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Beechwood - Care Home with Nursing Physical Disabilities Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 19 July 2018

This inspection took place on 21 and 24 May 2018 and both days were unannounced. The service was previously inspected 6 February 2017. 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 to at least good. They sent us a review of their action plan in October 2017 to show us the progress they had made to complete the necessary actions.

Beechwood 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 care home accommodates 22 people in one building.

There was a registered manager in post but they were absent from the service at the time of the inspection. 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.

People told us they felt safe living at the home. Staff we spoke with were knowledgeable about safeguarding people and could explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans were in place to reduce the risks and ensure people’s safety. Personal emergency evacuation plans lacked some detail in relation to evacuating people in the event of a fire. Night time staffing levels were a concern and there was no system in place to accurately determine staffing levels.

Environmental checks had not been completed robustly, although the provider had plans in place to recruit additional maintenance staff to improve this. Refurbishments were taking place and the provider was working towards improving the safety of the home in the event of a fire.

Medicines management had improved since our last inspection and there were systems in place to monitor this. We saw people received their medicines in a timely way from staff who had been trained to carry out this role. People managed their own medicines where they had been assessed to do this safely and staff competencies had been assessed in line with good practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The manager had complied with their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had regular reminders about the principles of the Act and the peripatetic manager had worked hard to enhance staff knowledge to ensure people’s human rights were protected.

Menus had been planned with people at the home to improve their choice and plans were in place to ensure the availability of fortified snacks for people to take without the need to ask during the day. People were sensitively supported at mealtimes, which were a relaxed and enjoyable experience for people at the home. Some improvements in records relating to people’s food and fluid intake was required and the registered provider acted immediately to rectify this.

Staff interacted with people with warmth and respect and we saw the atmosphere in the home was friendly and supportive. Staff were able to spend time chatting and laughing with people.

People felt able to raise any concerns with staff which was an improvement from our last inspection where we found concerns and complaints had not been acted upon.

The provider was in the process of changing all care plans to provide better guidance for staff. Care plans which had not been updated contained person centred information but the sheer volume of records made it complicated for staff to read.

The home had not be

Inspection areas

Safe

Requires improvement

Updated 19 July 2018

The service was not always safe.

People and their relatives told us they were safe, but we were concerned with staffing levels during the night to respond promptly to people’s needs.

Risks to people were assessed, recorded and reviewed to ensure they were up to date. Accidents and incidents were analysed to ensure lessons were learnt.

Medicines management had improved.

Effective

Requires improvement

Updated 19 July 2018

The service was not always effective.

Staff received appropriate induction, and training. However, supervision had not always been carried out within the specified period.

Assessments of people’s mental capacity was in accordance with the principles of the Mental Capacity Act 2005, although the home was in the process of organising best interest meetings for those people assessed as lacking capacity.

People received support to access health care services and to meet their nutrition and hydration needs.

Caring

Good

Updated 19 July 2018

The service was caring.

People and relatives spoke highly of staff and told us staff were caring.

We observed positive interactions between staff and people who lived at the home.

People’s privacy and dignity were respected and staff ensured people’s human rights

Responsive

Requires improvement

Updated 19 July 2018

The service was not always responsive.

Care plans reflected people’s, preferences, choices and personal histories but were complicated for staff to read. They were in the process of being updated to a simpler system to ensure staff had the necessary guidance.

We observed people making choices in their everyday lives and staff supported people to make choices when required.

People knew how to complain and felt their concerns were listened to and acted on.

Well-led

Requires improvement

Updated 19 July 2018

The service was not always well-led.

Audits had not been robust which meant where improvements were required they had not been identified. The registered provider had completed a very robust audit which had picked up the issues and we had confidence these were being addressed.

People and staff told us they were supported by the new management arrangements and had confidence they would improve the service.

The registered provider held regular meetings with people, their relatives and staff to inform them of the changes and to gain feedback and input into service developments.