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Archived: Beech House (Exeter) Limited Good

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Reports


Inspection carried out on 15 October 2018

During a routine inspection

This inspection took place on the 15 and 16 October 2018 and was unannounced.

Beech House is a 'care home.' People in care homes receive accommodation and 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 can accommodate up to 23 older people including those living with dementia, in one adapted building.

Accommodation is provided over three floors and can be accessed using stair lifts. There is also a large rear garden for people to use.

At the time of our inspection there were 23 people using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good but in the area of safety, there was room for improvement. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager 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 using the service and their relatives were positive about the care and support provided at Beech House. They said staff treated people respectfully and in a kind and caring manner.

People were safe at the home and appropriate referrals were being made to the safeguarding team where necessary and staff understood their responsibilities in keeping people safe from any harm.

People's healthcare needs were being met and medicines were being stored and managed safely.

The risks of infection and fire safety were not kept to a minimum. So we have made recommendations to the provider on the improvements that are required.

Care and support needs were assessed, documented and reviewed at regular intervals. However, some information about people had not been recorded by the staff.

Staff knew about people's dietary needs and preferences. People told us there was a choice of meals and said the food was good.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome.

People and their relatives or friends felt able to raise any concerns or complaints. There was a procedure in place for people to follow if they wanted to raise any issues.

The views of people, their visitors and health care professionals were regularly collected so that improvements could be made to the service.

The provider had systems in place to monitor the quality of care provided and where issues were identified they acted to make improvements. There were some areas in the way information was being recorded where further development was required.

Inspection carried out on 29 March 2016

During a routine inspection

This inspection was unannounced and took place on 29 and 30 March 2016. The inspection was carried out by one inspector.

The service provides accommodation and personal care for up to 23 people with mental health, dementia, or illness associated with old age. On the day of this inspection there were 23 people living there. The service was last inspected on 1 July 2014. No concerns were identified with the care being provided to people at that inspection.

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.

People who lived in the home, relatives and staff all praised the warm and caring family atmosphere. The home is family run, and the registered manager is also one of the providers. The family worked together to carry out many of the day-to-day tasks such as cooking, or taking people to medical appointments. People told us about the many ways the providers made them feel part of the family, including parties and barbecues where everyone was made welcome. Comments included “It is outstanding” and “I think it is wonderful.” Comments from staff included “It’s lovely here – so friendly”, “It’s one of the homeliest homes I have worked in. I feel at home here,” and “I enjoy coming to work. It’s well managed.”

Safe procedures had been followed when recruiting new staff. Checks and references had been carried out before new staff began working with people. Risks to people’s health, safety and welfare were assessed and regularly reviewed. Actions were taken promptly where possible to reduce risks. People told us they felt safe living at Beech House. Comments included “I have never seen any occasion when the staff are anything other than kind.”

Staff had received training in all aspects of safeguarding people and they knew how to identify and report any concerns. Staff had received training, supervision and support to enable them to effectively support each person’s mental and physical health needs. New staff received thorough induction training before they began working with people. All staff received ongoing training on topics covering all aspects of their jobs. One member of staff told us “Training is good – both ‘in-house’ and ‘out’.”

Medicines were stored and administered safely. We observed medicines being administered and found safe procedures were followed.

There were enough staff to meet people’s support needs and to care for them safely. Comments included, “Yes, there are enough staff. There always seems to be plenty”. A member of staff told us “Yes, there is definitely enough staff. It’s like a family home – no stress. We all know our duties and we all help each other.”

Staff were kind, cheerful and understanding of each person’s individual needs. People were treated with dignity and respect. A person who lived in the home said “They are very kind.” A relative told us “There is a regular team of staff who really, really care. I am thrilled with it. It’s fantastic.”

Staff had an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. DoLS applications had been submitted where relevant. Staff understood the importance of seeking consent before carrying out care tasks. We observed staff seeking consent from people before carrying out any tasks for them. .

People had been involved and consulted in drawing up and agreeing a plan of their support needs. Their care plans were comprehensive, well laid out and easy to read. The care plans explained each person’s daily routines and how they wanted staff to support them. The plans were regularly reviewed and updated. The care plans and daily notes provided evidence to show that people were supported to maintain good health

Inspection carried out on 10 September 2014

During a routine inspection

The inspection was carried out by one inspector. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

This is a summary of what we found:

Is the service safe?

The service was safe because people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough qualified, skilled and experienced staff to meet people's needs.

Systems were in place to make sure that the registered manager and care staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The Care Quality Commission [CQC] monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The Registered Manager had been trained to understand when an application should be made and how to submit one. The registered manager had submitted one application to the local authority to ensure the person's legal rights were followed and policies and procedures were in place.

People who lived at the home had not been protected from the risk of fire. This had been due to not all smokers at the home complying with the home’s no smoking policy within the home. A person had been smoking in a corridor beside a fire escape door which had been opened. The registered manager and care staff were aware of this and had discussed this with the person concerned. We discussed our concerns about the risk of fire presented by the person. On the day of the inspection the registered manager contacted a fire protection company and made arrangements for the fire escape door to be part of the home's fire alarm system. This meant that the fire escape door would be kept locked and an alarm would sound when it had been opened. The registered manager spoke to the person concerned and reiterated the risks associated with smoking in the home. A risk assessment was completed which included the new measures put in place. The registered manager told us the risk assessment would be reviewed daily. The person agreed to the improved precautions. This meant that the risk of fire had been reduced.

