Southgate Beaumont

Southgate Beaumont is a residential care home providing personal and nursing care to older people in one adapted building. At the time of our inspection there were 44 people using the service.

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

There was mixed feedback from people who told us some staff were not caring and did not engage in meaningful conversation with them,

There were systems in place to assess and monitor the quality of the service provided. However, improvements were needed to make sure people were always treated with respect and dignity. The provider’s governance arrangements around ensuring that people were always well treated, had not yet made been fully embedded.

People told us they felt safe using the service. Appropriate numbers of suitably skilled staff were deployed to meet people's needs in a timely manner. Medicines were managed safely. Staff followed appropriate infection control practices. Accident and incidents were recorded and acted upon. Any lessons learnt were used as opportunities to improve the quality of service.

Assessments were carried out prior to people joining the service to ensure their needs could be met. Where risks were identified, management plans were in place to manage these risks safely. Staff had the training, knowledge and experience to meet people's needs. People were supported to maintain good health and had access to a range of healthcare services when needed. People were encouraged to eat a healthy and well balanced diet for their wellbeing.

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.

People were supported to receive personalised care based on their individual needs and preferences. There were procedures in place to respond to complaints. The provider had investigated and responded promptly to any concerns received.

The provider worked in partnership with healthcare services and professionals to plan and deliver an effective service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 October 2018). There were seven breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made to meet the regulations, however we found there was a continued breach of regulation.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This was a planned inspection based on previous rating.

Enforcement

We have identified a continued breach in relation to ensuring people were well treated at this inspection.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The service had a registered manager, which 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 service is registered to provide accommodation for up to 52 people. There were 50 people using the service at the start of this inspection. The service specialises in the care of older people and is operated by a national care provider.

This was an unannounced comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs, and well-led.

At our last inspection of this service in March 2017, we found one breach of legal requirements. These was in respect of safe care and treatment, specifically for the management of wounds and pressure ulcers. The provider completed an action plan to show what they would do and by when to improve the rating of key question of 'Is it Safe?' to at least ‘Good.’ At this inspection, we found the necessary improvements had been made to addresses the previous regulatory breach.

At this inspection, most people using the service praised it, but a minority expressed broad or specific dissatisfactions to us that we looked into further. People’s representatives were generally happy with the service and said they would recommend it, and community healthcare professionals provided positive feedback.

We found people’s call bells were sometimes not answered in a timely manner. We also raised concerns about our observations of one person’s continence care, which the provider investigated and concluded was not in keeping with the clinical standards expected of the service. Therefore, despite some positive feedback and observations about caring approaches at the service, people’s dignity was not consistently respected as the approach of the service sometimes left people feeling uncared for.

Some people’s feedback and our checks of how the service handled concerns and complaints led us to conclude that these were not always listened and responded to, to improve on care quality.

There were recent occasions when the numbers of care and nursing staff working in practice did not quite meet planned staffing levels. We also found that recruitment checks of new staff were not sufficiently robust at ensuring they were safe to work with people using the service. These practices put people at unnecessary safety risk.

Where there was doubt that anyone had capacity to consent to aspects of the care and support the service proposed to provide them, the service did not always act in line with the principles of the Mental Capacity Act 2005 that helps to ensure actions are taken in people’s best interests.

Providers and registered managers must notify CQC about certain changes, events and incidents that affect their service or the people who use it. However, we had not been notified about two people using the service in 2018 experiencing significant injuries. This meant we did not have full oversight of the risks associated with the service.

Systems were in place to ensure that ongoing learning took place in response to accidents. However, this was not always conveyed to people involved in the accident or their representative under Duty of Candour expectations.

There were many auditing processes at the service that fed into a service improvement plan that was kept under review. However, these processes had not identified and addressed the care delivery concerns we identified, which demonstrated weaknesses in effective governance at the service.

The service provided people with a broad range of mental and physical stimulation, and supported people to develop and maintain relationships that mattered to them.

Although there was some mixed feedback about the quality of food provision, we found the service supported people to eat and drink enough and maintain a balanced diet.

The service holistically assessed people’s needs and care-delivery risks, and set up individualised care plans that were kept under review. This helped ensure people’s specific needs, such as in terms of communication or end-of-life care, were met. The service made sure staff had the skills, knowledge and experience to deliver effective care and support.

