Beachlands Residential Care Home

Beachlands Residential Care Home is a residential care home providing personal care to 21 older people. The service can support up to 29 people. People were living with a range of needs associated with the frailties of old age and some people were living with dementia.

People’s experience of using this service and what we found

The provider, registered manager and staff team had worked hard to address the areas for improvement following the last inspection. The management of risks to people’s skin and recording of accidents had been improved. Staff had received training in supporting people with dementia and were supported with regular supervision. People’s needs around eating and drinking were assessed, and the support each person needed was provided. Care plans included information about people’s life histories. People were supported to take part in activities that were important and meaningful to them.

Quality assurance systems were continuing to be developed, as they did not always effectively identify all areas for improvement. Changes had been made to record keeping but some further improvements were required to ensure that records fully reflected people’s needs, where they need more support and encouragement. For example, with engaging in activities. Further time was needed to fully embed these changes into day to day practice.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the service. Risk assessments provided guidance for staff about individual and environmental risks. Staff understood the risks associated with the people they supported. People received their medicines safely, when they needed them.

There was extensive building work ongoing at the time of the inspection. This was being carried out gradually and had been planned to reduce the impact on people. The cleanliness of the home and management of infection control had been maintained throughout the ongoing building work.

People needs and choices were assessed and planned for. Staff received regular training and supervision which enabled them to provide the care and support people needed. People were supported to eat and drink and variety of homecooked meals and snacks throughout the day. People were supported to access healthcare as 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. However, some improvements were needed in how this was recorded.

People were treated with kindness and care. Staff knew people well, understood their care needs and interests. People were involved in making decisions about their day to day care and support. People’s privacy was respected, and dignity upheld. People were encouraged to maintain their independence.

People were encouraged to take part in a range of activities. Complaints were responded to in a timely way. People’s end of life wishes had been explored.

The culture of the service was positive and inclusive. The registered manager was well thought of and supportive to people and staff. People and their relative’s views had been sought and acted upon to further improve the service. Staff worked in partnership with other professionals.

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 requires improvement (published 14 February 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This service had been in breach of regulation for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Accommodation was provided mainly on the ground floor, with a few rooms on the first floor. The service is situated in a quiet residential street in the East Sussex town of Seaford.

The last inspection of Beachlands was on 19 and 20 February 2018. At that inspection, the service was rated as Inadequate and the service was placed in special measures. This was because some people’s risk had not been appropriately assessed and the provider had not assessed if there were enough staff deployed to meet people’s needs. The provider had also not ensured the requirements of the Mental Capacity Act 2005 (MCA) were being followed and some people did not receive the support they needed where they had additional healthcare or nutritional needs. Also, staff had not been trained in relevant areas and people’s privacy, dignity and independence were not always supported. Some people's care plans did not clearly set out how they needed to be cared for, some staff did not follow people's care plans and although there were recreational activities provided, these were not accessible to all of the people. We also found systems for monitoring quality and safety were not effective and some records were not accurately completed.

After the last inspection, we followed our enforcement procedure to ensure the provider made the required improvements. We undertook this unannounced comprehensive inspection to check on the improvements made by the provider. We found the provider had been successful in making some improvements and the key question Caring is now rated as Good. The provider had also met regulations in relation to people’s safety and meeting the requirements of the MCA. The provider is no longer in special measures. However, the provider still needed to undertake further work to ensure people’s care plans set out how they needed to be cared for and they were followed by staff. Further improvements were needed to ensure the safety and quality of the service. This means, although improvements have been made, the service remains in breach of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service is now rated as Requires Improvement.

The service had 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. The provider for the service also owns another service as a separate legal entity. That service is also rated as Requires Improvement.

As at the last inspection, the provider had not ensured all people had person-centred care plans to outline how their individual needs were to be met and these were followed by staff. This included care plans for people who were living with dementia and people who chose not to leave their own rooms.

As at the last inspection, the provider’s audit systems did not to identify a range of areas to ensure safety and quality of care for people. This was because the provider’s audits did not cover all areas of care delivery, including the accurate and full completion of people's records and day to day maintenance of the service.

