22 December 2014
During a routine inspection
This inspection took place on 22 December 2014 and was unannounced. A previous inspection, undertaken in October 2013 found there had been a breach of Regulation 14 of the Health and Social Care Act 2008, in relation to the provision food and nutrition at the home. A further inspection carried out in February 2014 found that these issues had been addressed and there were no breaches of legal requirements.
Beacon Farm Care Home is registered to provide accommodation for up to 55 people. At the time of the inspection there were 28 older people using the service, some of whom were living with dementia.
The home has not had a manager registered since 30 September 2014. Our records showed the current acting manager had made a formal application to become the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered provider had policies and procedures designed to protect people from harm or abuse. Staff were aware of the need to protect people from abuse. There told us they had received training in relation to safeguarding adults and were able to describe the action they would take if they had any concerns. They told us they would report any concerns to the acting manager or the local authority safeguarding adult’s team. Staff were also aware of the registered provider’s whistleblowing policy and told us they would immediately raise any concerns they had about care. The registered provider monitored and reviewed accident and incidents and care practice was reviewed and updated in light of any identified issues or trends.
The premises were effectively maintained and fire systems and other safety checks carried out on a regular basis. The deputy manager showed us the system used to review people’s needs and how this information was used to determine appropriate staffing levels. Suitable recruitment procedures and checks were in place to ensure staff had the right skills to support people at the home. We found medicines were appropriately managed, recorded and stored safely.
Staff told felt they had the right skills and experience to look after people. They confirmed they had access to a range of training and updating. Records showed there was regular monitoring of staff training to ensure it was up to date. Staff told us, and records confirmed regular supervision took place and that they received annual appraisals. We found some records were for group supervision sessions and where these had taken place records had been photocopied and placed in the file for each staff member who attended the session. The deputy manager and regional manager said group supervision was only used when a key message or change needed to be communicated to groups of staff.
We found some people’s food and fluid charts indicated they had only had a small amount of fluid on one or two days in the previous week. We brought this to the deputy manager’s attention who said she would address this matter. Relatives told us they felt the standard and range of food and drink provided at the home was adequate. They said the meals were good and alternatives to the planned menu were available. Kitchen staff demonstrated knowledge of people’s individual dietary requirements and current guidance on nutrition.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff understood the concept of acting in people’s best interests and the need to ensure people made decisions about their care, wherever possible. We saw assessments and best interest meetings had taken place, where appropriate. The deputy manager confirmed that applications had been made to the local authority safeguarding adults team to ensure appropriate authorisation and safeguards were in place for those people who met the threshold for DoLS, in line with the MCA. We saw copies of applications still in progress and confirmation letters where DoLS applications had been approved. We found people’s bedroom doors were locked throughout the day, although staff could open them to allow people access, but could find no indication that this had been considered in line with people’s best interests. The regional manager agreed to look into how this could be reflected in people’s care plans.
Relatives told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists, opticians and other health professionals. Staff where able to explain how they maintained people’s dignity during the provision of personal care and understood about the need for confidentiality, when dealing with or reporting on people care needs.
Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care, as necessary. Some activities were offered for people to participate in. Staff and relatives told us about musical and entertainment events and we saw photographs of past activities at the home. The activities co-ordinator was relatively new to the post and explained ideas she had about developing tea dances at the home. However, there were limited activities individual to people’s specific needs, particularly for those people living with dementia. People and relatives told us they would speak to the acting manager if they wished to raise a complaint. The acting manager told us there had been no recent formal complaints, but that relatives would often approach her informally and these issues were dealt with, before the need for a formal complaint became necessary.
The acting manager and deputy manager undertook regular checks on people’s care and the environment of the home. The regional manager confirmed that she also carried out regular audits. Staff felt well supported and were positive about the acting manager’s impact on care at the home and the running of the service. There were regular meetings with staff and relatives of people who used the service, to allow them to comment on the running of the home.