We carried out an unannounced inspection of the service on 12 July 2016.Beechdale House Care Home provides accommodation and nursing care for up to 40 people. In addition to nursing needs some people were living with dementia. At the time of our inspection 26 people were using the service and one person was in hospital.
At the last comprehensive inspection on and 1 and 2 March 2016 this provider was placed into special measures by CQC. A breach of 12 legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to:
• providing care that was appropriate, safe and met people's needs,
• safeguarding people from abuse and improper treatment,
• having appropriate infection control prevention and measures in place,
• providing sufficient numbers of suitably qualified, competent and skilled staff,
• treating people with dignity and respect,
• providing person centred care,
• safe management of people's medicines,
• maintaining the premises and equipment,
• assessment and monitoring of the service,
• providing staff with appropriate support, training, supervision and appraisal,
• having a process to receive and act on complaints,
• ensuring all conditions of registration with the CQC were being met.
During this inspection we found that some improvements had been made and these breaches in regulation had been met. However, we identified further work and time was required for improvements to fully embed and be sustained.
Beechdale House Care Home is required to have 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. At the time of our inspection the registered manager was no longer working at the service. A new manager was in post and they were in the process of submitting their registered manager application. We will monitor this.
Improvements had been made to how people who used the service were protected from abuse and avoidable harm. Where concerns had been identified the provider had taken correct action in informing the local authority responsible for investigating safeguarding’s and had informed CQC. Staff had received adult safeguarding awareness information and further training had been planned for.
Risks associated to people's individual needs had been assessed and planned for. We found the information provided to staff of how to manage known risks were variable. Accidents and incidents were recorded and action had been taken to reduce risks from reoccurring. However, the provider lacked systems and processes that analysed events that would provide oversight of any patterns, trends and themes.
Improvements had been made to the premises and equipment. The premises were found to be safe and equipment had been serviced and new clinical equipment purchased.
The cleanliness of the service had improved. Additional domestic staff had been employed and cleaning schedules reviewed and improved. The service had recently had an infection control audit completed by the local clinical commissioning group. The provider had developed an action plan in response to the shortfalls identified.
The provider had completed appropriate recruitment checks before staff began work to check their
suitability. A dependency tool had been introduced that determined what staffing levels were required. Staffing levels had increased to ensure people’s needs and safety were appropriately met.
The management of medicines had improved, but no protocols were in place for people that had prescribed medicines to be taken as required.
The support available to staff had improved. Staff received an induction to support them to understand their role and responsibilities. Staff had received opportunities to discuss their work, training and development needs. Staff meetings had been regular and was an additional method used to support staff.
The manager understood their role and responsibility in ensuring the Mental Capacity Act 2005
and Deprivation of Liberty Safeguards legislation was adhered to. Where required people’s capacity to consent to their care and treatment had been assessed and best interest decisions had been made appropriately. However, staff’s knowledgeable about the principles of this legislation was very limited. Where people were deprived of their liberty this was done in accordance to the authorisation in place.
People received sufficient to eat and drink and the menu choice was based on people's needs and
known preferences. Staff were aware of people’s dietary and nutritional needs and external healthcare professionals were involved when concerns were identified.
Staff supported people to maintain their health, this included accessing both routine and specialist
healthcare services. The service involved external health and social care professionals
appropriately in meeting people's individual needs. Improvements were found how people’s daily care records and charts were being completed. However, their continued to be a lack of monitoring or oversight of these records. Where it was identified that a person’s repositioning chart had not been fully completed staff were disciplined.
Some people required support to eat and drink but this was not always provided by staff in a caring, dignified or respectful manner. There was inconsistency in the care, kindness and compassion shown by staff. Care provided was often task led as opposed to being person centred.
The opportunities for people to participate in activities had improved. Plans were in place to develop and introduce further opportunities. It was unclear if these activities were based on people’s interest, hobbies and pastimes.
A complaints policy was in place and staff were aware of how to respond to any complaints or
concerns made. People who used the service, relatives and visitors had access to this information. Where concerns had been raised with the provider these had been responded to appropriately and in a timely manner.
Opportunities for people who used the service, relatives and representatives to be involved in meetings about their care and treatment were being developed. People had been assigned new named nurses and keyworkers and this information had been made available for people.
People that used the service, relatives and staff were positive that improvements had begun to be made to the service. The provider had made improvements in the way they were monitoring the quality and safety of the service. They had also identified further improvements that were in the process of being implemented. A new manager was in post that was responsive to the continued improvements required to further raise quality and standards.