The provider needed to make improvements so staff were supported in developing the skills they needed to meet people’s individual care needs. Staff were not being supported as they needed through regular supervision.

Although the provider had made improvements in ensuring people’s safety from risk, some areas required further development, this included reducing tripping risk and prevention of pressure damage.

Some people’s needs for fluids were not being consistently planned for. Some areas relating to offering choice for people with eating and drinking, including people who were living with memory loss, needed improvement.

The provider had taken action in other areas and people’s privacy and dignity was now fully respected. The registered manager consistently emphasised the importance of supporting people in being independent. Staff showed an empathetic, kindly approach to people.

The provider had been successful in recruiting more staff, so the service’s reliance on agency staff was now much reduced. All newly employed staff had a full induction to support them in their role.

People told us they felt safe at the service. Staff had an understanding of how to safeguard people from risk of abuse. Where people may not have had capacity to consent to care, assessments of their mental capacity took place. These were in accordance with the Mental Capacity Act 2005 (MCA).

Staff supported people with their medicines in a safe way. People were also appropriately supported with healthcare needs, this included where people had urinary catheters. People who went to the lounge could participate in a range of activities.

The provider had drawn up action plans in some relevant areas, this included a major plan to improve and develop the building and home environment. People said they were confident action would be taken if they raised concerns.

This is the third consecutive time the service has been rated as either Inadequate or Requires Improvement. This service will continue to be kept under review and, if needed, further enforcement action may be taken. You can see the actions we have told the provider to take at the end of the report.

This inspection took place on 19 and 20 February 2018. The first day was unannounced. At the last inspection of Beachlands Residential Care Home (Beachlands) in December 2016 and January 2017, the overall rating was requires improvement. At that inspection, we found breaches in Regulations 9, 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans were not reflective of people’s individual health and social needs and there were not enough meaningful activities for people to participate in. Mental capacity assessments for people who had limited capacity were not always followed or reflective of individual needs. Systems for monitoring quality were not always effective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions effective, responsive and well led to at least good. We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan. This inspection showed improvements had not been made and the service remained in breach of Regulations 9, 11 and 17. Additionally this inspection found the service was in breach of Regulation 12. The overall rating for Beachlands has been rated as Inadequate.

Beachlands 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. Beachlands provides accommodation and care for up to 29 people. There were 26 people living at the service when we inspected. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people needed support with their personal care and mobility. Some of the people were also living with dementia.

Accommodation was provided mainly on the ground floor, with a few rooms on the first floor. The service was situated in a quiet residential street in the East Sussex town of Seaford.

The service had a registered manager in place. 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 provider for the service is Beachlands Care Limited and Beachlands is their only registered premises.

As at the last inspection, the provider did not to identify a range of areas to ensure safety and quality of care for people. The provider told us that, due to difficulties with the recruitment of permanent staff, the service had been using agency care workers to provide much of the care to people for an extended period of time. Agency care workers were not given the information they needed to enable them to care for people safely. The provider had not identified that agency care workers were not always being supervised in their roles to ensure they provided people with safe and quality care. The provider had not ensured that their audits covered all areas of care delivery or ensured that all other audits were completed to the same standard. This included medicines audits and the accurate and full completion of people’s records.

As at the last inspection, the provider had not ensured all people had assessments and care plans to outline how their needs were to be met. This included assessments and care plans relating to people’s mobility, communication needs, continence care and for people who were living with dementia. Some activities provision had been started since the last inspection but these did not take place every day and they were aimed at people who were able to come to the main lounge. People who were not able to leave their own rooms were not supported by individual assessments of their needs to ensure their social needs were met, and risk of isolation reduced.

Although records showed staff had been trained in the Mental Capacity Act (2005), people who needed support with decision-making continued not to have mental capacity assessments completed to ensure they were appropriately supported.

Where people had individual risks, these were not consistently supported by clear assessments and care plans to reduce their risk. Staff were unclear about actions to take to ensure certain people’s risks were reduced. This included where people were at risk of pressure damage and infection. Relevant professionals were not always contacted to support people to reduce risk, including where they had difficulty in swallowing. The provider had also not developed a training plan so staff were supported in developing skills in relation to people’s more complex needs. For example, supporting people who had catheters or specific nutritional needs.

