Elephant Care Ltd

Updated 2 August 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was undertaken by an inspector and an assistant inspector.

Service and service type

Beechwood House Rest 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 owner of the service was registered as a manager with the Care Quality Commission. This means they are legally responsible as registered manager and provider for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We spoke with two local authority professionals who work with the service. We used this information to plan our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with seven people who used the service and a visiting relative about their experience of the care provided. We spoke with three care staff and the provider, who was also the registered manager.

We reviewed a range of records. This included five people’s care records and eight people’s current medicines administration records. We looked at two staff files in relation to recruitment, training and supervision. We also checked a variety of records relating to the management of the service.

After the inspection

We received some information from the provider that was promised during the inspection, including details of what they were doing to address the issues found. We prompted the provider to send other information that had been requested, such as training records and certification for the inspection of the bath hoist. Some of this was received after the agreed date, including current certification for the inspection of the bath hoist. Other information remains outstanding, including the training records.

Updated 2 August 2019

About the service

Beechwood House Rest Home is a residential care home providing personal care to nine people aged 65 and over at the time of the inspection. The service can accommodate up to 13 people in one adapted building.

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

Quality had deteriorated. The provider had not had close oversight. They had not satisfactorily addressed the issues identified at the last inspection. Their quality assurance had not identified the shortcomings found at this inspection. Records were incomplete and lacked detail. Legal requirements for displaying the inspection rating were not met. We have made a recommendation about understanding the requirement to notify CQC of changes in the management of the service.

People were not protected from avoidable harm. Checks on volunteers and staff were incomplete. There were reports of unkind staff. Incidents were not always reported or addressed. Risk assessments were incomplete or missing. Some environmental risks were not addressed, and there were shortfalls in cleanliness. Medicines were not managed safely.

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 and in their best interests; the policies and systems in the service did not support least restrictive practice. One person was unduly restricted, and we raised a safeguarding adults referral concerning this.

Staff did not all have the necessary skills to work safely. They did not always seek timely medical advice when people showed signs of being unwell. Assessments and care plans lacked detail regarding people’s care needs. Care was often task-focused rather than centred on people’s individual needs and wishes.

Most people said they liked the staff and we observed some respectful, gentle interactions. Care was offered discreetly. However, people’s preferences were not always respected. People had little involvement in planning their care.

People mostly said they liked the food. However, there was not usually a choice of main meal. People were not always offered alternatives if they did not want what was offered. We have made a recommendation regarding ensuring people always have enough to drink.

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 22 November 2018); there were multiple breaches of regulation and the service was placed into special measures. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection 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.

We carried out an unannounced comprehensive inspection of this service on 28 September, 2 October and 10 October 2018. 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 safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and notifications.

At this inspection we checked they now met legal requirements.

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

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse and improper treatment, good governance, person-centred care, and the requirement to display ratings.

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

We will meet the provider to advise them of the proposed regulatory action and 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.

Special measures

The overall rating for this service is inadequate and the service remains in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.