Archived: Beanlands Nursing Home

Beanlands Nursing Home is a residential care home providing personal and nursing care to up to 45 people in three separate wings. One of the wings specialises in supporting people who need nursing care. The service provides support to people over the age of 65, people living with Dementia, people with physical disabilities and people with sensory impairments. At the time of our inspection there were 33 people using the service.

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

There were ineffective and incomplete management processes which did not identify all issues found on inspection. Improvements are needed to make sure audits identify all areas for improvements and when things go wrong lessons learnt reviews completed.

Fire drills were not completed monthly as recommended by the fire risk assessment. More time was needed to develop and embed management practices as these were not consistent or always effective in identifying areas for improvement.

The registered manager promoted a culture of providing high quality care and worked in partnership with other organisations.

Medication was managed safely and there were enough staff to provide safe care. Relatives were unable to visit Beanlands Nursing Home in line with government guidelines due to the providers policy. We have made a recommendation around this. Infection prevention and control practices were broadly compliant with recommendations.

Staff felt they had the skills and training to do the job and people were supported to eat and drink enough. People benefitted from care plans and risk assessments which covered all areas of their lives to receive person centred care. Staff worked with partner agencies to make sure people had access to health and social care services to live a healthy life. The premises were accessible and maintained to a good standard.

Staff were caring and provided people with high quality and compassionate care. People were always afforded privacy and respect.

The registered manager responded appropriately to complaints and staff felt skilled to provide high quality end of life care. The provider met the accessible information standards and there were a wide range of activities offered.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 November 2022). This service remains requires improvement. This service has been rated requires improvement for the last two consecutive inspections. 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 regulation 18. The provider remained in breach of regulation 17.

At our last inspection we recommended that the provider reviews best practice around hydration assessment and implement a robust monitoring process. At this inspection we found the provider had acted on the recommendations and had made improvements.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management oversight of the submission of notifications at this inspection and audits did not identify all areas of improvement required.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

We found no evidence that people had been harmed however, they were still at risk of avoidable harm or experiencing poor care because the provider did not have effective systems in place to assess, monitor and drive improvement. Sufficient action had not been taken since the last inspection and this had led to continued concerns and breaches of regulation around governance, record keeping, safety, risk management, staff training and supervision.

The provider had not ensured staff in their organisation took responsibility to ensure improvements were made and we found examples where external audits highlighted specific concerns and no action was taken. These were missed opportunities to improve safety and quality.

The provider has responded to our feedback at this inspection and taken immediate steps to make improvements with a longer-term action plan for this to continue. They have recruited a new registered manager during the pandemic who is working in a positive way to develop relationships and improve safety. The provider and registered manager are working alongside the local authority quality improvement team.

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. Records to evidence people consented to their care or where decisions were made in their best interest were not always in place.

People and their families had been supported during the pandemic to keep in touch through video calls and telephone. People were satisfied with the care and support they received from staff. We observed positive relationships between them, and staff knew people’s preferences.

Sufficient staff were on shift to care for people. The registered manager was working to overcome the current recruitment challenge so that people received support from a stable staff team. Agency workers were used, and inductions were not always completed which meant people experienced a negative experience as they did not know their needs or preferences.

People’s received their medicines safely, their health needs were well managed, and people experienced good outcomes in this area. We made a recommendation the provider reviews best practice in relation to the assessment of hydration to enable them to enhance the support people receive to drink enough fluids. Records around monitoring people’s health need to be more robust.

The staff team had coped well during the recent pandemic and overall, they were managing infection control well. We were not fully assured that their support of families visiting was well managed or that their infection control policy and audit process was up to date. They have accepted support from local professionals to improve these areas.

The registered manager had started to support the staff team to review their practice and make improvements. A positive culture was observed where staff worked together and spoke up if they felt they needed support. People and their relatives agreed that the registered manager was a positive influence in the team, and they were reassured by their approach.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 June 2019) and there were multiple breaches of regulation. This service remains rated requires improvement and has been rated this for two consecutive inspections.

