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Inspection carried out on 3 September 2018

During a routine inspection

The inspection took place on 3 and 4 September 2018. This inspection was unannounced on the first date and announced on the second date to ensure the provider was available to discuss feedback.

Stamford Bridge 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.

The care home accommodates up to 107 people across five separate areas, during this inspection 55 people were living at the service.

A new registered manager had applied to register with the Care Quality Commission (CQC) since our last inspection and their application had been accepted on 3 August 2018. They had worked for Barchester Healthcare Homes Limited for eleven years, some of which were spent managing and overseeing other Barchester run homes in the East Riding of Yorkshire. The registered manager had previously supported Stamford Bridge Beaumont and they were knowledgeable in terms of the current issues, work underway and plans to maintain sustained improvements across the service.

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 the last inspection in April 2018 we found the provider to be in breach of seven of the Health and Social Care Act 2008 (Regulated Activities) 2014 in Regulation 9 Person centred care, Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good governance and Regulation 18 Staffing.

We also identified one breach of the Care Quality Commission Registration Regulations 2009. This related to the failure to notify us of other events and incidents which had occurred at the service as the law requires.

The service was rated Requires improvement. The provider continued to complete an action plan to show what they would do and by when to improve the key questions Safe to at least requires improvement.

We found during this inspection that the provider had made significant improvements, which achieved compliance to meet the requirements of Regulations 9, 10, 11, 12, 13, 17 and 18.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At this inspection we rated the service Good. Although some areas of guidance and documentation needed embedding into day to day staff practice, overall there had been significant progress and improvement made throughout the service.

Management of medicines had improved since our last inspection. However, some areas of guidance and documentation required further attention. The impact to people was low as these were recording issues rather than errors in administration of medicines.

Quality assurance systems and audits identified where improvements needed to be made and noted good practice throughout the service so this could be communicated and celebrated with staff. However, some medicines audits required more detail to confirm which people’s medicines had been checked.

Staff deployment across the service had taken staff experience and skill mix into account to meet the dependency levels of people living at the service. Although we did observe a couple of minor concerns, overall this area had greatly i

Inspection carried out on 27 February 2018

During a routine inspection

The inspection took place on 27 February, 12, 13, 18, 19, 26, March and 6 April 2018 and was unannounced apart from the final date when feedback was given to the provider.

Stamford Bridge 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.

The care home accommodates up to 107 people across five separate areas, during this inspection 59 people were living at the service.

There was a manager employed by the service, and they were in the process of registering with the Care Quality Commission. Following this inspection the managers application for registration had been accepted. 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 the last inspection in September 2017 we found the provider to be in breach of eight of the Health and Social care Act 2008 (Regulated Activities) 2014 in Regulation 9 Person centred care, Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 14 Meeting hydration and nutritional needs, Regulation 17 Good governance and Regulation 18 Staffing.

The overall rating for this service is ‘Requires Improvement' and therefore the service will be remaining in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found during this inspection that the provider had met the breach for Regulation 14. Improvements had been made but not sufficiently to meet the requirements of Regulations 9, 10, 11, 12, 13, 17 and 18.

We also identified one breach of the Care Quality Commission Registration Regulations 2009. This related to the failure to notify us of other events and incidents which had occurred at the service which the provider is legally required to inform us of. We will deal with the notification issue outside of this inspection process.

Following the last inspection, we asked the provider

Inspection carried out on 30 August 2017

During a routine inspection

The inspection took place on 30 August, 11 and 15 September 2017 and was unannounced. Stamford Bridge Beaumont is a care home with nursing for up to 107 older people, some of whom were living with dementia. There were 76 people living at the service at the time of the inspection.

The service was meeting all regulations at our last inspection in November 2016. We had made two recommendations about responding to concerns and other issues, and the rating for that inspection was requires improvement. At this inspection we found breaches of Regulation 9 Person centred care, Regulation 10 Dignity and Respect, Regulation 11 Need for consent, Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 14 Meeting hydration and nutritional needs, Regulation 17 Good Governance and Regulation 18 Staffing. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager employed by the service. 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. Following the inspection we were told that the registered manager had left the service.

We found multiple failings at the service and risks to people had not been mitigated. People were not cared for appropriately. Risks to people had been identified but the written assessments did not reflect the practice of staff. Risks were not adequately managed. Accidents and incidents were not recorded consistently.

People who were at risk of dehydration and malnutrition did not always receive the level of support they needed to ensure good health. In addition positional changes for people were not carried out according to the instructions in people’s care plans putting them at risk of skin damage.

Staff were recruited safely but there were insufficient numbers of staff on duty to meet people’s needs effectively. There was a heavy reliance on agency staff who did not always know people well which put them at risk.

Some people had behaviours that challenged staff and staff were not trained appropriately. Training was not up to date and staff had not been adequately supported through supervision.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The principles of the Mental Capacity Act (MCA) 2005 were not fully understood by staff and the correct process for making best interest decisions had not been followed.

Medicines were not managed well in every area of the service. We saw poor practice by one staff when administering medicines. A community pharmacist informed us of their concerns about medicines management which included poor record keeping and missed doses of medicines.

