Beaconsfield Residential Care Home

Beaconsfield Residential Care Home is a care home providing personal care to people living with a mental health condition and/or a learning disability. The care home is registered to accommodate up to 22 people. There were 20 people using the service at the time of the inspection.

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

People were supported by staff who were kind, caring and who understood their likes, dislikes and preferences. People were happy living at Beaconsfield Residential Care Home and told us they felt safe.

Recruitment practices were effective and there were sufficient numbers of staff available to meet people’s needs. People were protected from avoidable harm, received their medicines as prescribed and infection control risks were managed safely. Individual and environmental risks were managed appropriately.

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

People's care plans contained detailed information about them and their care and support needs, to help staff deliver care that was individual to each person. These were reviewed regularly to ensure the care and support provided to people, continued to meet their needs.

People were supported to access health and social care professionals when needed, received enough to eat and drink and were happy with the food provided. Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

Staff showed an understanding of equality and diversity and people were treated with dignity, and their privacy was respected. Activities had been developed in line with people's wishes and there were varied and interesting options, to promote people’s health and well-being.

The service had a positive person-centred culture. Both people and staff told us the manager was approachable. The service worked in partnership with others and engaged people and staff. There was a positive staff culture, and this reflected in a happy and friendly atmosphere.

People and their relatives felt the manager was open, approachable and supportive. Everyone was confident they would take actions to address any concerns promptly. There were effective governance systems in place to identify any concerns in the service and drive improvement.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support

The model of care and setting maximised people’s choice, control and Independence. The size of the service having a negative impact on people, had been mitigated in the following ways; The building was a large home in a residential road with other large domestic homes of a similar size. There were deliberately no signs, intercom, cameras, industrial bins or anything else outside the building that may indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. Most people who lived at the service did not have a learning disability, however, those that did were supported to access their community. Choice and inclusion was actively promoted so people using the service could lead as full lives as possible.

Right care

Care was person-centred and promoted people’s dignity, privacy and human rights. All people living at the service had detailed and individualised care plans in place which demonstrated people’s support was built around them and this enabled people to live individualised lifestyles. People had a high level of autonomy over how they spent their time and were actively involved in making decisions around their care and the environment in which they lived.

Right culture

The ethos, values, attitudes and behaviours of the manager and care staff ensured people using the service lead confident, inclusive and empowered lives.

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

Rating at last inspection

The last rating for this service was requires improvement (published 18 July 2019).

Why we inspected

This focused inspection was prompted due to the inspection history of the service and the previous rating. We needed to check that improvements that had been made had been embedded and sustained. This report only covers our findings in relation to the Key Questions, Safe, Effective, Responsive and Well-led as these were the areas that required improvement at the previous inspection.

The rating from the previous comprehensive inspection for the key question 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beaconsfield Residential Care Home 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.

This location has a history of breaching the regulations and was rated as Inadequate following our inspection on the 26 November and 3 December 2018 and was placed in special measures. We imposed conditions on the provider’s registration as a result which required them to make urgent improvements to the service and thereafter undertake governance processes and report to us monthly.

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

At this inspection we found significant improvements had been made. The provider had recruited a new manager who was responsible for the day to day management of the service. They had implemented changes based on a service action plan for improvement.

People experienced an improved service and positive outcomes because of these changes, this included the safer and more effective management of people’s risks and medicines. Improved infection control practices, staff recruitment and the evaluation of accidents and incidents meant people were supported more safely. Restrictive practices had been assessed and changes had been made to enable people to have more freedom of choice.

We have made a recommendation about further improvements required to ensure people are supported to make informed decisions about the management of their medicines. Some improvements were still required to ensure good infection control and some risk assessments required further detail, and this was in progress at the time of our inspection.

People were now being supported to have more choice and control of their lives and staff were supporting people in less restrictive ways and in their best interests; the policies and systems in the service were now being implemented to support this in practice. Further improvements were required to embed the principles of the Mental Capacity Act (2005) into practice. A system was now in place to enable this work to be undertaken.

The service had introduced a needs assessment based on nationally recognised assessment tools. Staff had completed training in meeting people’s needs and this had resulted in people being supported more effectively. Further training was planned to continue providing staff with the opportunity to develop their skills, knowledge and competence. Improvements had been made to the environment, some further work was required, and this was planned, we have made a recommendation about this.

People told us staff were caring. Our observations and feedback from a visiting healthcare professional confirmed improvement had been made in the way people were treated. The service was more person centred with staff focusing on what people wanted and care plans were being developed to record peoples, needs choices and preferences. We have made a recommendation about the management of complaints.

The provider and manager had acted to make improvements to the service, meet their regulatory requirements and improve the quality and safety of the service for people. There was still work to be completed but an action plan was in place and this was overseen by both the manager and the provider to check improvements were being implemented

The service was working towards consistently applying the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 inadequate (published 14 January 2019) and there were multiple 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 regulations.

This service has been in Special Measures since January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

• People did not receive a service that provided them with safe, effective, compassionate and high-quality care.

• Risks to people’s safety and well-being were not managed effectively and this placed people at risk of harm.

