Archived: Beech House Nursing Home (Partington)

Beech House Nursing Home provides nursing and residential care for up to 28 older people. At the time of our inspection there were 25 people living in the home.

People are supported in two buildings. The house provides accommodation for people requiring nursing care. The bungalow next door provides residential care.

The house has a communal lounge area and large conservatory used as a dining room. The bungalow has a small dining area and separate small lounge area. The kitchen where meals are made is in the main house and there is a smaller kitchen for snacks and drinks in the bungalow. The laundry room is situated in the bungalow. The house has two floors; the upper floor is accessed by stairs and a lift.

At the comprehensive inspection of Beech House Nursing Home on 1and 3 December 2015 we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). We issued the provider with six requirements stating they must take action to address these breaches.

Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan, and to confirm that they now met all of the legal requirements.

During this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures."

The service had a new manager who had worked at Beech House Nursing Home for ten weeks prior to our inspection. They were in the process of being registered with the Care Quality Commission. 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.

At the last inspection we found there were not sufficient levels of staff of staff on duty. At this inspection we found staffing levels had not improved and we noted people did not receive their care in a timely manner.

We observed some positive interactions between people and staff when direct care was being provided. However, we saw staff rushing around and not always acknowledging people as they passed them or entered their rooms. Consideration was not always given to people's privacy and dignity as people's personal information was not always protected.

Robust recruitment processes had not been followed because one some staff member did not have references from their previous employment.

Care plans were based on the needs identified within the assessment, however we found care plans were not always person centred, and didn’t provide enough information on people’s past histories.

We found systems were in place to make sure people received their medicines safely. When we did raise an issue with medicines this was explored and resolved straight away.

Potential safety hazards were identified by the inspection team as we walked around the building. We brought these concerns to the management team’s attention and found these had been resolved on the second day of our inspection.

All areas of the home looked clean. Procedures were in place to prevent and control the spread of infection. An infection control audit in February 2017 had identified areas for improvement and these were being implemented.

Policies were in place to ensure people's rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Although policies and procedures were in place it was clear that they were not always put into practice.

People had access to activities, however we received mixed feedback with regards to the activities provided. People were not always protected from social isolation. The range of activities available were not always appropriate or stimulating for people.

People had enough to eat and drink throughout the day. Where people needed support with eating, they were supported by a member of staff. However, we found people who needed their fluid intake recorded had not always been completed correctly by staff.

Audits on the home's quality were not accurate which meant systems to improve the quality of provision at the home were not always effective. We found the home in breach of the regulation in relation to good governance as there were not effective systems in place to monitor the quality of the service. Surveys were completed but the information was not collated and used to improve the provision of care at the home.

The home environment was not dementia-friendly, in that adjustments had not been made to help people living with the condition to navigate around the home. We recommended that the home investigates and implements good practice in modern dementia care to improve people’s quality of life.

Healthcare services were available to people who required them. People had access to health care services when their health needs changed. Staff made referrals to health care professionals for further advice and guidance to manage their health conditions. Staff followed health professional's guidance and recommendations for people.

People told us they knew how to complain if they were unhappy and records showed the service responded appropriately to complaints they had received.

We found 11 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We served an Notice of Proposal to cancel the providers registration. The provider submitted representations that were not upheld, therefore a Notice of Decision was adopted the cancel the providers registration.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

We found people were not protected from unsafe care or treatment because records were not up to date or accurate and staffing levels were inadequate to meet the needs of people living with dementia.

We found the environment and premises did not support people living with dementia.

Is the service effective?

The service was not effective in the residential part for people living with dementia although people living in the nursing home said they were generally happy with the way things were.

Is the service responsive?

We found the home had not responded to the change in people's needs. The manager told us about things which had been discussed with the Local Authority but there was no record of these discussions or any outcomes recorded in the care plans we looked at.

Is the service caring?

Through speaking with the manager and some of the staff it was clear some staff genuinely cared for the people they supported but this was not consistent. One member of staff we spoke with did not have a clear understanding of the needs of people they supported or the importance of keeping accurate records.

The manager told us they were aware of this and would ensure this was addressed as a priority.

Is the service well led?

We spoke with the manager who told us they were aware of the concerns we had raised and had met with the provider to look at the issues around the bungalow.

We could see there were systems in place to monitor and assess the quality of service provision and to support and develop staff. We did not look at the outcome specifically relating to quality and management but could see information passed onto the manager from senior staff was not accurate.

The manager was able to recall information we needed and told us about issues the families had raised. This information should be properly recorded in order for it to be accessible by all staff.

We noted that the home was well maintained, offering ramped access, and in pleasant grounds with car parking facilities.

We observed that there were sufficient numbers of staff on duty. We saw that care staff interacted well with people who use the service. They treated people respectfully, offering privacy, dignity and choice.

Whilst on the visit we saw equipment being used. This was done efficiently and competently. Equipment was appropriate and appeared to be well maintained.

We checked a number of records and found that people's personal preferences were recorded within their care plans. There was also information available within bedrooms.

We spoke to a number of visitors, who all said that they were always welcomed at the home and offered refreshment. One visitor said that "it's perfect really, we get on well with the staff".

We noted that the home was well maintained, offering ramped access, and in pleasant grounds with car parking facilities.

We observed that there were sufficient numbers of staff on duty. We saw that care staff interacted well with people who use the service. They treated people respectfully, offering privacy, dignity and choice.

Whilst on the visit we saw equipment being used. This was done efficiently and competently. Equipment was appropriate and appeared to be well maintained. People were transferred from wheelchairs to easy chairs as a matter of course.

We checked a number of records and found that people's personal preferences were recorded within their care plans. There was also information available within people's bedrooms.

We spoke to a number of visitors, who all said that they were always welcomed at the home and offered refreshment. One visitor said that "you can't fault any of the staff". Another commented that her relative had shown a "tremendous improvement" since moving to the home.

We also spoke to people who use the service. One said that "staff are very kind" , whilst another told us that they are "very well looked after".

Some people felt more activities should be offered.

Complaints were dealt with appropriately and the home had received many compliments.