Beech Lawn Nursing and Residential Home

Beech Lawn Nursing and Residential Home is a residential care home providing personal and nursing care to up to 44 people. The service provides support to predominately older people and people living with dementia. We began the inspection on 13 December 2022. At the time of our inspection there were 43 people using the service. The service was experiencing an outbreak of Covid-19; therefore, we terminated the inspection on that date. We returned to complete the inspection on 4 January 2023. At that time there were 36 people using the service.

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

On the inspector’s arrival to the location on the first day of inspection the service had declared an outbreak of Covid-19. The service had been closed due to the need to protect people. The registered manager and quality assurance and training lead were not working in the service due to being affected by Covid-19. The clinical lead was on duty and supporting staff and residents affected. They were also informing all necessary health and social care agencies as required. We made the decision to minimise the impact of an inspection at this time and returned on 4 January 2023 to complete this.

Prior to the inspection we had received concerns that infection control measures were not effective at the start of the Covid-19 infection. Concerns were raised that a staff member had worked while testing positive to Covid-19. We found there had been a sudden and detrimental impact on staffing levels for the previous days prior to the inspection due to the impact of Covid-19 infections affecting staff. The registered manager confirmed they had been made aware of a staff member who had tested positive for Covid-19 while on shift and completed that shift as they were not symptomatic. Some staff were not wearing protective masks as was the guidance at that time. We raised this with the registered manager who took immediate action to ensure all staff used the necessary protective equipment as was required at that time when in an outbreak. We have made a recommendation in respect of this in the report.

There had been some staffing issues due to the impact of the recent Covid-19 outbreak. The registered manager had been supported by the commissioners due to the outbreak to seek additional staff and put a contingency plan in place. On the second day of inspection we found staffing levels had improved. Overseas staff had recently been employed and were going through their induction programme. Staff told us staffing had been an issue but had now improved. We found there were enough staff on duty to meet people's individual needs.

Staff were caring and treated people with kindness, respect and were mindful of people’s dignity. Comments included, “The staff are very patient and are keen to help me with things” and “I think they [staff] are very patient. It was difficult before Christmas. I think a lot of staff were poorly, but it’s got much better. I don’t usually have to wait long before somebody comes along to help”.

Incidents and accidents were managed safely. The managers took necessary actions to keep people safe and minimise the risk of reoccurrence. Steps were taken to learn lessons if things went wrong.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. A health professional told us the registered manager and clinical staff worked closely with them to ensure any placements at the service were suitable so that peoples individual needs could be met.

The provider had systems in place to protect people from the risk of abuse and people told us they felt safe. Risk assessments were completed to help identify and minimise risks people faced. Staff had been recruited safely.

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.

Staff knew how to keep people safe from harm. Staff had received appropriate training and support to enable them to carry out their role safely, including the management of medicines.

Staff told us that they had received training. The deputy-manager maintained oversight of training to ensure staff had the necessary training, knowledge and skills to provide consistent care.

Staff told us they were supported by the management team. One staff member new to the service, told us they felt valued and felt supported during their induction period.

The premises were clean and well maintained. The service had effective systems to monitor equipment and utilities. There were certificates in place to support this. Systems were in place to support people in the event of an emergency.

The registered manager provided clear direction and good leadership. Feedback about the service was consistently positive. In general comments about support was positive. Some people told us there had been a lot of changes in the staff team. Communication with other agencies had not always been positive. However, all stakeholders told us this had improved and there was now a static staff team who communicated well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good published (19 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and infection control measures. A decision was made for us to inspect and examine those risks.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beech Lawn Nursing and Residential Home on our website at www.cqc.org.uk.

Notice of inspection

This inspection was unannounced.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff and the registered manager had worked hard to contain this outbreak within the service. The service was appropriately staffed. Beech Lawn had not experienced difficulty in recruiting new staff.

There was a designated area for receiving all visitors to the service, checking their vaccination status and their Covid-19 self test result. Masks, aprons, gloves and hand sanitiser was readily available throughout the service. Essential care givers and visits to people in receipt of end of life care were possible. However, the service was currently closed to other visitors in accordance with national guidance.

Staff and people were regularly tested for Covid-19. All staff and people had been vaccinated.

Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised. Changes had been made to how staff were deployed to limit transmission risks between different areas of the service.

We were assured that this service met good infection prevention and control guidelines.

We spoke with two people living at the service and two relatives. All were positive about the service provided. Comments included, “Yes I get visitors. I saw my friend two days ago,” “Staff are always around when I need them,” “Staff are more than kind, they are wonderful. A relative told us of the detrimental impact the lockdowns had had on her family member. However, they are now visiting regularly again.