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 not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and breaches of regulation found and it was prompted in part due to concerns received about staff training and risk management. A decision was made for us to complete a focused inspection and examine those risks. We reviewed safe, effective and well-led only. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the governance and oversight of the service and staff training and support at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Why we inspected: This inspection was prompted by a serious incident and information of concerns we received.

People’s experience of using this service: People told us that they were happy at the service. They said that staff were busy which meant that at times they waited for staff to attend to them.

We have made a recommendation about this.

People and their relatives told us staff treated them well and with kindness and respect. Relatives said they were always made to feel welcome when visiting their family member.

Medicines were not always managed safely. An electronic system was in place at the start of our visit. Nursing staff told us they had not received proper training and they found using the system difficult. The provider withdrew the system during our inspection.

Records relating to risks associated with people’s care were not always completed. Risk assessments were not always up to date, and some had not been updated following an incident.

Systems were not in place to monitor accidents and incidents. Safeguarding incidents had not been reported to the Care Quality Commission (CQC) or the local authority. Notifications regarding events and incidents that had occurred at the service were not always submitted. This is a requirement of the providers registration.

The provider did not always maintain appropriate records relating to the requirements of the Mental Capacity Act 2005 (MCA). Authorisations under the Deprivation of Liberty Safeguards (DoLS) had expired. The safeguarding lead took prompt action to address this.

Agency staff did not receive an induction before they began providing care to people.

Staff had not completed all subjects of mandatory training to ensure they had the skills they required for their roles. Records showed staff did not always receive supervision and appraisal of their performance. The provider had plans in place to address this.

There was a complaints policy in place. People and their relatives knew how to complain. Records relating to investigation and outcome of complaints were not always available for us to review.

The governance of the service was not robust. The provider had an awareness of the issues we identified, but had not taken sufficient action to manage the associated risks within the service.

Activities were on offer to all people who used the service. There was a timetable in place and dedicated staff to organise and facilitate activities.

Rating at last inspection: At the last inspection the service was rated Good (report published 30 June 2018).

Enforcement: We have identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to the safety and governance of the service. In addition to this, we also found two breaches of the CQC (Registration) Regulations 2009 where the provider failed to notify us of incidents and deaths which had occurred at the service. The provider is legally required to inform us of these incidents. We are dealing with this outside of the inspection process. More information is in detailed findings below.

Please see the action we have told the provider to take at the end of this report.

Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well led to at least good.

At this inspection, we found the provider had made all the required improvements and addressed the regulatory breaches identified last time we visited the service.

Beanlands Nursing 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.

The provider is registered to accommodate up to 45 older people who may have physical disabilities, terminal illness and those requiring respite care or a period of convalescence. People were supported with both personal care and nursing needs. At the time of the inspection 36 people were using the service.

There was a registered manager in post. 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.

Not all agency staff who worked at the home received an induction. We have made a recommendation about this.

Care records showed people's plan of care were written in a way that reflected their wishes, preferences, needs and choices in areas such as people's routine, preferred foods and social activities. Social activities had improved and took place on a regular, planned basis. These included musical events, exercise and crafts. We found the plan of activities did not include all activities available to people. We have made a recommendation about this.

The environment and equipment was well maintained and subject to service contracts and safety checks. All areas seen were clean and kept hygienic.

Staff sought advice from external health and social care professionals at the appropriate time. We saw evidence in care records of appointments with GP's, opticians and dieticians. This ensured people's health was monitored effectively.

A four-week menu was in place and we saw people were offered a choice of well balanced meals and snacks. People told us the food was good. People's nutritional needs were assessed and recorded.

We saw good standards of privacy and dignity for people receiving care. Staff were kind and friendly in their approach to people. When supporting people to move from one place to another staff took time and were gentle and reassuring.

People were supported to express themselves and communicate through a range of different methods. They had individual communication support plans in place, which were followed by staff. People's needs were reviewed and monitored on a regular basis.

People were provided with information on how to make a complaint.

There were systems and processes in place to monitor and evaluate the service provided. People's views about the service were sought and considered through resident's meetings and satisfaction surveys.

Arrangements were in place to ensure people received their medicines safely.

