Archived: Beech Tree House Residential Home

Beech Tree House Residential Home is a care home. It is registered with the Care Quality Commission to provide accommodation and personal care to up to 16 people. The home specialises in the care of older people who are living with dementia. Accommodation was set over two floors.

At the time of the inspection there were 12 people living at the home.

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

People lived in a home where the provider did not have effective oversight to identify and address concerns and shortfalls in the service. During the inspection we identified a number of issues relating to people’s health and safety and fire safety. These issues had not been identified by the provider’s quality monitoring systems and potentially placed people at risk.

A fire safety officer raised concerns regarding fire safety. Although the acting manager was able to address some issues immediately, others required the provider to take action.

The provider had not followed robust recruitment procedures to make sure staff working with people were safe to do so.

People’s needs and risks were poorly assessed and managed. People’s care plans did not all contain up to date information about their needs. There was no clear information about how risks to people would be minimised in accordance with their current needs. This placed people at risk of receiving care which was inconsistent or inappropriate.

People were mainly supported to have maximum choice and control of their lives and staff usually supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were being supported by an acting manager who was open and approachable. They had been working with the Local Authority to identify issues and make improvements.

People looked comfortable and relaxed with staff who supported them with tasks. The acting manager was working to promote a more person-centred approach to care. They were updating care plans to make sure staff had the information required to provide care and support in accordance with people’s wishes and preferences.

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 the home was good (published 27 January 2018)

On 8 March 2021 a targeted inspection was carried out to look at infection prevention and control practice. This did not identify any concerns.

Why we inspected

We received concerns in relation to the quality of people’s care including, how people’s legal rights were respected in relation to their capacity to make decisions and how people’s nutritional needs were being met. Issues were also raised about staff competency in administering medicines and records at the home. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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

Enforcement action

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 safe care and treatment, good governance, premises and equipment and fitness of person’s employed at this inspection.

Please see the action we have told the provider to take at the end of this report.

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

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Following a small outbreak in January 2021, all residents and staff had tested negative for Coronavirus (COVID-19) at the time of this inspection.

When staff came on shift, they were expected to record their temperatures, gel their hands and put on their personal protective equipment, (PPE) before entering the building. Staff entered through the back door but then walked through the building to change their clothes. We discussed this with the provider who said staff could use the laundry room to get changed which was next to the back door. This was implemented immediately to further reduce the risk of cross infection. A staff member told us, “We had string bags made for us, we put our clothes in their then into a black sack”.

Staff had received basic training in infection control as part of their induction, including how to safely put on and take off PPE such as gloves, aprons, and face coverings. The registered manager told us; “Staff also completed a workbook that was specifically related to infection control.” Records showed not all staff were to date with these workbooks. We discussed this with the provider who assured us this would be rectified.

When changing their PPE between rooms, staff removed it outside the persons room, placed it in a bag and took it to the clinical waste bin at the front of the building then put on fresh PPE. We discussed this with the provider who agreed to place foot operated waste bins in each bedroom for staff to remove their PPE prior to leaving the room. This will further reduce the risk cross contamination.

During the recent lockdown the provider had stopped all visitors coming into the home. One staff member told us, “We support people to have video calls and phone calls to keep in touch”. The provider was aware of the recent change in guidance and has implemented a “nominated person” approach, where one visitor can now visit their relative in the home. They will be required to book their visit and follow infection control procedures. The provider has a visitor’s pod for all other visitors and will resume garden visits in line with government guidance.

The home was split into two floors. The registered manager told us they could not implement zoning as the corridors were not closed off but if people did test positive, they would be required to isolate in their room. The registered manager said they had support from Public Health England and the local commissioning team when they did have and outbreak in the home.

The provider was not admitting people to the home currently even though they had one vacancy. The registered manager told us, no one would be admitted without a negative test first and their belongings would go into isolation for 72 hours prior to the person moving in, the providers admissions policy confirmed this was the correct process for the home.

The registered manager ensured regular testing was carried out, weekly for staff and monthly for people living in the home, this was in line with COVID-19 testing guidance. The registered manager told us, and records confirmed, they gained consent from relatives for people who were not able to consent to testing, but this information was not recorded in line with the Mental Capacity Act. We discussed this with the provider who assured us they would review this and ensure all care records are updated.

When we completed our previous inspection on 27 September 2016 we found concerns relating to the administration of medicines. There were now records in place to demonstrate how many tablets people had been given if a variable dose. All handwritten entries were counter signed to reduce the risk of errors. However, people with medicine patches were not always having them administered safely.

At the last inspection, we also found concerns with people’s privacy and dignity not being respected when they were in a shared bedroom. At this inspection we found there had been improvements. People and their families were consulted prior to moving into a shared bedroom. If a person lacked capacity their best interest had been considered.

Beech Tree House Residential Home 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.

Beech Tree House Residential Home is registered to accommodate up to 16 people in one building. The home specialises in providing care and support for older people with dementia. Most people had limited verbal communication. At the time of the inspection there were 16 people living at the home.

