Archived: Beechwood Specialist Services

The building is a large detached property overlooking the River Mersey in Aigburth. It provides people with their own bedroom and shared lounges, dining areas and bathrooms. Due to the size and layout of the building it does not provide a domestic style of living for people. The provider has altered the way the building is used to begin to address this issue.

The home did not have a registered manager. 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. A manager had been appointed who has since applied to register with CQC.

At our last inspection of the home in January 2016 we asked the provider to make improvements with regards to providing safe care and treatment, safeguarding service users and ensuring systems were in place for monitoring the service. At this inspection we found that improvements had been made.

Staff had different approaches to supporting people at different times. We saw some examples of very good individual care provide to people. However we also saw times when staff concentrated on the task they were carrying out and were not as respectful to people as they should be.

Care plans did not always reflect the person’s likes and dislikes and their preferred lifestyle. Staff knew this information but ensuring it was recorded would help to plan activities and occupation with people.

People had mixed views about the support they received with activities and occupying their time. Plans were in place but not yet fully operating to support people with activities and occupation that they enjoyed and would benefit from.

People liked and trusted the staff team. They said they felt confident to raise any concerns or complaints that they had.

Policies and procedures were in place to guide staff on recognising and reporting any safeguarding concerns that arose. Staff knew about these and told us that they would follow them when needed.

A whistle blowing policy was also in place and records showed that the provider took any whistle blowing concerns seriously and acted upon them.

People received the support they need with their medication. Their health care needs were assessed and they were supported to access health advice. Care plans were in place to guide staff on how to meet people’s health care needs.

Procedures for ensuring people were not unduly deprived of their liberty had been followed.

The building was safe and work had taken place to make it a more pleasant environment for people to live in. This had included splitting the home into separate units so people had a smaller living environment with the intention that each unit could specialise in supporting people with different needs.

Robust recruitment procedures were in place and followed to check staff were safe to work with people who may be vulnerable. Staff received training and supervision to help them carry out their role effectively.

The provider ensured they had a clear oversight of the home and how it was operating with clear systems in place for checking the safety and quality of the service and planning improvements.

As part of this inspection we spoke at length with three people using the service, two relatives of people using the service and two staff as well as the registered manager and the deputy manager. We observed staff interacting with people using the service. We reviewed records relating to the safety and of the premises and management of the home which included care plans for three people, policies, staff training records, safety inspections and quality audits.

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

Is the service safe?

We saw that an assessment had taken place before people had gone to live at the home and was followed by a comprehensive risk assessment after people had lived at the home for a short time. The premises were appropriate and safe: essential maintenance and safety inspections had taken place and recommendations or issues had been addressed promptly. Staff knew how to deal with emergency situations but not all staff had taken part in a fire drill. The deputy manager told us that there was always a member of staff on duty who would take the lead in the event of a fire, who had appropriate training. Staff had been supported to receive appropriate training to meet the care needs of people using the service.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. In the weeks before we visited the home applications had been made for 48 people for DOLS. This was in response to a recent Supreme Court ruling concerning mental capacity to consent and deprivation of liberty when people are unable to exit a service at will. Overall we found that the service was safe, although planned refurbishment of the home was needed. Many items of furniture, especially armchairs were in need of replacement to improve people's comfort and wellbeing. We were told that this had been approved and was imminent. In a phone conversation with a relative a few days after we visited, we were told that the new furniture had been delivered.

Is the service effective?

The service was effective. A person told us that staff were, 'Really marvellous. They are really kind to me and they help everyone.' Another said, 'I couldn't walk without crutches when I came here, they took them off me and helped me to walk on my own.' A relative told us, 'I couldn't wish for better care for (the person using the service).' Another said, and staff confirmed that a person using the service had been unable to eat when they had arrived at the home and had been fed by percutaneous endoscopic gastric tube (PEG) but that staff had helped them to eat food. A relative told us that some of the staff had, 'been there for years' and that there was a family atmosphere in the home.

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff told us that some people were supported through an effective plan of care, to leave the home and move to living independently. Care plans reflected assessed risks and had been reviewed and updated appropriately. People told us that staff always asked them before helping them and that they were able to refuse to join activities. Staff understood mental capacity to consent issues. They talked about the ways that different people communicated and methods of helping them to understand information.

Is the service caring?

The service was caring. A person told us staff were caring and, 'They make me laugh.' Another said that the 'Attitude of staff and the way they care for other people is wonderful.' A relative described the staff as, 'Very caring.' They told us of the little things that staff did for people to improve their wellbeing and how that showed them that staff really cared about people. We spoke with staff who knew people's needs and spoke enthusiastically about the work that they did. We observed them interact with different people in a kind, patient and gentle way.

Is the service responsive?

The service was responsive to the changing needs of people using the service, to comments and suggestions and to recommendations made in reports about the safety of the premises. A person said, 'They listen to me' and that staff sometimes wrote things down for them because they couldn't always remember things. We saw that assessments of people's needs resulted in care plans that staff read. The care plans helped staff to know the needs and care that individual people required. Care plans were changed if people's needs changed. Relatives told us that they were always involved in reviewing the care or changes in needs for the person using the service. They gave us examples of suggestions they had made that had been acted on. We saw that people who used the service and relatives had regular meetings, which were documented and suggestions for activities were acted on. Audits had led to action plans for changes and improvements.

Is the service well led?

The service was well led by a registered manager who we met. People said the manager had made good changes since they had been in post, for example the food had improved. They thought the home was well led. Another said that the manager was, 'A really nice person and gets things done.' Relatives told us that the manager and deputy manager were very good. Staff said the manager was, 'Very supportive to us and knows everyone (that uses the service) by name.' The manager and deputy talked with us enthusiastically about planned changes to improve the environment and care that were imminent. It was clear that they worked and communicated well together. An effective management team is essential to maintaining a safe, effective care service. The service had a comprehensive system in place to monitor and assess the quality of the service and to make changes to improve it. The management team was supported by the provider's regional manager, health and safety and quality assurance departments. Staff were recruited according to a company policy and the appropriate checks were made to ensure that people were cared safely by honest, reliable, trustworthy staff who were suitable trained.

The detailed evidence supporting our summary please can be read in our full report.

'Some places don't speak to you very well, that doesn't happen here."

'Staff are kind, brilliant, very hard working."

We found people were treated respectfully and given support to have their say in how they wanted to be helped and were supported to do the things they wanted to do.

During our visit we also saw evidence that the staff were well supported in their roles. Medicines were managed safely and effectively and the organisation monitored the quality of the service provided on a regular basis.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

'The staff are very pleasant and it makes me feel pleasant'.

'This is my home and the staff are like my family'.

'The food is good and we can go out in the minibus every day'.

We observed during our inspection that the people living at Beechwood appeared happy and content living there. We found people were treated respectfully and given support to have their say in how they wanted to be helped and were supported to do the things they wanted to do.

During our visit we also saw evidence that the staff were well supported in their roles and the organisation was monitoring the quality of the service provided on a regular basis.