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Inspection carried out on 7 August 2020

During an inspection looking at part of the service

Beech Lawn Care Home is a care home providing personal care and accommodation for up to 19 people with mental health needs in one adapted building.

We found the following examples of good practice.

• The service sent letters or emails to visitors prior to arranging a suitable time to visit. These included a code of conduct to outline the expectations during visits to ensure people’s safety and reduce the risk of infection transmission. Visitors had access to alcohol hand gel and face masks during their visits.

• Staff took time to speak with people, show them how to put on and take off their personal protective equipment (PPE) and explain the risks should they choose not to wear PPE. Staff wore PPE at all times to reduce the risk of transmitting the infection.

• Staff worked with people and their relatives to ensure they were aware of isolation procedures should they be needed. Relatives were encouraged to attend garden visits and use video calls and phone calls to support people’s well-being.

Further information is in the findings below.

Inspection carried out on 7 August 2018

During a routine inspection

This comprehensive inspection took place on 7 August 2018 and was unannounced. Beech Lawn Care Home is registered to provide personal care and accommodation for up to a maximum of 28 older people, including those who may be living with dementia related conditions. The provider operates with 21 places. At the time of this inspection the service was being provided to 18 people. Beech Lawn Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection in June 2017 the service did not meet all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated ‘Requires Improvement’. This was because the provider was in breach of regulation 17: Good governance, with regard to not having effective systems in place to monitor and improve the quality of the service or to mitigate risks. The provider had not made applications to the local authority where they restricted people’s freedom.

At this inspection the service was rated ‘Good’. This was because the provider met the regulation on good governance. They had systems in place to monitor the quality of service delivery, which included action plans for making changes. We saw no evidence of how conclusions were reached and information was processed within these systems and discussed with the registered manager how these could be developed.

The provider was required to have a registered manager and the same one had been in post for the last seven years. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

People were protected from the risk of harm. Systems were in in place to detect, monitor and report potential or actual safeguarding concerns. Staff were appropriately trained in this area and understood their responsibilities. Risks for people were managed and reduced so that they avoided injury or harm. The premises were safely maintained and we saw documentary evidence of this. Staffing numbers were sufficient to meet people’s needs. Recruitment practices were safely carried out. The management of medication and prevention and control of infection were safe.

Qualified and competent staff supported people and were themselves regularly supervised and appraised regarding their personal performance. People’s rights were protected regarding their mental capacity and staff understood the importance of obtaining people's consent. Decisions were only made in peoples’ best interests where they lacked capacity to make them. People received adequate nutrition and hydration. The premises were suitable for providing care to older people and those living with dementia.

People received compassionate care from kind staff who knew about people’s needs and preferences. People were involved in the management of their care and decision making. Information was provided to people in an accessible format. People’s wellbeing, privacy, dignity and independence were monitored and respected.

People had person-centred care plans, which reflected their needs well. These were regularly reviewed. There were opportunities for people to engage in pastimes and activities. People were supported to maintain family connections and support networks. An effective complaint procedure ensured people’s complaints were investigated without bias. Support to people at the end of life was sensitively and suitably provided.

The culture of the service and the management style were both open and approachable. Pe

Inspection carried out on 21 June 2017

During a routine inspection

Beech Lawn Care Home is registered to provide care and accommodation to 28 older people who may be living with dementia. It is located on the outskirts of Hull and has good access to public transport routes to and from the city.

This inspection took place on 21 and 23 June 2017 and was unannounced. The service was last inspected in March 2015 and was found to be compliant with all of the regulations inspected at that time. We rated the service as ‘Good’.

At the time of this comprehensive inspection 20 people were living at the service. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was not always safe. People were not always supported by suitable numbers of staff and sometimes had to wait for long periods to receive support. A person who used the service had raised concerns through the provider's questionnaire and during the inspection we were told by one person had to wait for over two hours to be supported with the care they required.

The service was not always effective. We found that the provider had failed to ensure staff with appropriate skills were deployed at all times. We saw evidence to confirm on 17 night shifts in June 2017 no member of staff had completed first aid training, which increased the possibility that people would not receive the care they required in an emergency situation. The provider had also failed to make applications to deprive 11 people of their liberty in line with current legislation.

The service was not always well-led. The provider failed to operate effective systems to assess, monitor and improve the quality and safety of the service as required. You can see what actions we have asked the provider to take at the end of this report.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs that could indicate abuse had occurred. Staff knew what action to take to ensure people were safe. Risk assessments were in place to mitigate known risks. Safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began working in the service. Appropriate systems were in place for the management of medicines and people’s medicines were administered as prescribed.

Staff had undertaken a range of training and completed or were in the process of completing nationally recognised qualifications in care. Staff received appropriate levels of supervision and appraisal, their knowledge and skills were assessed regularly by the registered manager. People received a balanced diet of their choosing; their nutritional needs were known and catered for. Relevant professionals were involved in people’s care. Their advice and guidance was incorporated in to people’s care plans.

People told us they were supported by caring and attentive staff who knew their needs and understood their preferences. Relatives we spoke with were complimentary about staff’s approach and felt their family member’s needs were met in a caring way. People told us and we observed them being treated with dignity and respect by staff. The provider utilised IT systems that ensured private and sensitive information was held securely and not accessed by unauthorised people.

