried out surveys, phone calls and checked online reviews to gather feedback.

However, it was not always clear what actions were taken in response to the feedback received about the service, which limited assurance that people’s views were driving improvements.

People and their relatives told us that management were approachable and willing to listen to concerns.

Residents’ meetings provided a forum for people to influence aspects of the service, such as menus and activities, and people told us their suggestions about menu changes had been acted upon.

Despite this, only a small number of people regularly attended these meetings, and there was no clear system for gathering feedback from those who did not attend.

This meant not everyone had equal opportunity to contribute to decisions about the service.

Relatives said they felt confident any issues they raised would be addressed.

However, the lack of consistent follow‑through on wider feedback limited how effectively people were involved in decisions about their care and the service overall.
 

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

The service ensured people had moving and handling aids where needed to support their mobility needs.

People who required equipment such as nursing chairs and specialised cutlery had access to these items.

The layout of the service was accessible for people who used equipment such as wheelchairs.

However, we saw that people who required assistance with meals sometimes had to wait longer than others at their tables, which resulted in some people becoming unsettled.

People who were supported to have meals in their rooms told us they could wait an extended time for meals but understood this was usually down to staffing levels.

The service used a call bell system so people could request support when they needed it.

We saw the registered manager was able to see how long call bells had taken to answer.

Staff and leaders did not always ensure all people were involved in their care planning and processes for them to give feedback was inconsistent. This meant people’s care was not always tailored in response to this.

People’s experiences of care and support differed. During our assessment we observed most people who spent time in the communal areas of the service had good access to staff and activities. People who were supported in bed were visited by the activity team during the week. However, some staff told us they were not always available to spend time with people outside of providing care. We saw where people were able to access the activities that took place in the service their experiences appeared positive.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

We saw evidence that DNAR (Do Not Attempt Resuscitation) and ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms were in place. These documents outlines a person's preferences for emergency care, particularly in situations where they may be unable to communicate their wishes. 

Staff were able to see these documents on the relevant person’s electronic care record so that in an emergency they knew who had these in place.

The service frequently supported people on fast-track end of life packages. People’s care plans gave them the opportunity to plan for future changes in their care and to make informed decisions including end of life care preferences if they wished. However, the care plans for people in receipt of end of life care did not provide detailed guidance for staff about their wishes or how they wanted to be supported in their final days. This meant staff did not always have the information they needed to deliver personalised, compassionate end‑of‑life care. In addition, some staff told us, given the number of people they were supporting at the end of life, they would welcome further training to increase their confidence and competence. That they did not feel they had enough experience to always provide the right support, it does not indicate inadequate training. However, their lack of experience could increase the risk that people’s preferences and comfort may not be fully respected.