9 June 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out by two inspectors.
Service and service type
Bushey House Beaumont is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Bushey House Beaumont is a care home [with/without] nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post. However, the manager had applied to be registered.
Notice of inspection
This inspection was unannounced.
Inspection activity started on 21 April 2022 and ended on 16 May 2022. We visited the location’s service on 21 April 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
We used all this information to plan our inspection.
During the inspection
We spoke with six people who used the service and received feedback from four relatives about their experience of the care provided. We spoke with the manager, the regional manager, the regional director, the clinical development nurse and five staff members. We reviewed a range of records. This included six people’s care plans and daily notes for an additional three people. A variety of records relating to the management of the service were reviewed.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records.
9 June 2022
About the service
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.
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.