The food we saw was nutritious. The chef was aware of how to fortify diets and provided fortified drinks and finger foods for people. However, care staff practice and supervision was poor when serving and assisting people to eat and drink.

Staff were described by people as being caring and we saw kindness shown to people by some staff. However, other staff did not always promote people's dignity or meet people's basic care needs through the care they provided.

Care plans did not always reflect the care we observed being provided by staff.

Activities were not meaningful to people living with dementia. There were no stimulating activities for people during the inspection and very few items available to stimulate people, such as books or magazines to look at.

The service had some chara

Inspection carried out on 8 November 2016

During a routine inspection

This inspection took place on 8, 10 and 24 November 2016 and was unannounced.

Stamford Bridge Beaumont is a care home which offers nursing and personal care for up to 107 people. The home is situated in Stamford Bridge, which is situated in the East Riding of Yorkshire, close to the city of York. Accommodation is provided over three floors in a Georgian listed building and purpose built extension. The home is divided into five main areas with three of these being used to support people with dementia. At the time of our inspection there were 80 people using the service.

The service is required to have a registered manager, and at the time of our inspection there was no registered manager in post. 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. The previous registered manager for the home had recently left, and a unit manager was fulfilling the role of ‘acting manager’ for the home, until a permanent manager was appointed. Another member of staff was also ‘acting up’ as the deputy manager for the home, whilst the appointed deputy manager was completing a six month secondment post at another home. This meant we were unable to rate the key question, 'Is the service well-led?' any higher than requires improvement.

At our last inspection in July 2015 the registered provider was not meeting legal requirements in relation to the safe management of medicines. At this inspection we found that practice had improved and the registered provider was now meeting legal requirements. Medication was appropriately stored, administered and recorded on medication administration records. Staff responsible for the administration of medication received training and any medication errors were appropriately investigated.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. Some people, staff and relatives raised concerns about staffing consistency and staffing levels, especially at weekends and when there were staff absences at short notice. Staff told us that whilst there were always sufficient numbers of staff to meet people’s basic care needs, on some days it was difficult to find time for social interaction on a one to one basis, when there was unexpected staff absence and insufficient time to arrange replacement cover. We have made a recommendation about this in our report.

People’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. The registered provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and concerns were appropriately reported. Staff we spoke with understood the different types of abuse that could occur and were able to explain what they would do if they had any concerns.

Staff completed a range of training to help them carry out their roles effectively, and there was a schedule for refreshing this training when it was required. Staff received supervision to support them in their role.

The registered provider sought consent to provide care in line with legislation and guidance. Staff had completed Mental Capacity Act (MCA) training and were able to demonstrate an understanding of the principles of the MCA.

People were supported to maintain good health and access healthcare services. We saw evidence in care files that the registered provider had supported people to access healthcare services where required, such as GPs, speech and language therapists, chiropodists and the local nurse practitioner.

Most people were satisfied with the quality of meals available and told us they got sufficient to eat and drink. Two relatives raised concerns about the availab

Inspection carried out on 20 July 2015

During an inspection to make sure that the improvements required had been made

Stamford Bridge Beaumont is a care home which offers nursing and personal care for up to 107 people. The home is situated in Stamford Bridge, which is a village in the East Riding of Yorkshire, close to the City of York. Accommodation is provided over three floors in a Georgian listed building and purpose built extension. The home is divided into five main areas with three of these being used to support people living with dementia. At the time of our visit 84 people were accommodated in the home.

There was a registered manager in post at the time of this inspection who had been registered with the CQC since January 2013. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We carried out an unannounced comprehensive inspection of this service on 11 & 12 February 2015 when we found the registered provider was breaching one of the essential standards of quality and safety (the regulations) relating to Management of Medicines Regulation 13, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

In April 2015 the legislation changed to The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The above breach now corresponds to Regulation 12 (1): Safe care and treatment.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirement in relation to the breach. We undertook a focused inspection on the 20 July 2015 to check that the registered provider had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this one breach of legal requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Stamford Bridge Beaumont’ on our website at www.cqc.org.uk

At our focused inspection on the 20 July 2015, we found that the provider had followed their action plan in which they had told us they would be compliant by 31 March 2015. We found that sufficient improvements had been made to the way that staff administered and recorded medicines that the level of risk to people who used the service had reduced from a moderate impact to a minor impact. The registered manager had introduced new audit tools and medicine checks to assess and monitor the level of risk, but our observations showed that errors were still occurring and further improvement to staff practice with regard to medicine management was needed.

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

Inspection carried out on 11 & 12 February 2015

During a routine inspection

This inspection took place on 11 and 12 February 2015 and was unannounced. We previously visited the service on 29 April 2014 and although we did not make any compliance actions, we found that the service required improvement in a variety of areas. We found that people were rushed with their meals, care had not been taken with people’s appearance, staff had not made sure that people were sitting safely in their wheelchairs, people were not always referred for specialist assessments, and not everyone was aware of how to express their concerns.

