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Archived: Beechwood Specialist Services Requires improvement

Reports


Inspection carried out on 12 January 2017

During a routine inspection

Beechwood Specialist Services is registered to provide accommodation and support for up to sixty adults who require support with their mental and physical health. At the time of this inspection there were 37 people living there.

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.

Inspection carried out on 12 & 13 January 2016

During a routine inspection

This inspection was carried out on 12 & 13 January 2016, the first day of the inspection was unannounced. We carried out this inspection at this time as the home were in special measures and had been rated inadequate and we needed to check that improvements had been made to the quality and safety of the service.

Beechwood Specialist Services is registered to provide accommodation and support for up to sixty adults who require support with their mental and physical health. At the time of this inspection there were 45 people living there.

The building is a large detached property located overlooking the seafront 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 home has 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.

At our last comprehensive inspection of the home in July 2015 we had found a number of breaches of regulations. As a result we served warning notices on the home for failing to provide safe care and treatment, safeguard people from abuse and provide good governance for the service. We found that improvements had been made in all of these areas but further improvements were needed to meet all parts of these regulations. However, in response to the improvements that had been made we took the home out of special measures.

We had found that people were not getting the care they needed with their health in a safe way. At this inspection we found that improvements had been made to people’s health care and people we spoke with told us they were satisfied with the support they had received. However we found that further improvements were needed as records of the health care support people required were not always in place and a recent investigation had shown that one person had missed an important health appointment.

We had found that safeguarding allegations had not always been reported in a timely manner. At this inspection we found that staff knew how to recognise and report potential abuse and had done so in a timely manner. We also saw that the management team took robust action to deal with any safeguarding allegations that arose. However there had been safeguarding investigations upheld at the home which identified that further improvement was needed in the way the home identified and managed potential safeguarding related to people’s health care.

We had found that the provider did not meet the requirements of the Mental Capacity Act 2005 (MCA). During this inspection we found that this had improved and people were supported to make decisions and were not deprived of their liberty without lawful processes being followed.

We had found that quality assurance systems at the home had not been effective in identifying and improving the service provided. At this inspection we found a number of improvements. This included consulting with people living at the home and their relatives and acting on their views. Action had been taken to improve the environment and make it safe and care records had been re-written and reviewed. However we identified that further improvement were required because systems and processes did not always operate effectively enough to assess, mitigate and monitor risks relating to the health, safety and welfare of service users.

Following the inspection in July 2015 we had also given the home a number of requirement actions. We had required them to make improvements to regulations covering the environment, person centred care and staff training and supervision.

We had found that the building was not always safe and that it did not provide a suitable environment for people to live in. At this inspection we found the safety of the building had improved and it provided a safe environment for people to live in. Action had also been taken to make the building more comfortable and welcoming. The provider had spilt the decoration and building work into two phases. Phase one had been completed and we were assured firm plans were in place for undertaking phase two which would provide smaller units for people to live in.

We had also found that people’s views and preferences had not always been obtained. At this inspection we found that the provider had begun the process of consulting with people about their care and their home. This had included meeting with people and taking action on their opinions and views. A contract with an external advocacy agency had been agreed so that people living at the home could receive outside support and advice to make their opinions of their care heard.

We had found that staff had not received suitable training or supervision to enable them to carry out their role effectively. At this inspection we found that staff had received formal one to one supervision from senior staff and had undertaken a number of training courses. However staff had not undertaken training to understand the more specialist needs and conditions some of the people living at Beechwood had. Senior staff were not always available to provide a good role model for staff as they carried out their daily role in supporting people.

The care people received was inconsistent. Some people received support from staff who were kind, patient and caring, others received support from staff who appeared disinterested and did not engage with them.

Medication was managed safely and well with systems in place to minimise the risk of errors occurring.

Staff were aware of the action to take in emergencies and accident and incidents were monitored so that any emerging patterns could be noted and acted upon.

