Beechcare

Beechcare is a residential care home providing accommodation for persons who require personal care to up to 6 people, however they can only accommodate up to 5 people as one bedroom had been changed into office space. The service provides support to people with a learning disability and autistic people, people with mental health needs, and people who have a physical disability. At the time of our inspection there were 3 people using the service.

The service is a bungalow and has 5 bedrooms, the 6th bedroom has been made into an office.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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. The provider had demonstrated how they were meeting and supporting people in with the principles of Right support, Right care, Right culture.

Right Support:

The provider had made improvements since the last inspection. The provider had worked hard to ensure they were following the RSRCRC guidance. Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to achieve their aspirations and goals, for example, one person was being supported to take their washing to the laundry room and staff told us how they had fun doing it and it became part of their routine. Some people also had goals in their support plan to be as independent as possible with their personal care and staff were supporting this. The provider had made improvements regarding the environment to ensure people were supported in a clean and safe environment.

Right Care:

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs. Relatives gave positive feedback about the staff and the support they gave. Peoples care and support plans contained relevant and up to date information.

Right Culture:

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. People and those important to them, including advocates, were involved in planning their care. People received good quality care and support because trained staff and specialists could meet their needs and wishes. For example, staff completed training in learning disabilities and Autism, epilepsy and alternative methods of communication.

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 07 October 2022) and there were breaches of regulation. 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 regulations.

This service has been in Special Measures since 07 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 26 July 2022 and rated the service inadequate. Breaches of legal requirements were found. We imposed a condition on the providers registration for this service which required them to send us updates on the action they were taking to address the issues. The provider was compliant with this condition. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Beechcare is a residential care home providing accommodation for persons who require personal care to up to six people. The service provides support to people with a learning disability and autistic people, people with mental health needs, and people who have a physical disability. At the time of our inspection there were four people using the service.

The service is a bungalow and has five bedrooms, the sixth bedroom has been made into an office.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

The provider had not always demonstrated how they were meeting and supporting people in with the principles of Right support, Right care, Right culture.

Right Support

Staff supported people to take part in activities, however this was not always recorded accurately and efficiently. People had not benefitted from the interactive and stimulating environment. For example, the sensory room was not easily accessible as it was used to store equipment. People’s relatives told us agency staff did not always engage and interact with people they were supporting.

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.

Right Care

Not all staff understood how to protect people from poor care and abuse. Staff told us of incidents that had not been recorded or reported. The service had not always worked well with other agencies to do so. The service had not always identified and reported safeguarding concerns to the local authority. The service did not have enough appropriately skilled staff to meet people’s needs and keep them safe. Relatives told us there were only a few staff who knew people well and how to support them. People were being supported by staff who had not received safeguarding training or the restrictive practises training that was detailed in a person’s care plan. People did not always receive care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. For example, during inspection we observed staff not always promoting people’s independence.

Right Culture

Not all staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. For example, the service needed the support of agency staff who did not always know people’s needs or wishes. People did not always receive good quality care and support. For example, people who needed one to one support from staff did not always receive this.

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

Rating at last inspection

The last rating for this service was good (published 15 November 2018).

Why we inspected

We received concerns in relation to the management of people’s specific health and support needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. However, during the inspection, further concerns were found, and all key questions were covered.

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.

Immediately following inspection, we asked the provider for assurances about the immediate actions they were taking to address the most serious risks. This included management of weight, constipation and behaviour support plans. The overall rating for the service has changed from good to inadequate based on the findings of this inspection. 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 Beechcare 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 monitor the service and will take further action if needed.

We have identified breaches in relation to the service not keeping people safe from harm or abuse and inadequate risk assessments and guidance for staff about risks to people. We also identified that staff had not undertaken the required training to support people effectively and safely. The registered provider had failed to effectively monitor and improve the quality of the service.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 six 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 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.

Beechcare provides accommodation and support for up to six people who may have a learning disability, autistic spectrum disorder or physical disabilities. The service is set in a bungalow in a quiet residential area. There were five people living at the home when we inspected.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager in post who was available and supported us during 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.