• People were not always safeguarded from abuse and incidents and accidents were not managed safely to prevent a reoccurrence.

• People’s needs and preferences were not always assessed or person-centred plans developed to guide staff on how to meet people’s needs.

• Staff did not complete training in meeting people’s needs and this meant people were at risk of inappropriate care and treatment.

• The principles of the Mental Capacity Act 2005 were not understood and applied. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

• People were not always treated respectfully or in a way that promoted their privacy and dignity. The service was not well-led and the governance system was ineffective and did not identify the risks to the health, safety and well-being of people or actions for continuous improvements.

• There is more information about this in the full report.

Rating at last inspection:

The service was last rated as Requires Improvement the report was published on 22 February 2017. Following the inspection, we asked the provider to tell us the actions they would take in response to the breaches of Regulations found during this inspection

About the service:

Beaconsfield Residential Care Home is a residential care home providing personal care for up to 22 people living with a mental health condition and/or a learning disability. At the time of our inspection 21 people were living in the home who met these criteria. One person had been admitted with physical health needs.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

We have told the provider to take immediate action to address some of the concerns we found. We received an action plan from the provider telling us about the actions they have taken. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: 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.”

Following our inspection, we raised our concerns about people’s safety with the local authority safeguarding team and Fire and Rescue Service.

Beaconsfield residential care home provides accommodation and support for up to 22 people with mental health needs. The Home is a four storey Victorian building; It has a dining room, three lounges and a paved area at the rear of the building. It is situated only a short distance from Southsea beach and a few minutes’ walk from a shopping precinct. The home is registered with the care quality commission (CQC) to accommodate 22 people and the home was at full occupancy at the time of the inspection.

During this inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regards to person centred care, staffing, good governance and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of this report.

At the time of the inspection the home had a registered manager. 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.

The people living at the home told us that they felt safe. The staff we spoke with had a good understanding about safeguarding and whistleblowing procedures and told us they wouldn’t hesitate to report concerns.

We saw appropriate arrangements were in place for the management of medicines. Systems were in place to manage and reduce risks to people. In people's care files we saw comprehensive risk assessments and care plans to mitigate risks.

Recruitment practices required strengthening. Staff had been appointed and commenced working at the home prior to the Disclosure and Barring service (DBS) check having been received. This exposed people to the risk of being supported by unsuitable staff.

We found there was not enough suitably trained and experienced staff on duty to meet people’s social and emotional needs. Staffing levels were not determined using a formal calculation based on the needs of people using the service. We observed interactions were task led and people were sat around with little stimulation offered.

We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

People's nutritional needs were met depending on their individual assessed needs and people were positive about the quality and quantity of food provided. People told us they were offered choice at mealtimes and were able to request additional snacks if they were hungry in between meals.

People told us they were supported by staff that were kind and caring. Staff maintained people’s privacy and dignity and promoted their independence.

People were not supported to live full and active lives. There was no stimulation or attempts made to engage people in meaningful activity. People had expressed the wish to attend an activity but this had not been addressed by the management.

We were told that there had been no complaints received. People told us they felt confident to raise complaint with staff but currently did not have any issues of concern.

We found there was no system in place to asses and monitor the quality of the service provided to ensure improvements were implement to the service provided.

We saw meetings had been conducted regularly with people and staff. Surveys had been sent and an analysis undertaken of the results. Improvements to be implemented had been identified but not consistently actioned.

Staff and people spoke of a positive culture and a management that were approachable and supportive

One inspector carried out this inspection.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Is the service safe?

People had individual risk assessments. Where a risk or need had been identified, there was a written plan to inform staff as to how to reduce the risk. We saw people had access to medical support as necessary and their medicines had been administered safely. The building had been maintained to ensure people's safety. One person said, " It is clean and comfortable. It's not posh, but meets my needs".

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes in order to ensure people's rights and freedoms are not restricted without proper authorisation. We found staff had been trained to understand when an application should be made to the local authority, and how to submit one. There were proper policies and procedures in place and these had been followed.

Is the service effective?

We observed people were happy with the care they received and they told us they were happy. It was clear from what we saw and from speaking with staff they understood people's care and support needs and they knew them well.

Is the service caring?

We observed that staff had a good understanding of people's support needs. They were supportive and were available when people needed them. People described the staff as, "Real good people' and 'They are very good, this is why I have lived here for many years'

Is the service responsive?

Records showed people's preferences and interests had been recorded and care and support had been provided to meet their needs and wishes.

Is the service well-led?

People were asked their views and these were listened to. There were systems to record, monitor, evaluate and improve the service, care and support that people received.

People had their needs and wishes assessed and recorded before coming to live in the home and the home's manager worked with other professionals to ensure that the home met individual needs.

The staff team were trained in protecting people from risk of abuse and those that spoke with us were aware of their responsibilities.

Staff were only employed following a structured recruitment process and relevant checks were undertaken before they commenced work.

There was a complaints policy and procedure in place and complaints and concerns were investigated by the manager.

A family member told us. 'My son can be very difficult but the staff are kind and patient. He is looked after well in every way. The food is excellent and they support him well.'