The service is registered to provide accommodation, personal care and nursing care for up to 107 people, some of whom are living with a dementia type illness. The home is separated into five units and three of these are used to accommodate people living with dementia. People are accommodated in single rooms with en-suite facilities. The home is in Stamford Bridge, a village in the East Riding of Yorkshire that is also close to the city of York. It is close to local amenities and has a car park.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 29 September 2014. 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 told us that they felt safe living at the home. Staff had completed training on safeguarding adults from abuse and were able to describe to us the action they would take if they had concerns about someone’s safety. They said that they were confident all staff would recognise and report any incidents or allegations of abuse.

The arrangements for ordering and storing medication were robust but medicines were not always administered safely by staff and recording was not always accurate.

The registered manager and staff had completed training on providing support for people with a dementia related condition although we found that staff were not aware of or following good practice guidance.

We observed good interactions between people who lived at the home and staff on the day of the inspection. People told us that staff were caring and compassionate and this was supported by the relatives and health / social care professionals who we spoke with. People also told us that staff were effective and skilled. Staff told us that they were happy with the training and support provided for them.

People were supported to make their own decisions and when they were not able to do so, meetings were held to ensure that decisions were made in the person’s best interests. If it was considered that people were being deprived of their liberty, the correct documentation was in place to confirm this had been authorised.

We saw that there were sufficient numbers of staff on duty to meet the needs of people who lived at the home. New staff had been employed in line with the home’s recruitment and selection policies to ensure that only people considered suitable to work with vulnerable people had been employed.

People’s nutritional needs had been assessed and people told us that they were satisfied with the meals provided by the home. People were supported appropriately by staff to eat and drink safely and their special diets were catered for.

There were systems in place to seek feedback from people who lived at the home, relatives, health and social care professionals and staff. People’s comments and complaints were usually, but not always, responded to appropriately.

People who lived at the home, relatives and staff told us that the home was well managed. The quality audits undertaken by the registered manager were designed to identify any areas of concern or areas that were unsafe, and there were systems in place to ensure that lessons were learned from any issues identified.

We saw that the home was clean and well maintained.

Inspection carried out on 29/04/2014

During a routine inspection

Stamford Bridge Beaumont is a care home which offers nursing and personal care for up to 107 people. Some of whom were living with a dementia type illness. The home is situated in Stamford Bridge, which is a village in the East Riding of Yorkshire, close to the City of York. Accommodation is provided over three floors in a Georgian listed building and purpose built extension. The home is divided into five main areas with three of these being used to support people with dementia. The registered provider is Barchester Healthcare Homes Limited. At the time of our visit 80 people were accommodated in the home.

There was a registered manager in post at the time of this inspection who had been registered with the CQC since January 2013. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS are part of the MCA (Mental Capacity Act 2005) legislation which is in place for people who are unable to make decisions for themselves. The legislation is designed to ensure that any decisions are made in people’s best interests. We found that correct procedures were followed if anyone had needed to be referred regarding any Deprivation of Liberty Safeguards (DoLS) queries.

We found there were assessments in place to help people be safe, live their lives as they chose whilst minimising risk and to be supported by the right numbers of staff.  However, we noted that staff were not always risk aware and observant, sometimes being focussed on tasks rather than people. This meant that care was not centred on the individual and their needs.

People had some involvement in their assessments to help make sure their needs were known by the staff. People told us their choices were recorded and that they had access to health professionals. However we found inconsistencies in the meeting of people’s health needs.

The level of support people received and the activities available to people varied in the different areas of the service. This meant that care and support people received was not consistent.

However, people told us they liked the staff; felt listened to and their choices were respected. People and their relatives were consulted about their care at regular meetings.

People told us that the registered manager was approachable, knew the needs of people who lived in the home and chatted with people. The quality of the service was checked regularly through the use of audits. The management used the audits to help identify areas of improvement. However, during this inspection we found that some areas and practices in the home required improvement.

Inspection carried out on 15 October 2013

During a routine inspection

We found the provider had systems in place to gain and review consent from people who used the service. People who used the service and their relatives spoke positively about the care they received. One person said the staff were "Really marvellous" to their relative. Another person commented "This place is so good, they are all good here."

All of the observations we made throughout our visit were positive. We found that staff worked hard to provide effective, safe and appropriate care. However, we found that some staff needed to revisit the principles of person-centred care and use of language in their record keeping to make sure that care provided was non-discriminatory, positive and tailored to the individual’s ability.

People who used the service were cared for in a warm, comfortable and clean environment that was well maintained.

Overall, we found that effective management systems were in place to promote people’s safety and wellbeing.

Inspection carried out on 28 June 2012

During a routine inspection

People living in the home and visitors told us that they felt the staff could not do anymore. They felt that overall the care was very good and staff worked well with people.

Most people who visited the home told us that people who use the service were treated with respect and dignity although one person said that a member of staff could be rather abrupt. The manager agreed to explore this matter as a priority. Relatives told us that the quality of care was very good and staff were helpful and kind. Their comments included. “The care is very personal and I couldn’t ask for anything better,” “They look after people very well”; “The staff are wonderful, very kind and caring”; and, “They will do anything for you, everything here is very natural nothing is contrived.”

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