Archived: Beaufort House

Beaufort House is a residential care home. It provides accommodation and personal care for up to 37 older people. At the time of the inspection there were 21 people living at the service.

People’s experience of using this service and what we found

During this inspection we did not speak directly with people at the service due to the increased risks associated with the Covid-19 pandemic. People appeared relaxed and had a good rapport with staff. Staff demonstrated a good awareness of the safeguarding processes and told us they would feel comfortable raising concerns with the interim manager.

People’s medicines were administered and managed safely. We found arrangements for the ordering, storage, administration and recording were effective. Assessments were in place to identify and reduce risks to people. Staffing levels were safe and robust recruitment systems were in place. The service was clean and infection control management was in place.

People were supported to have maximum choice and control of their lives, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service was well-led. Governance systems within the service were effective and monitored the risk to the health, safety and welfare of people. We received positive feedback about how the service was managed from relatives and staff. There was a positive staff team and culture. There were effective systems to seek and act on feedback from people, their relatives, staff and visiting professionals. Legal requirements around notifications and displaying performance ratings were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 15 August 2019), there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of either regulation.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 and 24 June 2019. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in regard to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance).

We undertook this focussed inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beaufort House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beaufort House accommodates up to 37 older people. At the time of the inspection 33 people were living there.

People’s experience of using this service:

Medicines were not being administered safely and records were not accurate and up to date. The storage of Medicines required improving along with how medicines were left unlocked. The service had no effective audit in place that identified shortfalls relating to the safe managements of medicines. Care plans were not always personalised with important information and some risk assessments required additional information.

Staff received supervision, training and an annual appraisal. People were supported by staff who were kind and caring and who had built a positive caring relationships with people. Staff knew who to raise concerns with and different types of abuse. People felt about to raise a complaint should they need to.

People were happy with the service and all felt the registered manager was approachable and friendly. All people felt safe. People were supported to access medical appointments and health professionals when required. People had their views sought and had access to activities such themed days, live music and days out. Staff were able to demonstrate a good understanding of dignity and respect and how to promote independence.

People were supported by staff who have checks undertaken to ensure they were suitable to work with vulnerable adults. Incidents and accidents were recorded, and an overview held so that any trends and themes could be identified.

Rating at last inspection: Outstanding (published December 2016).

Why we inspected: This was a planned inspection based on previous rating. At this inspection we found a deterioration had been made and the overall rating had changed from Outstanding to Requires Improvement.

Follow up: We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will continue to monitor the service through the information we receive. We will visit the service in line with our inspection schedule, or sooner if required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 21 and 23 September 2016 and was unannounced. There were 32 people living at the service at the time of this inspection.

There was an experienced manager at the service who was registered with CQC. 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.

People consistently told us about the excellent care and support they received. People using the service, their relatives and visiting professionals said the service was “fantastic”; “one of the very best”; and “truly marvellous…” They said the service was safe. Comments included, “I feel very safe here. There are always people around to help me…” and “Mum was definitely safe here. There was never a shortage of staff, staff gave her the time she needed”. A visiting health professional said, “People thrive here…they are the best service…It is a pleasure to come here.” Another said, “This place is fantastic. Beyond fault. I’ve had no problems or faults in 13 years... It is outstanding…”

End of life care was provided by staff who were skilled and competent and ensured effective pain and symptom management. A palliative care specialist said, “This service is brilliant. They are excellent with family members…” Relatives were very appreciative of the care and support they received during their family member’s last days. One said, “They do whatever it takes to make people comfortable. The support we received was absolutely wonderful.”

People’s wellbeing and happiness was central to this service. Staff had developed a positive rapport with people and they were gentle, attentive, kind and respectful in their approach. One person said, “The staff are really lovely…I see how nice they are with all the other people too.” A relative commented, “There is a welcoming ethos here. It’s a family.” Another said, “This was the only home in the area I wanted (person’s name) to come to. Staff are wonderful…” People’s independence was encouraged and people were supported to do as much as possible for themselves.

The culture within the service was open, friendly and welcoming. People, staff and professionals expressed confidence in the registered manager and provider. The registered manager was open and transparent in their approach. They placed emphasis on continuous improvement of the service and promoted links with the community, which benefitted people using the service.

People were protected from harm by staff who had a good understanding of the actions to take if they suspected someone was being abused or neglected. Risks to people had been assessed and measures were in place to prevent avoidable harm and to help ensure their independence was supported and respected. Accidents and incidents were monitored to identify themes and to help prevent any reoccurrence. There were sufficient numbers of experienced and caring staff to support people. People’s medicines were managed safely. The service had safe recruitment systems in place to ensure staff were suitable to work at the service.

People were protected by good practice in relation to decision making. The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS); ensuring people’s rights were protected.

People were promptly referred to health care professionals when needed and health care professionals expressed their full confidence in the service, telling us people’s health needs were monitored and managed very well. People enjoyed varied and nutritious meals and mealtime were sociable and relaxed occasions.

Staff received training, induction and supervision to ensure they understood people’s needs and were able to work effectively and safely. Staff said they were well supported to do their job.

People received care and support that was based on their individual needs and preferences. Personal care records included people's individual plans of care, life history, likes and dislikes and preferred activities. People were offered a range of interesting and diverse activities and were supported to pursue hobbies and pastimes that were of interest to them, and that were suited to their varying abilities. People and their relatives felt confident to raise any concerns and told us they were confident any concerns would be resolved without delay. No concerns were received during this inspection.

People’s views were sought and taken into account in how the service was run. The provider made changes and improvements in response to feedback. There was a robust system of monitoring the service to identify any improvements that needed to be made. The management team acted on the results of audits and surveys to improve the overall quality of the service.

People told us they were very happy with the care at the home. One person said "Everything is so good and nothing is ever too much trouble for the staff".

We observed people's care plans were individualised to ensure they met each person's care and support needs and contained detailed risk assessments. We saw that care plans were up to date, reviewed monthly and re assessed every six months.

People told us they enjoyed the food and said there was always plenty of choice. One person said "The food is so good my weight keeps going up". We observed a person who was intolerant to gluten, was able to enjoy the same food as other people as their food was made with gluten free ingredients.

People commented on the high standard of maintenance in the home and surrounding grounds. One person told us how grateful they were that their room had been decorated to their taste which had made them feel at home. We observed that new door closures ensured that people had the choice of leaving their room doors open but would close in the event of fire.

We observed throughout the visit that staff treated people with respect, kindness and dignity which supported people to live full and happy lives in the home.

We saw evidence that the quality of care and services were continually monitored and changes were made dependent on the outcome.

We observed staff gaining people's consent in a skilled way. We saw staff using risk assessments practically by picking up on people's health issues and escalating them. We saw people being given choices in relation to food, how they chose to spend their day and their daily routines.

People who used the service were positive about the care they received. People told us "I think we are very fortunate here" and "you won't find a better home". We observed interactions between staff and people who were unable to give their opinion due to confusion or illness. Staff treated these people with dignity, sensitivity and respect without exception.

We observed that staff were knowledgeable, skilled and able to spend time with people. People told us they are "very caring", "wonderful" and worked hard to meet the needs of each individual through care plans and service delivery.

We observed procedures were in place to prevent infections. One person told us "everything is wonderfully clean" and "it's like a five star hotel here".

We saw evidence that the quality of care was being continually monitored and learning implemented by staff who took on board people's comments and the outcomes of various audits.