Although the provider assured us they provided adequate staffing levels and kept this under review, depending on people’s needs, they had not actively reviewed if they had sufficient staff deployed to meet people’s current needs. This related particularly to assessment of staffing levels in relation to people’s dependency and a review of staffing levels at night and. The provider had not been successful in recruiting any staff since the last inspection, where they were found to have safe systems for staff recruitment.

The provider had not identified they were not making sure people’s privacy and dignity was respected. This included ensuring there was no risk of communal use of certain underclothing. Although people had some of their individual preferences documented, staff were not respecting these. For example, staff were not always ensuring people could watch their preferred television channels in their own rooms.

People told us they felt safe at the service. Staff had an understanding of how to safeguard people from risk of abuse and were confident the registered manager would ensure any allegations of abuse were appropriately managed.

Other risks were effectively managed, including fire safety and supporting people with their medicines. Staff were trained in relevant areas, including health and safety and moving and handling. Staff said they were supervised and felt supported in their roles. They said there was a good rapport between them and management.

People made very favourable comments about the meals. They also said they were supported to access external healthcare supports when they needed. People told us they were supported by kindly, caring staff and they could spend their days as they wanted to. Staff showed people a friendly supportive approach. People’s visitors and relatives were welcomed into the home.

The provider had developed action plans in some relevant areas, including a major plan to improve and develop the building and home environment. People said they were confident action would be taken if they raised concerns.

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.

The home had 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.

Care plans did not all reflect people’s assessed level of care needs as they changed. The lack of meaningful activities for people, specifically those who lived with dementia, at this time impacted on people’s well-being.

The registered manager demonstrated empathy for the people who used the service and worked hard to deliver good care. However, the quality assurance systems did not show how they reflected on their practice and drove continuous improvement.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff did not all have a good understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Where people’s health needs had changed, such as not eating and drinking, care plans did not always reflect the changes and demonstrate the actions staff had taken to ensure their health. Information was not always readily available on people’s life history and there was no evidence that people were involved in their care plan.

Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. During the inspection process, immediate improvements had been made to the medicine documentation by securing the assistance from the dispensing pharmacist.

Risks associated with the environment and equipment had been identified on the first day of the inspection and these were immediately managed to mitigate the risk of harm to people.

Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. Staff retention was good and most staff we spoke with had worked at Beachlands for many years.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as diabetes and dementia. Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. One person said, “I like the food, its nice food.” There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People we spoke with were complimentary about the caring nature of some of the staff. People told us care staff were kind and compassionate.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report

People who used the service told us that they liked living at the home, they were happy with the care and treatment they received and the service met their needs. They told us that staff were 'kind and caring' and there was always someone around to provide help and support. One person who used the service told us, "I'm very happy here and have no complaints".

We saw that individual care plans provided structure and guidance for care workers, to ensure that the assessed current and on-going support needs of people using the service could be met consistently and safely.

People who used the service confirmed that they felt safe in the home.

Satisfactory recruitment procedures were in place.

People were protected against the risks associated with medication because the provider had appropriate arrangements in place to manage medicines.

The service had effective systems in place to deal with people's comments and complaints.

We found that care workers had developed awareness and a sound understanding of each individual's care and support needs. This was evident from direct observation of individuals being supported in a professional, sensitive and respectful manner.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We tracked the care records of four people who used the service which showed that people were provided with the care and support that they required and met their assessed needs.

We spoke with two staff members who confirmed that they were provided with safeguarding training and they were aware of their responsibilities regarding reporting and recording allegations of abuse.

We observed the care and support provided to people and we saw that the staff interacted with people in a caring, respectful and professional manner. Staff responded to requests for assistance promptly. We examined the homes training records. The records showed that the staff team received regular training in the mandatory areas.

We saw evidence of audit checks by senior members of staff of care planning. People who used the service spoke positively about the approach of the manager when concerns had arisen. One person told us, "I didn't like a certain meal. I told the manager and she made sure it was changed for me straight away."