At our last inspection, the service was rated 'Requires Improvement' overall with caring and responsive being rated as Good.

At our previous inspection on 29 June 2017, we found three breaches of Regulations and issued warning notices. The provider had failed to do all that was reasonably practicable to mitigate risks. Risks had not been assessed and mitigated, and medicines had not been managed safely. People did not benefit from an environment which was suitable for the purpose for which it was being used. The provider had not designed care and treatment with a view to achieving people's preferences and ensuring their needs were met. Accurate, complete and contemporaneous records had not been maintained. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made, and the previous breaches found at our last inspection had been met.

At our previous inspection we found risks relating to people and the environment had not always been assessed and minimised. Medicines had not been managed safely. At this inspection we found both areas had improved.

At our last inspection we found systems to monitor the service did not identify issues highlighted during the inspection. At this inspection we found improvements in this area; a new auditing system was in place alongside a schedule for audits which had been effective.

At our previous inspection the service had not been adapted to ensure all areas had wheelchair access, which meant some people were unable to access to kitchen. At this inspection we found improvements in this area, including access to and within the kitchen.

People were protected from the risk of abuse. Staff had received safeguarding training and knew how to recognise and report any concerns. There were enough staff to keep people safe and meet their needs. Staff had received training in infection control and utilised personal protective equipment appropriately. Accidents and incidents were recorded by staff and used as a tool to improve the service.

The service followed safe recruitment practice which included checking staff’s full employment history and obtaining criminal record checks.

The registered manager completed an assessment on people’s needs to ensure the service could meet the needs of the person prior to them receiving a service. Staff had received training and support to enable them to complete their roles. People were supported to eat and drink sufficient amounts to maintain a balanced diet. People were offered choices around meals and drinks, and preferences were recorded so staff could support people in a more consistent way. Staff worked well together and ensured that clear communication between themselves and external health professionals took place; for example, with care managers, commissioner GP's and district nurses.

People were supported by a staff team that showed kindness, compassion and respect towards them. People’s dignity and independence was promoted and people were supported to express their views.

People's care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known in the form of care plan summaries. Relatives were aware of how to raise concerns, and staff were able to identify if a person was unhappy about an aspect of their care.

Staff told us the service was well led and that they felt supported by the manager to make sure they could support and care for people safely and effectively. Staff said they could go to the manager at any time and they would be listened to. Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements.

Beechcare provides accommodation and support for up to six people who may have a learning disability, autistic spectrum disorder or physical disabilities. The home is a single storey building in a quiet residential area. There were four people living at the home when we inspected.

The service had a registered manager in post who was available and supported us during 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. The provider of the service is Beech Care limited which is owned by CareTech Holdings PLC.

At our previous inspection on 22 and 23 March 2016, we found breaches of Regulations 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to do all that was reasonably practicable to mitigate risks. Safety checks had been missed to ensure equipment and systems were effective in keeping people safe. People did not benefit from an environment which was suitable for the purpose for which it was being used. The provider had not designed care and treatment with a view to achieving people's preferences and ensuring their needs were met. Accurate, complete and contemporaneous records had not been maintained. We asked the provider to take action to meet the regulations.

The provider sent us an action plan on 22 June 2016 which showed they planned to make the changes and meet regulations by October 2016.

During this inspection we found that the provider and registered manager had not made all of the improvements that they had planned to make.

Relatives told us their family members received safe, effective, caring and responsive care and the service was well led.

Medicines were not always well managed. Medicines had not been recorded appropriately.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments were not in place for all areas of identified risks. People were at increased risk because fire safety advice had not been followed in a timely manner.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known in the form of care plan summaries. The registered manager was still working on reviewing and updating care plans to ensure they reflected the care people received from the service. We made a recommendation about this.

There were enough staff deployed on shift during the day to keep people safe. At night time staffing had been reduced to one waking night staff and one sleep in staff. The sleep in staff member was frequently woken to provide care and support. We made a recommendation about this.