Beech Lawn Nursing and Residential Home is a care home that provides personal and nursing care for up to 44 predominantly older people. The accommodation is arranged into four wings on two floors. At the time of the inspection 43 people used the service. Some of these people were living with dementia.

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

People were relaxed and comfortable with staff, and had no hesitation in asking for help from them. Staff were caring and spent time chatting with people as they moved around the service. People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, “I feel safe living here, I get good care and the staff are kind” and “My Mum has lived here for 12 years and she is safe here, I have no reason to worry at all.”

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.

The service employed three activity co-ordinators who supported people to take part in a range of activities. Where people spent time in their rooms, either through choice or because of their health needs, staff spent one-to-one time with them engaging in conversations or individual activities. Relatives told us they were welcome at any time and we saw staff greet relatives and chat with them as they arrived at the service.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through effective shift handovers with the nurse in charge and by accessing up-to-date electronic records.

Care plans were accurate and up to date. They provided staff with sufficient guidance to ensure people’s needs were met. Risks were identified and staff had guidance to help them support people to reduce the risk of avoidable harm.

There are enough staff on duty to meet people’s needs. Staffing numbers and times of shifts were adjusted as people's dependency levels changed. Staff were well supported by a system of induction, training, supervisions, appraisals and staff meetings. The staff team were well motivated. They told us their managers were supportive, approachable and fair.

People and their families were given information about how to complain and details of the complaints procedure were displayed at the service. The service sought the views of people, families, staff and other professionals and used feedback received to improve the quality of the service provided.

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. Report published on 7 January 2017.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

We last completed a comprehensive inspection of Beech Lawn Nursing and Residential Home on the 14 and 15 October 2015. Breaches of legal requirements were found and enforcement action was taken. This was because the legislative framework of the Mental Capacity Act 2005 (MCA) was not being met and the systems in place to assess and monitor the quality of service people received were not effective. Action was also required to ensure people had up to date care plans and risk assessments that reflected their needs and preferences which were reviewed regularly; and to ensure nursing competency was being assessed and there were enough staff to meet people’s needs.

We asked the provider to send us an action plan on how they were going to put these right. We returned to the service on 12 January 2016 to check whether the requirements had been met in relation to the enforcement action we had taken regarding the MCA and how the provider monitored the quality of the service. At that inspection we found improvements had been made. However, we found a breach of regulation as requirements relating to the legislative framework of the Mental Capacity Act 2005 (MCA) were still not always being followed.

At this inspection we also checked whether improvements had been made regarding the concerns identified at the previous comprehensive inspection on 14 and 15 October 2015 and we found improvements had been made.

Beech Lawn Nursing and Residential Home provides nursing and residential care for up to 44 older people who require support in their later life or are living with dementia. On the day of the inspection 29 people lived in the home.

A manager was employed to manage the service. They were in the process of registering with CQC and had been in post for two months. 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 manager and staff had attended training on the Mental Capacity Act 2005 (MCA) and staff’s understanding of the MCA and how it affected the way they supported individuals, had improved. During the inspection, most MCA assessments were in place. Following the inspection, the manager confirmed MCA assessments had now been completed for everyone who lacked capacity.

Since the previous inspection where improvements were found, audits had not always been carried out in line with best practice. Where audits had been completed, it was not clear whether action had been taken regarding any concerns identified. The new manager had put an annual schedule of audits in place and assured us any areas for improvement would be acted upon.

People had care plans in place which included detail about their needs but not always about their preferences. The manager told us they were reviewing people’s care plans to include information from people, those important to them and staff who knew them well. People and staff confirmed they knew and respected people’s preferences.

People had up to date risk assessments in place to help reduce any risks related to people’s care and support needs. Guidance for staff to help mitigate risks to people was recorded in people’s care plans. Staff told us they were regularly asked for their opinions regarding whether people’s support could be made safer in any way.

People and staff told us there were sufficient numbers of suitably qualified staff to meet their needs.

People told us they felt safe using the service. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. The recruitment process of new staff was robust.

People received support from staff who knew them well and had the knowledge and skills to meet their needs. Staff spoke with affection about the people they supported. People and their relatives spoke highly of staff and the support provided. Comments included, “The staff are very good and friendly.” People had care plans in place which described what their health and social care needs were.

People received the support they needed to remain healthy. Staff monitored people’s health and referred them appropriately to external professionals if they had concerns about any changes. Any guidance provided was then recorded and followed. A relative told us, “The staff recently got my relative through a chest infection, they were marvellous.”

There was a positive culture within the service. The manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team. Staff talked about ‘making a difference’ and ‘respecting people’s choices’ and had a clear aim of improving people’s lives.

