Archived: Beaconsfield Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment, the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to the need for consent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider attempted to discuss people’s health, care, wellbeing, and communication needs with them.

Care plans had improved since the last inspection and contained more person-centred information. However, people had not always been involved in their assessments. The manager told us people were not interested in their reviews, but they would use their views in the care plans. They also told us not many family members were involved. There were mixed views from people as to whether they were involved. One person told us, “I don’t know anything about my care plan.” Two people told us staff write their care plans and then talk to them about it. Another person was not sure if they were involved in their care plans.

The provider did not always follow legislation and current evidence-based good practice and standards when planning and delivering people’s care. The provider used evidence-based tools to identify people at risk of malnutrition and their risk of developing pressure ulcers.

However, behaviour related support, smoking in a care home and guidance relating to people with a learning disability and autism were not always follow when supporting people. This meant staff did not have accurate information to support people safely.

The provider did not always work well across teams and services to support people. They did not always share accurate up to date assessments of people’s needs when people moved between different services.

Professionals who worked closely with the provider told us the provider was responsive when things were pointed out to them; however, most professionals were concerned the provider was not always identifying concerns and acting to drive improvement on their own.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice, and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The manager told us there were 4 people who were diagnosed with Type 2 diabetes which they told us was medicine and diet controlled. They told us there were a further 2 people who had pre-diabetes. Care plans and risk assessments stated people should be encouraged to have low sugar and not ‘starchy’ foods to support their blood sugar control. We reviewed menus and food intake for these people. Food intake was not always recorded and notes on occasions stated, for example, “ate most of their lunch.” We reviewed 4 weeks of menu’s which we found were very carbohydrate heavy and unsuitable for diet-controlled diabetes. For example, of 28 meals available in a week excluding breakfast, 26 meals contained carbohydrates. There were similar concerns with the other 3 weeks of menus.

The manager told us about 1 person whose diabetes was controlled with medicine and diet, they told us no one was prescribed insulin. This person’s current assessment contained contradictory information about the medicine they were prescribed for diabetes. Their care plan stated, they like anything the cook presents for the people at lunchtime. This person was being presented with carbohydrates with most of their meals. There was a risk staff could be confused about what medicine the person was prescribed. The provider was placing this person at risk of harm by providing a diet high in carbohydrates which can raise a person’s blood sugar level.

The staff had been successful at supporting a person who was relucted to undergo required surgery. Work was done with the person and the hospital, and the person was successfully supported to have their surgery. We spoke with the person involved who told us, “I have my life back, it’s brilliant.”

One relative was concerned because they had to prompt the service to make appointments when their relative complained of medical concerns. They told us, “They will do things but need to be prodded and don’t instigate which is why I have to get involved.” Other relatives felt the service was responsive to people’s health needs.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. Care plans and risk assessments were not effectively reviewed to ensure care and treatment and plans of care remained effective. This included care plans and risk assessments in relation to smoking, choking and diabetes management.

Care plans did not consistently identify people’s short, mid, and long-term life choices, goals, ambitions, and outcomes. Therefore, these could not be monitored to ensure people received the support needed to achieve their desired outcomes.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. Mental capacity assessments and best interest decisions were not in place to agree for staff to check people every hour throughout the day and night. Where mental capacity assessments and best interest decisions were in place, they either lacked detail about how it had been decided that the person lacked capacity, did not adequately document the views of those consulted and best interest forms had several questions which were not always answered.

Mental capacity assessments did not always cover the recorded decision to be made. In addition, they did not cover for example, checking people’s bedrooms and removing items considered to be a risk to that person. Some people used advocates to support their decisions and choices.

One person who was assessed to have capacity had a best interest decision document in place which restricted their rights. The provider demonstrated a limited understanding of the MCA process and to whom it applies.

Staff were able to describe how they would seek people’s permission for personal care and for administering medicines. One staff member told us, “For private things I will ask permission if going into their room, I will knock, and they will tell you if you can come in, and respect their privacy, views and opinions.”