Is the service effective?

The service was effective because we found that people's privacy was protected at Beech House. People's health and care needs had been assessed with them or their representative and they had been involved in compiling their plans of care.

Is the service caring?

The service was caring. We spoke with seven people who lived at the home. We asked them for their opinions about the staff that supported them. Feedback from people was positive. For example, one person told us “Always enough staff". Another person said "There’s usually someone around when you need them, I’ve never had a problem".

When speaking with and observing care staff during this inspection it was clear they genuinely cared for the people they supported. They told us about people's health and social care needs and how these needs had been met in an individual way.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The service was responsive to people's changing needs. For example, we saw that one person had been referred to a community dietician when it had been noted the person had lost weight. We saw from records that planned care and treatment had been provided in line with people's individual care plans. Aspects of people's needs or care had been linked to risk assessments. Specialist health needs had been identified where required and appropriate health care professionals had been consulted and involved in providing care. We spoke with seven people who lived at the home. They were able to confirm that they had been satisfied with the level of care provided at the home.

Is the service well-led?

The service was well led.

The manager was registered with the Care Quality Commission on 23 December 2010. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

We saw there was a system in operation which had been designed to enable the provider to regularly assess and monitor the quality of the services provided. For example during February 2014 the registered manager had sought feedback from people who lived at the home. The registered manager told us, and people who lived at the home confirmed, that their opinions about the running of the home were sought on a daily basis.

Inspection carried out on 1 August 2013

During a routine inspection

During our visit we spoke with the registered manager, three care staff and five people who lived in the home. We observed staff interacting with two people who were unable to communicate verbally. We also spoke with a community based health professional who was visiting the home that day. We looked at the way the home assessed and planned people’s care and found people received care and support that met their needs. One person told us “I like it here. It’s a good home.”

At our last inspection of Beech House on 19 March 2013 we found the provider was not compliant with outcome 2: Consent to care and treatment, and outcome 21: Records. During this inspection we looked at the actions taken by the provider to address the areas of non-compliance. We found record keeping had improved. Records now showed people’s consent and agreement was sought before carrying out any care or treatment. We also saw records of monthly reviews carried out on each person’s care plan. This showed the home was now compliant in these outcome areas.

In a tour of the home we found the environment was comfortable and homely. Most areas were in good decorative order. Some areas were in need of redecoration but we saw the provider had arranged for a schedule of redecoration and alterations. This schedule for improvement was in progress.

Inspection carried out on 19 March 2013

During a routine inspection

We found that consent had not been obtained when people's needs changed. We also found that the Deprivation of Liberty Safeguard procedure had been completed when it was required on one occasion.

We spoke with three people who live at Beech House. One person told us “the staff do everything I ask for, when I want to go out they come with me or arrange transport”; another person told us “the staff do what they can for me, they arrange for me to go to a day centre”. We saw five care plan files which had detailed information about peoples needs and preferences. The care files had good information from other professional who were involved in providing care and treatment for people at Beech House.

We saw the medication system which had clear procedures for monitoring, administering, recording, disposal and storage of medication.

We found that staff were recruited safely and had the relevant skills and qualifications to work with people with dementia.

We saw that records were kept securely. However we found that reviews of care plans and risk assessments had not been undertaken in four of the five case files that we saw

Inspection carried out on 23 March 2012

During a routine inspection

We (the Commission) were at the home for approximately eight-and-a-half hours, carrying out an unannounced visit to Beech House. The inspector was accompanied by an expert by experience, who spent for four hours talking to people about their experience of the service being inspected. The information they gained is included in this report.

We obtained views of the service from seven of the 23 people who lived at the home, and from a health care professional who supported people at the home. We met other people who were less able to give us their views in detail because of their frailty or other health needs. We observed some of the support these people received, to get a better understanding of their experiences and daily life at the home. We also spoke with three care staff and the registered manager.

We found that people received support from relevant professionals to meet their various physical and mental health needs. And staff received training and supervision to help them meet peoples' needs. Care plans and the assessments of people's needs that they were based on were detailed and up to date. This helped the home's staff to provide individuals with the care and support they wanted or needed. People told us they felt safe with the staff, who were polite and pleasant when engaging with or approached by individuals.

One person told us they had been in another home where things had not worked out and they were happy to have moved to Beech House. Someone who had lived at the home many years also stated they were very happy. People’s dignity and independence were respected. One person explained “You do what you want. You can come and go...You can have a bath whenever you like.” Another appreciated being able to look after their bedroom, doing some of the cleaning for example, whilst a third person enjoyed baking cakes which everyone benefited from.

People were enabled to be part of the community. They went out locally, independently or with staff, and the home had a camper van used for small group outings, on day trips.

Action was taken by the home to monitor the quality and safety of the service, with people’s views sought through an annual survey as well as on a daily basis. People felt listened to, regarding the way the service was provided generally and in relation to their own care. Some had been involved in discussions about the redecoration of their bedrooms, for example. When individuals’ needs affected their ability to agree the care they needed and wanted, staff were mindful of their rights and considered carefully how to support the person appropriately.

Reports under our old system of regulation (including those from before CQC was created)