There was a registered manager in place who was present for the first day 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. The registered manager was supported by a deputy manager to run the home. There were two directors for the provider who provided regular support to the registered manager and staff.

One person was at risk of choking and the speech and language therapist had not been consulted on safe practice. Staff had not received training or provided with guidance about people requiring soft diets. Most accidents and incidents had lessons learnt identified and action taken. Sometimes these actions had not been recorded.

Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People were protected from potential abuse because staff were able to recognise signs and knew how to report it. Most medicine was managed safely but the application of medicines patches did not follow relevant guidance..

The provider and registered manager promoted a clear ethos. People had a positive relationship with the registered manager and provider. There was a positive approach to improving the service Staff felt supported and the new registered manager had brought about positive improvements. The registered manager and provider had systems to monitor the quality of the service and made improvements in accordance with people’s changing needs. They had completed statutory notifications in line with legislation to inform external agencies of significant events.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. When people lacked capacity the statutory principles of the Mental Capacity Act 2005 had been followed. People and their relatives were positive about the food and meal times were treated as a social opportunity. Staff had most of the skills and knowledge required to effectively support people. People and their relatives told us their healthcare needs were met and staff supported them to see other health and social care professionals.

People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. When people had specific needs or differences they had been considered by staff. People, or their representatives, were involved in decisions about the care and support they received. There were enough staff to meet people’s care and health needs.

Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. A programme of activities was in place to provide a range of opportunities. People were encouraged to suggest activities and trips which would respect their hobbies and interests. There was an available complaints policy and there had been no formal complaints about the service since the last inspection.

Beech Tree House is registered to provide care and accommodation to up to 16 people. The home specialises in the care of older people who are living with dementia. At the time of the inspection there were 14 people living at the home.

The last inspection of the home was carried out in October 2013. No concerns were highlighted at that inspection.

There is no registered manager in post. However there is a manager who has applied to be registered with the Care Quality Commission. 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 new manager of the home was described as very approachable and supportive. They had already identified some areas of practice which required improvement and had made some changes in response to these. These included additional information in care plans and changes to infection control practices.

We found that improvements were needed to make sure records of medication administration were correctly completed to minimise the risk of errors. The manager informed us they had already identified a more robust audit of medication administration records was required and planned to put this in place.

We also found that improvements were needed to make sure people had the support and information they required to help them to make choices and ensure their privacy and dignity was respected. Where people occupied shared rooms people did not have the opportunity to meet before making a decision to share. Neither were there any assessments in place to outline how the people had been identified as compatible or how privacy issues would be addressed.

People were very complimentary about the staff who supported them. One person told us “They [staff] are all very nice people.” Where people were unable to express their views verbally we saw they approached staff happily and appeared pleased when staff spent time with them.

There was a happy and relaxed atmosphere in the home. Staff interacted well with people which provided on-going social stimulation. There was also a range of organised activities for people to join in with if they choose to.

The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff knew how to report any concerns and had confidence that any issues raised would result in action being taken to make sure people were safe.

Generally people’s privacy and dignity was respected and people were able to make choices about how they spent their time. People were able to see visitors in communal areas or the privacy of their rooms.

Staff had a good knowledge of people and their needs. They monitored people’s health and sought advice from appropriate healthcare professionals when needed. Staff were able to adjust the care and support people received according to their changing needs.

People said they continued to make choices about all aspects of their day to day lives. People said that they were able to choose what time they got up, when they went to bed and how they spent their day. One person told us 'I decide what I do each day. Usually I get up early but sometimes I like a lie it, no one seems to mind.' Another person said 'Nobody questions what you do, it's very free and easy.'

The building was well maintained and there was a large accessible garden which was also well maintained. People we asked said that they enjoyed spending time in the garden in good weather. Some people told us that staff assisted them to walk to the village shop to make purchases and keep in touch with the local community.

The recruitment procedure minimised the risks of abuse to people who lived at the home by making sure that all staff were thoroughly checked before beginning work.

There were systems in place to effectively monitor the quality of the service offered and ensure the safety of people who lived at the home.

During our inspection we observed that staff always asked people if they were happy to be assisted before care was carried out. One person said 'They always ask if you want to do things, they are very good.' Another person said 'Sometimes I don't want to do anything so they leave me in peace.' We noted that some people were unable to verbally give consent and consent was implied by the person using the service. For example when someone was discreetly asked if they wished to use the bathroom the person got up from their chair and went happily with the carer.

The people who were able to express an opinion said that they were very happy with the care that they received. One person said 'I suppose they look after me very well but I wish I could do more for myself.' Another person commented 'They never refuse us anything, they are all very kind.'

People appeared very comfortable and all were well dressed and clean which demonstrated that staff took time to assist people with their personal care needs.

We saw that the manager worked alongside care staff to offer ongoing guidance and support. One member of staff said 'I love working here, we are a really good team and everyone helps each other.'