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The Beeches Residential Home Good

Reports


Inspection carried out on 12 September 2017

During a routine inspection

This inspection took place on 12 September 2017.

The Beeches is a care home, run by D J Barzotelli, providing accommodation with personal care and support for up to 18 adults with learning disabilities. The home is situated close to Canterbury town centre. 17 people were living there at the time of the inspection.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good.

People told us they were happy in the home. The majority of people had lived there for many years and were supported by the registered manager and staff whom they had known and had worked there for the last 10 to 15 years. There was an established warm culture of support and friendly banter amongst people and staff that they described as being like a ‘large family’.

The registered manager worked alongside staff and spent time with people. People said they were comfortable and confident to say what they thought and there was a clear easy to understand complaint procedure. People’s views about the service offered were routinely sought. What people liked and what could be better were taken into consideration in the development of the service, alongside current good practice guidance from professional organisations. The entrance hall area had been decorated following feedback and with involvement of people who had chosen a new colour scheme and furnishings.

There were plenty of staff to support people and staff were recruited safely. Staff were kind and caring to people and people were treated with dignity and respect. Staff knew how to recognise and respond to abuse and the registered manager had reported any safeguarding concerns to the local authority. Action had been taken to prevent incidents happening again as far as possible.

There were clear ways to help people make decisions. Staff had a good understanding of the Mental Capacity Act. 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. There were some restrictions in the environment to protect people. These did not affect everyone, for example some people had keys and all restrictions were kept under review by the registered manager.

People were occupied with their own routines during the day and had established their preferred lifestyle. Each person had their own interests and preferences and these were supported with a variety of planned and spontaneous activities. People’s care plans were informative and person centred and included assessments of risk to protect people. People were supported to develop their independence as much as they wanted to.

People said they enjoyed the meals and some people chatted with the cook about the food. There was a set menu and people, who needed them, had variations to accommodate specialist diets and health care conditions.

People were supported to keep as well and healthy as possible. If people became unwell the staff responded promptly and made sure that people accessed the appropriate services as quickly as possible. People received their medicines safely and when they needed them, by staff who were trained and competent.

The registered manager and staff made sure they had the skills, accessed the right specialist support and had appropriate equipment to support people if their needs changed and the team had gone the extra mile to care for people at the end of their life.

The registered manager carried out checks of the home and systems to make sure it was safe and staff knew how to respond if there was an issue or an emergency. The Care Quality Commission had been notified of important events within the service, as required by law.

Further information is in the detailed findings below

Inspection carried out on 13 February 2017

During an inspection to make sure that the improvements required had been made

Care service description

The Beeches Residential Home provides accommodation and personal care for up to eighteen adults with a learning disability. There were seventeen people living at the service at the time of the inspection. The accommodation is over two floors, with some bedrooms on the ground floor and some upstairs. There is a communal lounge, large dining room/activities room and a garden to the side and rear of the home.

Rating at the last inspection

At the last inspection, on 11 and 12 December 2014 the service was rated Good overall and Requires Improvement in the 'Safe' domain.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 and 12 December 2014. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 19 of the Health and Social Care Act Regulated Activities Regulations 2014, Fit and proper persons employed and Regulation 13 of the Health and Social Care Act Regulated Activities Regulations 2014, Management of medicines. We undertook this announced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Beeches Residential Care Home on our website at www.cqc.org.uk.

Why the service is rated good

At this inspection we found the service remained Good overall and is now rated Good in the Safe domain.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Comprehensive checks were carried out on staff to ensure they were fit and suitable for their role.

Medicines were managed and stored appropriately. Staff had received up to date training in how to administer medicines and their competency had been checked to ensure people received their medicines as intended by their doctor.

The service had taken reasonable steps to make sure that people were safeguarded from abuse and protected from risk of harm.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised. Regular health and safety checks were undertaken of the environment and equipment. People and staff took part in fire drills to ensure they knew what to do if a fire should occur. Each person had a Personal evacuation plan, setting out the support and any equipment they needed to leave the building safely in the event of a fire.

There were systems in place to review accidents and incidents and make any relevant improvements as a result.

Staffing levels were regularly assessed to make sure that there were enough staff on duty during the day and night to meet people’s individual needs.

Inspection carried out on 11 and 12 December 2014

During a routine inspection

The inspection was carried out on 11 and 12 December 2014 and was unannounced. At the previous inspection in December 2013, we found that there were no breaches of legal requirements.

The Beeches Residential Home provides accommodation and personal care for up to eighteen adults with a learning disability. There were sixteen people living at the home at the time of the inspection. The accommodation is over two floors, with some bedrooms on the ground floor and some upstairs. There is a communal lounge and a large dining room/activities room. There is a garden at the side and rear of the home.

