Archived: Beechey House

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' 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 found-

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. We saw records that showed equipment at the home had been maintained and serviced regularly. There were enough staff on duty to meet the needs of people living in the home and two members of the management team were available on call in case of emergencies.

Care was not always planned to meet people's needs. Where a need was identified a clear plan for staff was not always in place to meet this need. For example, one person was noted to, "Hit staff and other residents", however there was no guidance or prompts that staff should take should this happen nor was there a strategy in place to reduce the potential for this occurring. There were no behaviour charts in place to identify potential triggers for the behaviour. There was also no risk assessment in place to ensure the safety and welfare of the person and others.

We spoke with three people and one person's relative. One person told us, "It's nice here". A person's relative commented, 'I think my wife is being well looked after".

CQC monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. No applications had been submitted, however the provider had a policy and relevant staff understood how an application should be made.

Is the service responsive?

People accessed the services of healthcare professionals as required. One relative told us, "My wife has access to all the professionals, the GP, chiropodist and other specialists". We spoke with a visiting healthcare professional who told us that the home made appropriate referrals and that staff followed their advice regarding the care and treatment of people. Records of visits from healthcare professionals were kept. For example, we found that visits from chiropodists, speech and language therapists and GPs were documented. The provider had made arrangements to deal with emergencies. For example, we found that evacuation equipment was present in the home and people had personal evacuation plans.

Is the service caring?

People were treated with consideration and respect and their privacy was maintained. We spoke with two people and the relatives of one person. One person told us, 'The staff are lovely". One person's relative said, 'They are all very kind, and the new manager is very good". Staff communicated with people in a sensitive and considerate manner. For example, we saw a member of staff reassuring one person who was becoming restless. They supported the person in going for a walk in the garden. We observed another member of staff supporting a person with their meal. The staff member assisted the person to eat in a dignified and unhurried manner.

Is the service well led?

The provider undertook a variety of audits to check the quality of the service. For example, we looked at audit reports relating to infection prevention and control, health and safety and accidents. We found that actions had been taken as a result of this monitoring. For example, a safety audit had identified the need to remove a hazard that blocked the fire exit.

People told us that they had recently attended a resident/relative meeting which gave them the opportunity to comment on the service provided. One relative told us that the management consulted with them when they made changes to the care provided for their wife.

The provider had not notified the commission of a number of incidents and events as they are required. The provider told us that they would ensure these notifications are made in future.

Is the service effective?

Peoples' needs were assessed; however care was not always planned and delivered to meet their needs. For example, we looked at the accident records for people living in the home. We found that where one person had fallen, a need to change to their plan of care had been identified to promote their safety; however this change was not evident when we looked at the person's care plan. One person's relative told us, that they felt that their wife's care needs were being met.

People's needs were taken into account with signage and the layout of the home enabling people to move around freely and safely.

Following our inspection in June 2013 the provider had failed to provide the Care Quality Commission (CQC) with an action plan detailing the progress in meeting the shortfalls.

Where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements.

People were not protected from the risks of inadequate nutrition and hydration. This was because nutritional assessments had not been completed and there were no plans in place to address identified risks. Staff did not have sufficient skills and knowledge in nutrition to ensure that people were fully protected from the risks of inadequate nutrition and hydration.

We found that care staff employed by Beechey House knew people well, we saw and they were able to tell us how they provided care and treatment for individuals. However, people did not experience care, treatment and support that met their needs and protected their rights. This was because their needs were not assessed and planned for. This meant that care plans did not accurately reflect people's needs and they were at risk of receiving unsafe or inappropriate care that did not protect their welfare and safety.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. This was because the provider had not taken steps to provide care in an environment that was adequately maintained.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

People living at Beechey House were positive about their experience of living at the home. No one had any complaints or concerns about how the home was run and managed.

We used a number of different methods to help us understand the experiences of people using the service. This was because they had complex needs which meant they were unable to tell us about their experience.

We used the Short Observational Framework for Inspection (SOFI). It is a specific way of observing care to help us understand the experiences of people who could not talk with us. We observed that people were in positive or neutral moods and frequently smiled with each other and staff. People freely approached staff and had good relationships with them.

Where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements.

People were not always appropriately supported to be able to eat and drink sufficient amounts to meet their needs.

Records showed that there were effective recruitment and selection processes in place.

The provider did not have a robust quality assurance system in place to ensure the standard of service was maintained or manage risks to the health, safety and welfare of people using the service and others.

Because people with dementia are not always able to reliably tell us about their experiences, we spent the majority of the visit observing people and looking at their records. We observed how they interacted with staff members, other people who use the service and the environment.

We observed positive staff interactions with people living in the home and that the staff knew the people well and gave care in a friendly and supportive manner. We found that care plans accurately reflected people's needs. The plans were written in a person centred way that gave specific information on what the person liked and disliked. This enabled the person to make their own choices about their care where possible.

We noted that the home had completed improvements in the suitability and safety of the premises. This included refurbishing rooms and replacing carpets.

The home had recently implemented an audit plan as part of their quality assurance system.