There was a management structure in the service which provided clear lines of responsibility and accountability. The manager, who had overall responsibility for the service was supported by other senior staff who had designated management responsibilities. The manager was working with these staff members to help them develop their roles. Staff were confident raising new ideas with the manager about how the team could be deployed more effectively, and these were listened to.

The manager and staff monitored the quality of the service by regularly speaking with people to ensure they were happy with the service they received. People and their relatives told us the management team were approachable. They also confirmed they knew who to speak to regarding any changes or concerns and that these were dealt with swiftly and efficiently.

After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to our enforcement action. We undertook this focused inspection on 12 January 2016 to check they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Beech Lawn Nursing and Residential Home on our website at www.cqc.org.uk

Beech Lawn Nursing and Residential Home provides nursing and residential care for up to 44 older people who require support in their later life or are living with dementia.

There were 35 people living at the service at the time of this inspection. The service is on two floors, with access to the upper floors via stairs, chair lift, or wheel chair lift. Some bedrooms have en-suite facilities which have a toilet and wash basin. There are shared bathrooms, shower facilities and toilets, two lounges, and three dining rooms. There is an outside patio area with seating.

The registered manager for the service had recently resigned and was leaving on 14 January 2016. A new manager had been employed to replace the existing registered manager, and informed us an application for registration with the Care Quality Commission would be submitted shortly. 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’s mental capacity was being assessed in respect of some areas of their care, such as the use of bed rails and consent to care and treatment. This helped to ensure decisions were being made in line with people’s wishes. However, people’s care plans did not always provide guidance and direction for staff about how to support people when they did not have the capacity to make decisions for themselves. This meant decisions may not always be made in people’s best interests. However, training was being arranged to ensure the registered manager and staff had a better understanding of how the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) protected people to ensure their freedom was supported and respected. A computerised care planning system was being implemented, and would help to prompt staff to complete mental capacity assessments when necessary. People who may be deprived of their liberty had been assessed.

Monitoring systems had and were continuing to be devised, implemented and improved to help ensure the quality of the service people received was effective and meet their needs. The provider visited the service on a weekly basis and had introduced a management report which would help highlight areas of concern, in respect of staffing, the environment and documentation. The new manager had a good understanding of the importance of monitoring the service. People, their family and loved ones were being encouraged to be part of care planning reviews, and informed about how to provide feedback about the service they were receiving.

We found a breach 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 the report.

This is a summary of what we found-

Before our inspection we received some anonymous information of concern about the service. The information related to concerns that the provider was not meeting people's continence care needs, and a lack of staff was affecting the safe and effective care of people who lived at Beech Lawn.

Is the service safe?

At the time of our inspection we found the service to be safe.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People who lived at Beech Lawn were complementary of the care and support they received, comments included, 'very very good' and 'good as gold, everybody'I don't think there is anybody I could say is not'. Some people told us that there had been problems with the ordering and receiving of their allocated continence pads, people confirmed that this had at times caused them to feel uncomfortable.

There were enough qualified, skilled and experienced staff to meet people's needs.

People who lived at Beech Lawn told us that the staff were kind and caring. However, some comments indicated that people felt there was a lack of staff. For example we were told, 'yes they are a bit short', 'if there is a shortage of staff they tell me' and 'to me there is a shortage of staff'.

We spent time in the office looking at records with the manager and the majority of time we talked with seven people who used the service, two relatives and eight members of staff and the manager.

We spoke with one person and asked them about what they liked about living at the home. They said "staff are marvellous and I am very satisfied with the care I receive" another person said "we have choices in everything we do and the meals are good"

We spoke with two relatives who visited daily. They were full of praise for the service their relatives received. They made comments to us such as "staff are marvellous", "I see everything going on each day and I can't fault them".

We spoke with eight members of staff about a variety of topics including the training and support they received, how they respect people's privacy and dignity and how they kept people safe. One member of staff explained in detail how they would ensure the privacy and dignity of people they cared for and said "I would always explain what I am doing and cover people up with towels to protect their dignity", I asked another member of staff how they offered choices to people, they replied "in the morning I ask people what they want to wear".

During the observations we saw staff help two people to mobilise. We also saw staff conversing with people when they were laying up tables for lunch. We saw staff assisting people to eat their lunch. We saw people talking to each other at lunch.

We witnessed staff interaction with people which was generally positive. People told us staff answered call bells promptly. They said the staff were 'polite, good girls'. People told us the food was good and they were offered choices. One person said 'I can watch TV through the night if I wake up'.

We heard care workers ask people what they would like to do and gave them ideas if they could not make a choice.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

We found staff received appropriate professional development and supervision.