Bushey House Beaumont

Bushey House Beaumont is a residential care home providing personal and nursing care to up to 62 people. The service provides support to younger and older people, some of whom are living with dementia and people with a physical disability. At the time of our inspection there were 39 people using the service, two of these people were in hospital when we visited the service.

Bushey House Beaumont provides care and support in one adapted building over two floors. There are shared communal spaces such as a lounge, dining room and an activities room and gardens for people to use.

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

At times people's safety was put at risk. Staff received appropriate training for their role and people felt they had good knowledge and skills. However, we found that training was not always put into practice, for example around people at risk of choking, repositioning and ensuring other safety elements were promoted.

People told us staff were kind but busy. There were times when people were left alone to eat and drink when support was needed. There had also been occasions when people were not assisted to use the toilet. The management team were addressing this through disciplinary processes, training and spot checks. The provider had added an extra staff member at night and the ancillary staff were supporting at mealtimes as a result of the concerns. However we found that staffing issues remained and the provider needed review staffing in the service. Staff told us while the home was not full, they could manage with staffing levels but at times were busy.

People felt they were safe and most felt supported by the service. Individual risks were assessed in most cases, and staff were aware of these. Reviews of events and accidents were carried out and any actions needed were carried out. The provider was taking learning from recent concerns and feedback and implementing remedial actions as a result.

People’s medicines were managed safely for the most part however records relating to as needed medicines, such as paracetamol, were not always completed. This was being reviewed by member of the management team. Staff knew how to report any concerns about a person’s safety or welfare. However, this had not always been identified or reported as we had received concerns from external visitors.

Staff enjoyed working for the service and told us the culture was to ensure care was person centred. They stated they would be happy to have a relative of theirs living there. Care plans were in place, but some were difficult to read due to the handwriting and some had gaps in information. Care plans were reviewed regularly, however when using the resident of the day review process, this was not always completed robustly.

Staff felt supported by the provider and management team. They were positive about the new manager.

People and relatives were asked for their views about the service and were positive about the management team. Staff were also asked for their views and felt the management team were approachable. There were monitoring processes in place to help improve the standard of service and address the shortfalls. Additional management support and training had been implemented to help drive the changes needed.

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

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 this service was Good (Published 18 December 2019).

Why we inspected

We received concerns in relation to people’s care needs not being met, which included continence care, management of pressure care, dietary needs and safe medicines practice. There were concerns relating to staffing, safeguarding people from harm and the overall management of the home. As a result, we undertook a focused inspection to review the key questions of safe 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 and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

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.

Bushey House Beaumont is registered to provide accommodation for people who require nursing or personal care for up to 62 people. At the time of this inspection 35 people were living in the home.

The home is a Grade II listed building and offers accommodation to people over two floors. The environment is generous in providing people with communal space where they can spend their time. The home has generous lawns and gardens that show off a peaceful landscape to the rear of the building.

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

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

People told us they felt safe and well supported by staff who knew them well. Staff were trained and skilled to meet people’s health needs. They knew how to recognise possible signs of abuse and report concerns to their managers or external safeguarding authorities.

People’s medicines were administered safely by staff who were trained and had their competency checked. Infection control procedures were followed by staff when cleaning and when offering personal care to people.

There were enough staff employed through robust procedures to meet people’s needs in a timely way. When things went wrong staff completed a root cause analysis of the incident to ensure that any actions needed to improve the service could identified and implemented.

People praised staff for their kind, caring and respectful attitude. Opportunities for people to pursue their hobbies and interests were provided.

People’s likes, dislikes and cultural preferences were known and respected by staff and management in the home. Staff met and catered for people’s diverse dietary needs. When there was a need for it, health professionals like dieticians were involved to help people achieve a good nutrition.

The registered manager involved people, relatives and staff in the running of the home. This was done through meetings and surveys. Complaints received were investigated and fully responded to.

The registered manager and the provider completed a range of regular audits to ensure they were assessing the quality and safety of the service provided. Where actions were needed to improve the service, these were completed in a timely way.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 27 November 2018) and there were multiple breaches of regulation. 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 and the provider was no longer in breach of regulations.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bushey Beaumont 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.