The service had not been adapted to ensure all areas had wheelchair access, which meant some people were unable to access to kitchen.

Systems to monitor the quality of the service were in place. Audits picked up a number of issues and concerns which the management team had completed and were continuing to work through. Audits had not picked up all the issues we found during the inspection. Action to address previous breaches of regulations was not timely.

Effective recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Staff had received training relevant to their roles. Staff had received regular supervision.

Relatives were encouraged to feedback to the service through surveys.

People were encouraged to take part in activities that they enjoyed.

Staff knew and understood how to protect people from abuse and harm and keep them safe. The home had a safeguarding policy in place which listed staff’s roles and responsibilities.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority.

People had choices of food at each meal time. People with specialist diets had been catered for. Staff supported people with their food and drink, following health and social care professional’s guidance.

People were supported and helped to maintain their health and to access health services when they needed them. People’s weights had been consistently monitored to ensure people remained in good health.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Relatives knew who to talk to if they were unhappy about the service.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the management team and the provider. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift took place to make sure all staff were kept up to date.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This service requires that a registered manager be 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. The provider had appointed a manager to manage the home. They had not submitted an application to register with the Care Quality Commission (CQC) registration department at the time of our inspection, but confirmed they would start this process. The new manager was present throughout both days of the inspection.

Appropriate action was not always taken to protect people from potential harm and some risk assessments needed to be implemented to keep people safe. People did not have up to date personal emergency evacuation plans that staff could refer to in emergency situations such as fires.

Records of incidents lacked detail. One person’s behaviour could challenge others and staff were frequently harmed by this person. There were no behaviour guidelines available for staff to follow to support this person consistently.

There was insufficient guidance in place to ensure people’s healthcare needs were always met. Follow ups of identified health problems were not documented well.

People did not benefit from an environment designed to meet their physical needs. One person had previously enjoyed to engage in activities in the kitchen but were no longer able to do this because of a change in their mobility.

Documentation was in need of review to reflect the most current needs of people. Documentation was conflicting and repetitive in areas. Staff did not have clear guidelines about people’s current needs or how to support them in the best possible way. Parts of one person’s care plan contained conflicting information.

Some staff training had lapsed. Staff did have a good knowledge of people’s individual needs and how they could support people well.

Medicines were managed safely. However, when people were prescribed creams documentation was not in place to advise staff where creams should be administered. This is an area which needs to improve.

There was enough staff to meet people’s immediate needs. Staff said people’s physical needs had changed over the last 18 months and additional staff would be beneficial so tasks such as personal care would not have to be rushed.

Staff had a good understanding of how to keep people safe and contact names and numbers were available should concerns of peoples safety need to be raised.

The new manager had arranged formal supervision for staff. Staff said they felt well supported by the new manager.

People had choice around their food and drink. Staff involved people in choosing what they would like by showing them pictures and showing them the available options.

Staff were caring and compassionate and spoke to people kindly. People’s choices were respected and staff spent time engaging people in communication and activities suitable for their current needs.

People were protected by a robust complaints procedure. There was a complaints procedure in place for people and their representatives, the service had received several compliments.

Staff felt positive about the future of the service and were positive in the feedback they gave about the new manager who they found supportive and approachable. The new manager had started to implement changes to improve the service people received.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

During the inspection people spent time at home doing activities they liked. These included doing puzzles, looking at magazines and spending time with staff. We observed that people were comfortable in the presence of staff and staff understood people's individual methods of communication.

People's care records showed that they and their representatives had been asked about how they liked to be supported. Care plans contained information that was designed to be meaningful and accessible to people with the use of plenty of pictures and photographs. We observed that people's choices and preferences were recorded and respected.

People saw health and social care professionals when they needed to and staff recorded the outcomes of appointments.

The provider had systems in place to monitor the quality of the service provided at the home. These included asking people and their representatives, and other professionals for their views.