People who used the service told us they felt safe. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

Staff and people we spoke with said staffing levels were sufficient to meet their requirements. We looked at recruitment processes and found staff had been recruited safely. Staff received regular supervision and appraisal. Staff also received all the necessary training relevant to their roles.

End of life care was provided and the correct documentation had been completed. Staff had completed a recognised training course to support people to have a comfortable and dignified death.

Beanlands Nursing Home is registered to provide nursing care for up to 45 people who may have a physical disability, terminal illness and require respite care or a period of convalescence. Some people at the home are also living with dementia. Facilities are spread over two floors and include accommodation in single or potentially twin rooms. The home is set in private gardens in a residential area on the outskirts of Cross Hills, Yorkshire.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since December 2015. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they were safe living at the home and staff had a good understanding of safeguarding adults procedures. We found a range of safety issues at the home including issues regarding window restrictors, open sharps boxes, laundry facilities that were not secure from the public and open store rooms. Some people had bedrails without covers in place, meaning there was a risk of entrapment.

Maintenance of the premises had been undertaken, although records were not always signed to confirm they had been completed appropriately, and checks had failed to identify the safety issues highlighted at the inspection. We have made a recommendation about this. People had emergency evacuation plans in place. Accidents and incidents were monitored and reviewed to identify any issues or concerns.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills. All staff had been subject to a Disclosure and Barring Service check (DBS). People and staff members told us there were enough staff at the home, although said it could be busy at times. We have made a recommendation to the provider about how they assess staffing numbers and care needs. We found issues with the management of medicines at the home, particularly around the use and recording of topical medicines, such as creams, and variable dose medicines.

Staff told us they had access to a range of training and updating, and records confirmed this. They told us they also received annual appraisals and regular supervision. People told us, and our observations confirmed the home was maintained in a clean and tidy manner.

People’s health and wellbeing was monitored and there was regular access to general practitioners, dentists and other specialist health staff.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager confirmed applications for DoLS had been made or granted. It was not always clear appropriate action had been taken, in line with the MCA, to obtain consent or determine action in people’s best interests, where they did not have capacity. People were asked their consent on a day to day basis.

People were happy with the quality and range of meals and drinks provided at the home. They told us they could request alternative items. Special diets were catered for and kitchen staff had knowledge of people’s individual dietary requirements.

The environment was not always suited to supporting people living with dementia or a cognitive impairment. We have made a recommendation about this.

People told us they were happy with the care provided. We observed staff treated people patiently and with due care and consideration. Staff demonstrated a good understanding of people’s individual needs, preferences and personalities. People and relatives said they were always treated with respect and dignity. They told us there were meetings at which they could express their views.

Care plans were detailed and related appropriately to the individual needs of the person. A range of activities were offered for people to participate in. Records suggested activities for people living with dementia were not always individualised to their particular needs. We have made a recommendation about this. The registered manager told us there had been one formal complaint in the last 12 months. Some relatives suggested responses to concerns were not always timely.

The registered manager told us regular checks on people’s care and the environment of the home were undertaken. However, these checks and audits had failed to identify the issues we noted at this inspection, particularly around safety issues and topical medicines. Staff felt well supported by management, who they said were approachable and responsive. The provider had sought people’s views through the use of quality questionnaires, although these were not always well completed. Records were not always well maintained or up to date.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the Safe care and treatment, Need for consent and Good Governance. You can see what action we told the provider to take at the back of the full version of the report.

We re-visited the service to check that these improvements had been made. We did not speak with people about the way they received their medicines on this occasion as we had not identified any concerns in this area at our previous visit. We did however observe a medication round during lunchtime and noted that people were offered their medication in an appropriate and professional way. Staff allowed people time to take their medication and explained the purpose of the medication when asked.

We saw how staff supported people, at their own pace, to make sure they knew how best to meet a person's need.

Before people received any care or treatment they were routinely asked for their consent. However, people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage the administration of medicines safely.

There were effective recruitment and selection processes in place. People were supported by suitably qualified, skilled and experienced staff. Staff were described as 'very kind' and 'pleasant.' People told us they felt well looked after. Without exception, people gave us the impression that their experiences at the service were positive and that they received a good standard of care.

There was an effective complaints system available. At the time of our visit there were no on-going complaints.