Archived: Beechcare Care Home

There was a registered manager at the home. 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 home decoration looked tired in areas but there was an ongoing plan of works at the home. The home cleaning schedules showed the home was cleaned thoroughly. However we did see that infection control measures had been compromised in some parts of the home. Where we noticed any odour new flooring was already on order. We have made a recommendation about this.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. This included nursing and care staff who were not hurried or rushed and when people requested care or support, this was delivered quickly. However there had been isolated days when the home has not been fully covered. The provider operated safe recruitment procedures. We have made a recommendation about this.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. People gave us positive feedback about the home. People felt safe and well supported.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to

manage these safely.

Medicines were ordered, stored and administered safely. Clear and accurate medicines records were maintained.

Staff knew each person well and had a good knowledge of the needs of people who lived at the home. Training records showed that staff had completed training in a range of areas that reflected their job role. Staff told us that they had received supervision and appraisals were on-going.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the home to be meeting the requirements of Deprivation of Liberty Safeguards.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. People had choices of food at each meal time. People were offered more food if they wanted it and people that did not want to eat what had been cooked were offered alternatives. People with specialist diets had been catered for. The chef had a good understanding of how to make sure even puréed and soft diet could look appetising.

People and/or their family were involved in their care planning, and staff supported people with health care appointments and visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice; however trips in to the community were currently limited.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager and deputy manager were very approachable and understanding.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken.

During this inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to residential care homes. We spoke with the manager and saw evidence that appropriate procedures were in place to follow when an application for DoLS needed to be submitted. All care staff had been trained in DoLS, in the principles of the Mental Capacity Act 2005 (MCA) and in the safeguarding of vulnerable adults. We found that people's mental capacity was assessed according to legal requirements. We found that risk assessments with clear action plans were in place which ensured that people were safe. Policies were in place to deal with foreseeable emergencies and people who lived in the service had personal emergency evacuation plans.

Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. We saw that the delivery of care was in line with people's care plans and assessed needs. A relative of a person who used the service said, "Our family member is involved with her care plan and we are also invited to participate”. Care plans, risk assessments and handovers reflected people’s current needs. Changes in care plans were effectively communicated to staff.

Is the service caring?

We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. We saw that staff showed kindness and patience when they supported people at mealtimes or during activities. Two people who lived in the service said, “I am well cared for and the staff are really kind and caring”, “The staff are like my second family”. A member of staff said, “It is a privilege to look after our residents”.

Is the service responsive?

People's needs had been assessed before they moved into the service and their care plans were reviewed regularly to reflect any change in their needs. We observed that people’s requests for help were responded to without delay on the day of our inspection. People were able to choose what they preferred to eat. Requests that were made during residents meetings or expressed in satisfaction surveys were followed through and responsive action was taken.

Is the service well-led?

The manager operated a system of quality assurance and completed audits to identify how the service had been performing. Additionally, a regional director carried out inspections that included compliance checks and improvement plans. When audits identified the need for an improvement, this was implemented. People and their relatives or representatives and staff were consulted about how the service was run. Annual survey questionnaires were provided and their results were analysed. Two members of staff told us, "The manager and deputy manager are very approachable and listen to us”, “We get as much one to one support as we need”. A relative told us, “The manager is brilliant, she knows what is going on and has made positive changes to the service since she has been in post”. A health care professional specialised in skin integrity who visited the service said, “The service have a sound system in place to monitor people’s skin integrity and healing process”.

During this inspection we set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that overall people were protected from harm because staff were aware of their responsibility to respond to concerns if they considered a person to be at risk of harm. Medicines had been administered and stored appropriately and when errors had occurred they had been investigated to ensure the risk of further mistakes was reduced.

The home had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. One application had been made to the Court of Protection as it had been identified that a person living at the home was being deprived of their liberty. The manager of the home understood when an application should be made and how to submit one. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed before they moved into the home. Specialist dietary, mobility and equipment needs had been identified in care plans where required. However, information in care plans did not always reflect how care was delivered in the home. Care records were not always completed. Specialist input had been sought when required but it was not always clear if guidance was being followed. We have asked the provider to tell us how they are going to do to meet the requirements of the law in relation to meeting individual needs.

Is the service caring?

We saw that although people were supported by kind and attentive staff, they sometimes had to wait to have their needs met because staff were very busy. We saw that care workers showed patience and gave encouragement when supporting people. One person living at the home told us the staff were 'All kind girls'.

Is the service responsive?

We found there were systems in place to allow people to voice their concerns and make suggestions concerning changes they would like to see at the home. There was a new manager in post who had been working at the home for eight weeks when we inspected on 03 June 2014. We heard that they had been seeking feedback from people living at the home as well as from their relatives.

Is the service well-led?

Staff we spoke with told us that they found the manager of the home approachable. They felt they could raise concerns and they would be listened to. We spoke with one relative who told us 'I'm happy with it' when asked about the care their family member received. They told us they had been kept well informed concerning any issues.

Some of the systems in place to assess and monitor the quality of the service were not effective at the time of our visit but it had been identified where improvements needed to be made. We have asked the provider to tell us what they will do to ensure that the quality of the service is appropriately assessed and monitored.

At our inspection on the 17 January 2014 we found that people's welfare was not always protected due to shortcomings in the maintenance of care records and care plans. The home did not have sufficiently detailed plans in place that outlined how the home would manage foreseeable emergencies.

We carried out our inspection of 03 June 2014 to check to see if improvements had been made to the way in which care records and care plans were maintained and if the home had suitable arrangements in place to manage foreseeable emergencies.

People who used the service told us they liked the home and their room and that the temperature was comfortable. People who used the service told us they had no complaints.

We observed staff had a good knowledge of people's needs and interacted with people individually as they needed and gave people as much time as they needed.

We saw that the service provided safe care, through carrying out initial assessments, planning care based on collating the required information and making decisions based on risk assessments. However, people did not always experience care, treatment and support that met their needs and protected their rights because the service did not maintain constant and sufficient care records, did not involve the people who use the service in their care planning and care plans, had not made the care plans available in other more accessible formats, did not provide an accessible person centred care planning tool like a person centred or 'my plan', and there were insufficient contingency procedures in place to fully inform how to continue safe appropriate care in reasonable foreseeable emergencies.

We found people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found that comments and complaints that people made were responded to appropriately.

People we spoke to told us they were well cared for and they enjoyed the choice of food and activities on offer.

People we spoke to said that they enjoyed living in the home and that they enjoyed the activities on offer. Comments included 'I enjoy knitting' and 'I enjoy arts and crafts'.

People also told us that they were well looked after and that the staff were caring.

Relatives we spoke to told us that the staff were helpful and friendly and that nothing was too much trouble for them.

The majority of people we spoke to told us that they liked the meals provided, one person said 'I enjoy the food, it's very good', another said 'I would like to have more spicy food and would really like to have Indian, Chinese or Mexican food, which is not offered'

One person told us that they enjoyed making their room comfortable with their personal belongings, computer, and football merchandise.

Two people told us that they were admitted from an acute brain unit and that their family helped them make the choice about moving into the home.

A relative told us that the home provided everything possible for their family member.

People felt that there was sufficient staff employed in home meet their needs. We were told that the staff were kind and caring and always provided assistance when they required it.