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.