Bushey Beaumont accommodates 62 people across two separate units, each of which have separate adapted facilities. At the time of the inspection 44 people were living in the home.

The service did not have a registered manager in post. The previous manager left in February 2018. A new manager had been appointed two weeks prior to this inspection and would apply to register as the manager following this 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.’

People were not consistently supported to live in a safe environment. People’s call bells to request assistance were not responded to promptly and staffing was not effectively monitored or deployed. People did not receive their medicines as prescribed. Staff were aware of the risks to people’s health and wellbeing and measures were in place to manage these safely. People were supported by staff to be safe living in the home. Staff were aware of when to report any concerns about people’s safety. People lived in a clean and well-maintained environment and were cared for by staff who followed infection control procedures.

People’s consent to care had not consistently been sought in line with the legal requirements where they lacked the capacity to provide consent. People’s dietary needs were not always well managed. However people were supported appropriately by staff to eat and drink sufficient amounts. A range of health professionals supported people’s health needs when required, however follow up appointments were not always made. Staff received training in key areas to support them in their role, and staff received appropriate support from their line manager.

Complaints were not responded to in a timely manner and some people and relatives had lost confidence in raising their concerns. People’s social needs were not always met, particularly when people chose to not participate in group activities.

The service had undergone a period of instability whilst recruiting a permanent manager. People and relatives did not all think the service was well managed. However, they were positive about the recent appointment of the manager. Systems and processes to monitor and improve the quality of care had not been effectively managed. Notifications of significant incidents had not been submitted in a timely manner as required.

People’s dignity and privacy was mostly met and staff interactions were kind and considerate. Care staff supported people patiently and sensitively and enabled people to remain independent.

The service had undergone a period of instability whilst recruiting a permanent manager. People, relatives and staff did not all think the service was well managed, however they were positive about the recent appointment of the manager. Systems and processes to monitor and improve the quality of care had not been effectively managed. Notifications of significant incidents had not been submitted in a timely manner as required.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke with five people who used the service and they all said that they felt safe living at the home. We saw evidence that risk assessments had been undertaken to help minimise risks to people living at the home. The home had a complaints policy and procedure in place and people we spoke with all knew how they could make a complaint.

The registered manager had undertaken an unannounced night spot check on the night prior to our inspection as part of a planned programme of out of hour's visits to ensure that the home was safe and that people were being cared for appropriately.

Is the service effective?

We looked at the care records of six people who lived at the home. We found these provided details of what care and support people needed. The care plans detailed the type of support people required and when we spoke with staff they were able to demonstrate that they had a good knowledge of the needs of the people in their care.

Consent had been obtained from people and/or their relatives for the care and treatment which was documented in peoples care plans. However the provider consent policy did not contain any information on how people could withdraw their consent.

Is the service caring?

During our inspection we saw that staff were supporting people to undertake a range of tasks. We saw that staff involved and treated people with compassion, kindness, dignity and respect. Staff were kind and patient with people and people told us that most of the staff 'were lovely'.

Is the service responsive?

By responsive, we mean that services are organised so that they meet people's needs. We found that people's needs were being met in accordance with their assessed needs. There were arrangements in place to review people's needs and risk assessments so that they could continue to be responsive to people's changing needs.

Is the service well-led?

The service had a robust quality assurance system in place. The leadership, management and governance of the organisation assured the delivery of high-quality person-centred care. It supported learning and innovation, and promoted an open and fair culture.

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During our inspection we found that the home did not always obtain peoples or their relatives consent for care and treatment.

We saw evidence that the home had an efficient recruitment process which ensured that staff were suitable and qualified for their roles. However, not all staff had had regular supervision or annual appraisals.

During our inspection visit we observed that medication was appropriately stored and any medication that required storage at cooler temperatures was stored in the fridge. The fridge temperature was recorded daily. However we noted when we checked that some medication which was stored in the fridge had expired.

We saw evidence that the chef provided choices of food and drink for people to meet their diverse needs, making sure the food and drink which was provided was nutritionally balanced and supported people's health.

We were concerned about record keeping as some records were not readily available for inspection and could not easily be located when requested.