People were generally supported to maintain good health and access appropriate healthcare services. The service ensured the proper and safe use of medicines, and protected people from the risk of infection such as through keeping the premises clean and well-maintained. Parts of the service had benefitted from redecoration this year. Equipment and premises were regularly checked to ensure the environment was safe.

This is the first time the service has been rated Requires Improvement. We found seven breaches of regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection on 16 and 18 December 2014 the home was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The service had 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks assessments were being carried out to keep people safe. For one person with a risk of skin complications, action plans were in place to minimise the risk of serious skin complications. However, some actions were not being carried out to minimise this risk such as repositioning within a specific timeframe. For another person with pressure ulcers, timely intervention had not been made to a health professional to ensure the person received immediate care and support.

Staff were not always deployed effectively throughout the first floor. Some people raised concerns with response time to call bells and we saw some delayed responses to answering call bells. After the inspection, the registered manager sent us an action plan that detailed how staff would be deployed throughout the first floor so that they would be more readily available to answer call bells.

Medicines were being managed safely.

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles.

Staff sought people's consent to the care and support they provided. People's rights were protected under the Mental Capacity Act 2005. Deprivation of Liberty safeguarding application had been made for people that, due to their own safety, required supervision when going outside.

People had the level of support needed to eat and drink enough, and to maintain a balanced diet.

People were able to access healthcare services and attend routine medical appointments and health monitoring with staff support.

Staff encouraged positive, caring relationships with the people who lived at the home.

People were treated in a respectful and dignified manner by staff who understood the need to protect people's human rights.

There was a programme of activities. These activities took place regularly.

People received care that was shaped around their individual needs, interests and preferences. Care plans promoted a person-centred approach, and staff followed these plans.

We identified a breach of regulation relating to risk management. You can see what action we have asked the provider to take at the back of the full version of this report.

At this inspection we spoke with 15 people or their representatives, reviewed care records for ten people and spoke with nine staff and the manager.

We found people were protected against risks of receiving care or treatment that was inappropriate or unsafe. Staff worked with people with care and were respectful. People's welfare and safety was being maintained. One person said 'I am having a lazy morning, out of choice. At 93 I deserve to choose, the staff are very flexible.'

People were protected from risks of inadequate or inappropriate nutrition. Most people we spoke with were satisfied with the menu and quality of food. Staff we spoke with were aware of people's dietary needs. One person told us 'food is reasonable and there is lots of choice.'

The provider was assessing and monitoring the quality of service. Views were obtained from people, those acting on their behalf and staff. Risks were identified and managed relating to the health, welfare and safety or people. Some improvements had been made and action plans were in place to deal with issues that had been raised.

Concerns had been raised by people regarding the menu and quality of food. A new chef had recently been employed and there had been recent changes to the menu. One person told us 'the food is quite nice.' Some staff we spoke with were not aware of people's dietary needs.

We saw that people's dependency levels had been assessed and staffing levels had been increased since our previous visit. A permanent manager and staff had been recruited.

Staff were appropriately supported by the provider and acting manager to deliver care and treatment to people safely and to an appropriate standard. This included supervisions, planned appraisals and appropriate training.

People who use the service and their representatives were asked for their views about their care and treatment. Records showed that quality audits had been made by the regional manager but some actions had not been carried out or completed.

The provider had a system in place for identifying, receiving, handling and responding to complaints and comments made by people using the service and those acting on their behalf.

People who use the service told us that staff were often 'rushed' but tried their best to assist them when they needed help. One person told us, 'the staff are jolly good but there's not enough of them.' Another person commented, 'sometimes you have to wait a long time,' and added, 'I'm put to bed quite early.' Staff we spoke with told us they were concerned about staffing levels at the home and said they were rushed because people's needs had increased. We checked care plans at the home and found that dependency levels of individuals were not being routinely monitored or recorded.

Most people who use the service told us that the staff who supported them were kind and helpful. However some people told us that a few staff were rude to them. Comments included, 'they just rush in and out,' and 'some are good and some are bad.'

Staff we spoke with told us they did not feel supported by the organisation and we saw that staff were not receiving regular supervision or appraisals.