Archived: Beacon Edge Care Home

At our last inspection of Beacon Edge Care Home, the service was compliant with the Regulations in force at that time. However, we did make some recommendations for improvements in relation to staffing levels and the safe management of medicines (particularly creams/ointments).

During our inspection in November 2016, we found that the recommendations for improvements had not been actioned by the provider.

Beacon Edge Care Home provides care and support (with nursing) for up to 33 people who live with dementia. Accommodation is provided in single bedrooms all on the ground floor of the home. There are communal lounge and dining areas. The home is located in the town of Penrith and is set in its own grounds with ample parking.

The service should have a registered manager in post. At the time of our inspection the service did not have a registered manager. 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.

There were not always enough staff available to meet the needs of people who used this service and sometimes people had to wait for help. We observed some good interactions and friendly banter between staff, visitors and people who used the service. Staff did not consistently use this approach and this was particularly noticeable when they were supporting people with eating and drinking or where people had limited verbal communication skills.

Care plans and risk assessments had not been developed to meet the individual needs of people who used this service. Staff did not always know what had been written in care plans and daily notes. We observed that much of the support provided by staff was ‘task orientated’ rather than centred on people’s individual preferences. We have made a recommendation that the service finds out more about training for staff, based on current best practice, in relation to supporting the specialist needs of people living with dementia.

We observed some social activities taking place at the home during our inspection. These were limited to communal areas, meaning that people being looked after in bed were placed at risk of social isolation. Beacon Edge Care Home provided care for people living with dementia, but there was little evidence to show that activities and the environment took this condition into account. We have made a recommendation that the service finds out more about the environmental design of the premises in relation to the specialist needs of people with dementia.

The people we spoke to during our inspection thought that the frontline staff were caring, pleasant and helpful. Visitors told us that staff kept them up to date with any concerns there might be regarding their relatives. We did not see any signs of people feeling uncomfortable around staff.

Medicines were poorly managed and people were placed at risk of not receiving their medicines as prescribed.

People who used the service had not always been supported appropriately with eating and drinking. Special dietary requirements were poorly managed. However, we noted that when concerns had been identified advice had been obtained from the dietician or speech and language therapist.

There were gaps in the staff training programme and in the ways in which they received supervision and support, including the monitoring of their work practices. We have made a recommendation that the service considers current advice, guidance and legislation in relation to the safe recruitment and performance management of staff, including the provider’s own policies and procedures in relation to disciplinary measures. We have also made a recommendation that the service finds out more about training for staff, based on current best practice, in relation to supporting people at the end of their life.

The service did not have an effective system in place to help monitor and improve the quality and safety of the service. The systems that were in place had not been used appropriately. There had been no senior management oversight to help ensure effective quality monitoring and improvements were carried out. We have made a recommendation that the service seeks advice and guidance about the management of and learning from complaints.

The registered provider had reported accidents and incidents to us as required. However, we found that there were other matters that had not been reported such as the closure of the kitchen for refurbishment.

We found breaches of regulation in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing. We will report on any action we take once this is completed.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’.

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.

At our last inspection of Beacon Edge Care Home in November 2016 we found breaches of the regulations in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, good governance and staffing. We rated the service as “Inadequate” and the service was placed into special measures. Following this inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

Beacon Edge Care Home is registered to provide accommodation for people who require nursing and personal care for up to 33 people, some of whom may be living with dementia.

Accommodation, at the time of our inspection, was provided in single rooms all on the ground floor of the home. There are potentially 5 bedrooms on the first floor, but these were not in use as bedrooms at the time of our inspection. There are bathroom and toilet facilities throughout the home as well as two communal lounges and one dining area. At the time of our inspection there were 24 people using the service.

The service should have a registered manager but has not had one since July 2016. 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 our last inspection, in November 2016, we found that medicines were not handled safely and people’s health was at risk of harm. During our inspection on 19 April 2017, we saw that some improvements had been made with regards medicines. However, not enough progress had been made to ensure that all people were receiving their medicines safely and were protected from the risk of harm.

The care records that we reviewed showed that risk assessments, including assessments in relation to falls risk had taken place. We found that they had not consistently been reviewed and updated. We found that people using the service continued to experience falls, bruising and injuries.

We found improvements to the care plans of people who could at times display inappropriate behaviours. Advice and support from health care professionals had been sought and included in the care planning process. However, we observed that the advice had not always been followed by the staff supporting these people.