The home was run by a registered manager who was present on the day of our visit. 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. Comprehensive checks were not carried out on all staff at the home, to ensure that they were fit and suitable for their role. Applicants were interviewed and criminal record/barring checks were undertaken. However, the reason for gaps in people’s employment history were not routinely sought. One member of staff had been employed with two character references of which one was from a close family member and therefore was potentially biased towards the staff member.

Medicines were managed and stored appropriately. However, staff had not received up to date training in how to give medicines safely. Staffs’ competency in administering medicines safely had not been checked to ensure that people received their medicines as intended by their doctor.

The home had taken reasonable steps to make sure that people were safeguarded from abuse and protected from risk of harm. Staff had been trained in safeguarding adults and knew what action to take in the event of any suspicion of abuse. Professionals told us that the manager always contacted the local authority safeguarding team about any safeguarding concerns to ensure people’s safety.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised. The manager also carried out regular environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order. Although a general fire evacuation procedure was in place, we have made a recommendation that about ensuring people’s individual needs are taken into consideration so that they can leave the building safely in the event of a fire. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

Staffing levels had recently been assessed to make sure that there were enough staff on duty during the day and night to meet people’s individual needs.

People’s health needs were assessed and monitored and professional advice was sought when it was needed. Visiting health care professionals said that the staff worked well with them. They said that the advice they gave was always followed.

People were supported to have a balanced diet. Staff understood people’s likes and dislikes and dietary requirements such as if they were diabetic or needed their food cut into small pieces so that they could swallow it more easily. Meal times were relaxed and a positive social experience for people.

New staff received a comprehensive induction, which included specific training about supporting people with a learning disability and shadowing more senior staff. Staff were trained in areas necessary to their roles and also completed a wide variety of additional specialist training to make sure that they had the right knowledge and skills to meet people’s needs effectively.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Care plans contained mental capacity assessments, and DoLS applications were being made for everyone who lived in the home to ensure that people were not deprived of their liberty unnecessarily.

People’s care, treatment and support needs were clearly identified in their plans of care. They included people’s choices and preferences. Staff knew people well and understood their likes and dislikes. Personalised plans were being developed which included the things that were important to people from their point of view and a better understanding of people’s past histories. Staff treated people with kindness, encouraged their independence and responded to their needs. Visitors all commented on the caring nature of the home and the positive relationships between staff, people who lived at the home and their relatives .

People were offered an appropriate range of activities. These included trips out and in-house activities. People also spent their time in their rooms, talking with one another and staff, reading and listening to music and undertaking household tasks. They also enjoyed having visitors to the home.

The home was well led. Relatives and visiting professionals told us that the manager was approachable, and open to new ideas. Staff understood the aims of the home, were motivated and had confidence in the management of the home. They said that there was good communication in the staff team and that there was a low staff turnover.

Systems were in place to review the quality of the service and included feedback from people who lived in the home, their relatives and staff. The results of these surveys were that the majority of people were satisfied with the care provided at the home. One person commented, “The Beeches continues to be a warm and welcoming place. We are confident that The Beeches is well managed and we have always found the whole team friendly, helpful and approachable”. Improvement plans were developed where any shortfalls were identified to make sure that improvements were made and sustained.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 9 December 2013

During a routine inspection

We spoke with three people out of the 17 resident at the home. We also observed care given to people at the service, as well as interactions between staff and people, to determine how care was provided. People told us that the home was very good. One person said “I think the home is alright; the staff are kind to us”. Another person said “The staff try to help me if I need it”. We observed that staff supported people to make their own choices, for example, when asking one person which of three board games they should play together.

We found that care plans were comprehensive, personalised and took into account the needs and abilities of the people who used the service. We toured the premises and found that the equipment used at the home, including hoists, motorised wheelchairs, and adapted furniture, was in working order and maintained regularly.

Staff told us that they received the training required to carry out their roles well, and that they felt well supported by the management team and other staff. We noted that the manager had implemented regular discussions of the service with staff, as well as a program of appraisal and supervision, to ensure that any issues of concern could be quickly addressed. We found that the provider had implemented ways to gather feedback on the service from people and their relatives.

Inspection carried out on 8 January 2013

During a routine inspection

People who use services said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their health needs and that staff talked to them regularly about their care and any changes that may be needed. People told us they received care from a small team of staff and were happy with the care received and had no concerns relating to the home. All spoken with expressed a great deal of satisfaction from living within the service and did not raise any concerns about the quality of care. All said if they were not happy they would speak to staff or the manager.

We had the opportunity to speak with many of the people who lived within the service and all spoken with expressed satisfaction with regard to the quality of care. One person said she enjoyed helping out with the gardening and planting flowers in the summer. She spoke of how staff supported her to live the life that she wanted to lead. Another spoke of the model aeroplanes he liked to make and how staff supported him to make decisions and choices for himself.

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