Archived: The Beeches

We found the following examples of good practice.

• The service had signage displayed on all external doors to alert visitors to restrictions on entering the building and the infection control measures they would need to take. Sanitising hand gel and disposable face masks were provided.

• People were supported to take regular exercise and join in activities to maintain their wellbeing.

• Visits were arranged in line with government guidance and facilities were already available to accommodate visits during winter.

• Staff were wearing PPE in line with government guidance and designated areas were set up within the service for staff to remove and apply PPE.

Further information is in the detailed findings below.

The Beeches is a care home registered to provide support to up to 11 people with a learning disability and/or autism. There were 11 people using the service at the time of our inspection. The service is larger than recommended by best practice guidance. However, we have rated this service good because the provider was otherwise meeting the characteristics of good and was meeting the other principles of Registering the Right Support. The provider arranged the service in a way that ensured people received person-centred care and were supported to maximise their independence, choice, control and involvement in the community.

People’s experience of using this service

We received positive views about the support provided to people. Care and support were tailored to each person's needs and preferences. People were fully involved in developing and updating their planned care, goals and aspirations.

People were supported with activities and interests to suit them and to aid their independence. Staff knew people’s likes, dislikes and personalities well and supported people in the local community, on regular holidays and to music concerts.

Staff demonstrated effective skills in communication. Recruitment checks were in place to ensure staff were suitable to work at the service. Staff had received training and support to enable them to carry out their role. Staff were skilled to meet people’s needs. All feedback was used to make continuous improvements to the service. The registered manager had systems in place to safeguard people from abuse and staff knew how to minimise risks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People received their medicines on time and their health was well managed. Staff had positive links with healthcare professionals, which promoted people’s wellbeing.

The registered manager was approachable and had developed good relationships with people and staff. The management team were passionate about providing a family-based environment for people which supported them to live a fulfilling life and meet positive outcomes.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 22 September 2017).

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.

The Beeches is a care home for up to 11 people with a learning difficulty or mental health condition and is located in the village of Brandesburton, close to the town of Driffield, in the East Riding of Yorkshire. The service has spacious grounds with a parking area, good transport links and within walking distance of the local amenities.

A registered manager was 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.

Risk assessments were detailed and included the necessary information about each individual's specific needs and guidance on how to provide person centred care. Staff had excellent knowledge of people’s needs and how to adopt a positive approach to supporting those needs.

Emergency evacuation plans were in place. The manager was considering whether or not to include a photograph of each person which would assist in the event of a fire occurring. We also discussed a specific folder to hold everyone’s Personal Emergency Evacuation Plan (PEEP) for quick access by the fire warden. The manager advised he would look at putting these in place.

Care was planned in partnership with people living at the service and their relatives. The management and staff were committed to working with people. This created a family atmosphere which was apparent from talks with staff and people living at The Beeches.

People were treated with respect and compassion and were relaxed with staff. They told us they felt safe and that there was always enough staff on duty to meet their needs. Staff could identify different types of abuse and knew what actions to take if they witnessed any abuse or had concerns.

Everyone living and working at the home felt valued for their contribution in creating as close to a family environment as possible. This was regularly referred to as the, ‘The Beeches family’ during the inspection. The management were continually trying to improve their service and ensured staff and people living at the home were able to give feedback and ideas to feed into this process. Regular staff and residents meetings were held to plan future events and discuss any concerns or ideas for improvement.

The Beeches encouraged reflective practice in their staff team. Systems were in place to monitor and check the quality of services to identify where improvements were needed or where best practice had been effective.

The management structure was clear and all staff and people living at the service knew the manager by name. We observed positive interactions between people, staff and the manager and could see that the ethos of allowing staff to be led by individuals living at the service was embedded across the organisation.

People were supported to cook meals for the group or for themselves and staff encouraged independence by offering assistance to go shopping for ingredients. We could see that people’s preferences were in their care plans, and had also been catered for on the day of this inspection. Staff understood people’s specific dietary requirements and these were catered for accordingly.

People’s capacity to make decisions was regularly assessed and where people lacked mental capacity other options were exhausted before decisions were taken in their best interests. Involvement with health professionals and people’s relatives ensured the relevant individuals were involved in making those decisions. The manager had made appropriate applications for authorisation to restrict people’s liberty where it was necessary and in their best interests.