We noted that staff recruitment protocols, induction and staffing levels had improved since our last inspection. We also found that staff received support and supervision with regards to their work. However, there remained gaps in staff competency checks and aspects of staff training and development.

People were not always supported to have maximum choice and control of their lives but staff tried to support them in the least restrictive ways. DoLS authorisations had been applied for or were in place where relevant. The policies and systems in the service supported this practice.

At our last inspection we found that people had not always been adequately supported with eating and drinking. At this inspection we found some improvements, particularly around the deployment of staff at meal times and communication with the catering staff. However, concerns remain with the dining experience for people and the management of people at risk of malnutrition.

At this inspection we observed that staff treated people in a friendly and caring manner. People told us that they thought the staff cared about the people they supported. Health and social care professionals commented that people were looking better cared for and appeared more relaxed. We observed that the nurses in charge of the shift were well organised and demonstrated a professional manner. We also observed that staff were not always mindful of protecting people’s dignity, particularly during moving and handling processes nor were they effective in communicating with people who had limited verbal communication skills.

At the time of this inspection people had limited access to social and leisure activities because the activities co-ordinator was not at work. We observed staff trying to provide one to one activities with more able people and there was a musical entertainer in the home at the time of our visit. Activities were confined to the communal areas.

Staff and relatives told us that they had been kept up to date with the proposed changes and sale of the home via meetings with the managers. People were optimistic about the proposed changes.

At the last inspection of the service we found that the service did not have an effective system in place to monitor and improve the quality and safety of the service. The provider had given us a plan of the actions they intended to take to help make sure the service improved, although some of the timescales for achieving compliance with the regulations were too long. At this inspection we found that there had been some improvements made. However, we found that quality monitoring systems had not been robustly and effectively applied.

We found continuing breaches of the regulations in relation to safe care and treatment, safeguarding people from abuse and improper treatment, staffing, meeting nutritional needs, person centred care and good governance.

Additionally, we have made a recommendation about supporting people to access meaningful activities. At our last inspection we made some good practice recommendations but the provider had failed to acknowledge these.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

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.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with staff, looking at supplies of medicines and looking at records.

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

Is the service safe?

We found that the service was not safe because people were not protected against the risks associated with use and management of medicines because they were not administered and recorded appropriately.

Is the service effective?

We found that there were some good care plans for managing medicines however they were not always reviewed promptly. This meant that staff did not always have clear guidance available to them to make sure that people received appropriate care.

Is the service well led?

We saw that audits, or checks of medicines, were done to assess the way medicines were managed. However, staff did not always follow the provider's policy of doing regular checks after medicines rounds to reduce the risk of errors.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We found that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. This was because care plans were not based on up to date information and had not been read by all of the staff. In addition to this staff did not communicate in an effective manner. We saw that there was insufficient staff available during busy periods throughout the day.

Is the service effective?

We saw people were protected from unsafe or unsuitable equipment because the manager had carried out appropriate checks. Staff were supported by their manager and had received sufficient training.

Is the service caring?

We observed that people were cared for by warm and friendly staff, however they did not always have sufficient time to interact with people who used the service.

Is the service responsive?

Records confirmed that although people's preferences, interests, aspirations and diverse needs had been recorded this was not correctly reflected in care plans.

Is the service well-led?

Staff had a good understanding of the ethos of the service and quality assurance processes that were in place. The manager, who was relatively new in place, provided leadership and was aware of areas that required improvement. The provider had an effective system to regularly assess and monitor the quality of service that people received.

We spoke with people who used the service, those that were able told us that they were satisfied with the care they received. One person told us, "Staff look after me." Another said, "Its spot on!" another added, "I am looked after properly, they keep an eye on me which is a good thing."

We found that people were being cared for to an appropriate standard. Staff were aware of what to do if they suspected abuse was taking place and had been well trained and supported following the allegations made about the home. On the day of our inspection we found that there were enough staff to meet people's needs. We also gathered evidence that confirmed that shifts at the home were being covered and that staffing could be increased if people required extra support.

We found that people were asked for their consent and the provider acted in accordance with their wishes. People experienced care, treatment and support that met their needs and were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. On the day of our inspection there were enough qualified, skilled and experienced staff to meet people's needs and the provider had an effective system to regularly assess and monitor the quality of service that people received.

We found that people were treated in a respectful manner and involved in their care and treatment. Care plans were comprehensive and staff followed them correctly. People's nutritional needs were being thoroughly monitored and people were protected from the risk of abuse. At the time of our inspection there were enough staff to meet people's needs and they were well trained and supported. Records were stored safely and securely.