People were, whenever possible, involved with the initial and on-going planning of their care. People’s care plans reflected their levels of independence, abilities and support needs. People were encouraged to take part in activities and to follow their interests. The provider displayed their complaints policy within the service and provided it to people at the commencement of the service. The nominated individual told us complaints were u

Inspection carried out on 10 and 11 March 2015

During a routine inspection

This was an unannounced inspection undertaken on the 10 and 11 March 2015.

The service was last inspected on the December 2013 and found to be compliant the regulations looked at.

Beech lawn is registered with the Care Quality Commission to provide care and accommodation to 28 older people who may have dementia. It is located on the outskirts of Hull and has good access to public transport routes to and from the city.

At the time of the inspection there were 19 people living at the service.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had a good understanding of their duty to keep people safe from harm. They could recognise the signs of abuse and knew how to report this. They had received training about how to recognise and report abuse.

People’s medicines were handled, stored and administered safely by staff who had received the appropriate training.

Staff were provided in enough numbers to meet the needs of the people who used the service, the registered provider constantly monitored the staffing levels based on people’s needs and increased these when required. Staff were recruited safely and the registered provider had systems in place which ensued the right checks were done before the member of staff started working at the service. The registered manager made sure the environment was safe and repairs were undertaken promptly.

People’s human rights were protected by staff who had received training in the Mental Capacity Act 2005. People were cared for by staff who had been trained to meet their needs. Staff were supported to gain further qualifications and experience. The food provided was wholesome and nutritious and people’s weights were monitored when required, if people needed more support with their diet staff made referrals to health care professionals. People could access their GP when they needed to and staff monitored people’s health and wellbeing and supported them to lead a healthy lifestyle.

People were cared for by staff who had a good knowledge of their needs and how these should be met, they also had good relationships with the staff, who spent a lot of time with them. People’s choices were respected and they were supported to lead a lifestyle of their own choosing. People or their relatives were involved with the care and had a say about how they should be supported by the staff. Staff could refer to information to help effectively meet the needs of the people who used the service. Staff were caring in their approach, spoke to people respectfully and respected their wishes.

People lived in a well maintained and clean environment and there were no mal odours; however, the environment could be more dementia friendly, we have made a recommendation about this in the full report.

People could have a say about how the service was run; their opinions and suggestions were taken seriously. People could raise complaints and the registered provider had systems in place which addressed and investigated the complaint whenever possible to the complainant’s satisfaction.

The registered manager collated people’s views and those of relatives and health care professionals who had an interest in people’s wellbeing and set goals and action plans to address any short falls. The registered manager was available for people to talk to if they had any concerns. The registered manager undertook audits of the service provided which ensured people received a service which was safe and well run.

Inspection carried out on 17 December 2013

During a routine inspection

We looked at records of people who used the service and found that they included a signature from either the person who received care or a nominated representative. This ensured that people were engaged with their care and support and these arrangements were understood by them.

We spoke with members of staff and found they understood the process for making health care support appointments on behalf of people who used the service.

A person who used the service told us, �My room is cleaned every day for me.� A visiting relative also told us, �I have never noticed any foul odours all the time I have been coming and my relative�s room is very clean, and it is kept to a high standard.�

We looked at the staffing rota which confirmed there was always enough staff on duty to support people�s needs. The rota identified specific staff numbers for different shift patterns service and there were enough staff allocated to the numbers of people who used the service.

The manager told us that spot checks were conducted on a regular basis and records we saw confirmed this. Audits of staff included how they carried out; personal care tasks, dispensed medication, infection control and the use of hoists and equipment. This ensured people remained safe and good practice was monitored to reduce the risk of potential harm.

Inspection carried out on 3 January 2013

During a routine inspection

We looked at three care records of people who used the service and saw an assessment of their needs had been undertaken.

A relative told us that; �My mother likes the girls here, they care for her in a dignified and professional manner and her room is always nice and clean.�

We observed the lunchtime experience and a member of staff told us that; �One person used to eat his meal very quickly and now that the background music plays he sings along during mealtimes and he now eats his meal at a slower and more relaxing pace.� We saw that people�s food intake was monitored and any concerns brought to the attention of the manager and recorded in the persons care record.

We saw prescribed medication was stored in locked trolleys in the medicines room. The room included a fridge to store medicines at cooler temperatures as directed. The temperatures of the room and the fridge had been checked and recorded on a daily basis. This meant that people received medicines that maintained their potency due to appropriate storage.

We saw there was a main lounge and a quiet lounge, both of which were warm and comfortable. We saw that rooms were personalised by the people that used the service. This showed the service promoted people's independence and supported their daily living activities.

We saw there was a training plan in place which ensured all staff had training updated regularly.

Inspection carried out on 12 December 2011

During a routine inspection

People we spoke with told us they were free to come and go as they pleased. One person told us, �It�s like home from home, I do as I like.� Another person said, �There are some rules but I don�t feel restricted.� People also told us they felt the care they received was very good. One person said, �The care staff are wonderful, they always help me when I need it.�

People would approach the manager or the staff if they had any concerns and visiting relatives told us they would see the manager or the staff on duty if they had any concerns; they also told us they found the manager very approachable.

People who used the service told us they had been involved in meetings and felt they could have a say about how the home was run.