There were sufficient staff working at the home to meet peoples care needs. People liked the staff who supported them and we found that robust recruitment processes were in place to check staff were suitable to work with people who may be vulnerable.

An occupational therapy department had been created and staff employed to work within it seven days a week. This meant the people received equipment to support their mobility and comfort. It also meant that activities in the home had improved with people being provided with meaningful ways to occupy their time.

People had a choice of nutritious meals and received support if needed to eat their meals.

Inspection carried out on 23 July 2015

During a routine inspection

This was an unannounced inspection carried out on 23 July 2015. We carried out this inspection at this time due to information we had received from the police and Local Authority regarding the safety of people living at the home.

Beechwood Specialist Services is registered to provide accommodation and support for up to sixty adults who require support with their mental and physical health. At the time of the inspection 50 people were living at the home, many of whom were younger adults.

The building is a large detached property located overlooking the seafront in Aigburth. It provides people living there 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 home does 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.

We last inspected Beechwood in July 2014. At that inspection we looked at the support people had received with their care and welfare and whether they had been supported to consent to their treatment. We also looked at the premises, recruitment of staff and how the quality of the service was assessed by the provider. At the July 2014 inspection we had found the provider had met regulations in those areas.

At this inspection we found a number of breaches related to person centred care, safe care and treatment, safeguarding service user's from abuse and improper treatment, premises and equipment, good governance and staffing.

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

Some of the people living at Beechwood told us they did not wish to live there. They were unable to leave the home unaccompanied and had little to occupy them during the day.

Parts of the environment were unsafe, shabby and unsuitable for the people living there.

People were not consulted about their care and did not receive therapeutic support to enable them to manage their mental or physical health.

The registered provider did not meet the requirements of the Mental Capacity Act 2005 (MCA). They had not applied for and received Deprivation of Liberty Safeguards (DoLS) for people who needed them. This meant people who did not wish to live at the home were denied their legal rights.

Systems and processes for reporting potential abuse and keeping people safe did not work effectively.

Care plans did not provide up to date information to inform staff about people’s support needs. Where people's needs had changed their care plan and therefore guidance to staff had not been updated. This placed people at risk of receiving unsafe care.

Staff did not receive the support and training they needed to effectively carry out their role of supporting people with complex needs

Quality assurance systems were in place but did not operate effectively enough to ensure people received a safe, effective caring, responsive and well led service.

Staff did not receive the training, support and supervision they needed to support people with complex needs.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

 Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location from the providers registration.

Inspection carried out on 15 July 2014

During a routine inspection

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

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.

Inspection carried out on 26 June 2013

During a routine inspection

We spoke with eight people who lived at Beechwood during our inspection, all of whom spoke positively about the care they received. Some comments made were:

“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.

Inspection carried out on 30 October 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant some of them were not able to tell us their experiences. We spoke with six people who lived at Beechwood who told us they enjoyed living there and were happy with the care they received. Some comments made were:

“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.

Inspection carried out on 22 December 2010 and 23 June 2011

During a routine inspection

We heard that each month 10% of the people living at Beechwood and 10% of their relatives and/or representatives are sent a satisfaction questionnaire to complete and return. The returned questionnaires are analysed, a report produced and, if appropriate, an action plan is developed.

Thirty nine people out of a possible 64 responded to the March 2011 relative/representative satisfaction survey questionnaire. Results show that:

• 59% of respondents were very satisfied and 41% fairly satisfied with the care their relative receives at the home.

• 84% were very satisfied and 16% fairly satisfied with the activities/outings offered to their relative.

• 79.5% were very satisfied and 20.5% fairly satisfied that their relative's needs were being met.

• 84% of respondents were very satisfied and 16% fairly satisfied with the choice of menu provided at the home.

• 74% of respondents were very satisfied and 26% fairly satisfied with the environment.

• 74% of respondents were very satisfied and 26% fairly satisfied with the equipment supplied at the home.

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