The Beeches is a care home for people with a learning difficulty or mental health condition and is located in the village of Brandesburton, close to the town of Driffield, in the East Riding of Yorkshire. It can accommodate up to 11 people under the age of 65. The home is located on the outskirts of the village in spacious grounds with parking and is close to local amenities and transport routes.

The Beeches has two registered managers who work as a job share. 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 we spoke with were positive about the care and support they received and it was evident from our inspection that care was person centred. People told us they felt safe and we found that staff knew how to protect people from avoidable harm. Staff knew how to recognise different signs of abuse and they were clear about what action to take if they suspected abuse was taking place. The registered provider had a safeguarding policy in place that had been updated to align with local authority guidelines.

We looked at staff rotas. Staff and people living at the home told us there was enough staff on duty and staffing levels were regularly reviewed to ensure that there were sufficient numbers to meet people’s changing needs. However, we saw the registered provider did not have a robust system or process in place to support and record that staff had the required up to date qualifications, skills and experience necessary to ensure they were competent in undertaking their role and that this was regularly reviewed. This was a breach of regulation 17(2) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of this report.

People were encouraged to live as independently as possible and we saw detailed risk assessments and risk management plans were in place to enable people to live independently and undertake a variety of daily activities in a safe way.

We saw risk assessments for the home and the environment. However, these did not include personal emergency evacuation plans (PEEPs) for each individual person. PEEPs are documents that advise of the support people need in the event of an emergency evacuation taking place.

We looked at monthly checks on portable appliances, fire extinguishers, water temperatures and saw that these were all up to date and helped to ensure the safety of the premises for people.

The registered provider had a policy and procedure in place for the safe management of medication. However we saw where medication was required to be refrigerated it was stored in the food refrigerator in the kitchen. The registered provider told us a recent medication audit had failed to identify this as a breach of regulations and they told us they would obtain a separate refrigerator from their provider to store medication. We made a recommendation for the registered provider to followed guidance in this respect from The Royal Pharmaceutical Society.

Management and staff had received training in and understood the requirements of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. Where people may have lacked capacity the registered provider ensured that the MCA was followed and we saw that prompt application for deprivation of liberty safeguards (DoLS) had been completed. DoLS were regularly reviewed and evaluated. Where an individual had capacity to make decisions in other areas of their lives we saw that they were encouraged by staff to provide their consent.

We saw there was a choice of menu and staff were aware of people’s dietary needs that were recorded in their care plans. The registered service had an environmental health officer food hygiene rating (FHRS) award of five, which was the highest award.

People told us that they were well cared for and had access to a range of health professionals. People told us they could see a GP when they wanted to and they were trialling an electronic software system to self-manage their health and appointments. We saw records of professional contacts with healthcare services documented in people’s care plans. These included the GP, district nurse, community psychiatric nurse, and mental health practitioner.

We saw a variety of activities and seasonal events were organised in line with people’s requests and feedback. These were both individual and group activities and trips.

People and their relatives were involved in the assessment and planning of their care and support. Peoples care plans showed how they were involved in making decisions about their care, treatment and support. Care plans were detailed and included information about peoples likes and dislikes.

Staff told us of a supportive culture by management with a service that focused on the needs of the people living in the home.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

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

Is the service safe?

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity. We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was personalised and reflected people's choices and decisions. Care records were up to date.

People told us 'We get our medicine on time and when we need it' and we found that appropriate arrangements were in place in relation to recording, handling and safely administering medicines to people who used the service.

The provider set the staff rotas. Records showed that at times there were fluctuating levels of staff which had the potential to impact on the staff's ability to meet people's care needs. We have asked the provider to send us additional information showing how they are monitoring the staffing levels to ensure they continue to meet people's care needs.

Is the service effective?

People's health and care needs had been assessed and care plans were in place. There was some evidence of people being involved in assessments of their needs and planning of their care. People said they could discuss their care with the staff or manager and on the whole felt well supported and cared for. One person who used the service told us 'I like living here. I can do lots of things myself, but the staff are around when I need them.'

Is the service caring?

We observed that there were good interactions between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives.

We spoke with four people who used the service. One person said "The staff couldn't do more for us. I like living here in the home." Another person told us "The staff take good care of me." We saw that people who used the service were encouraged to live individual lifestyles in what they did each day, what they wore, what their interests were and what support they received.

Is the service responsive?

We saw that there was a complaints policy and procedure on display that was accessible to people who used the service. We spoke with four people and they said they could talk to the staff or care managers if they had any problems. They told us they felt happy and safe within the service and that any issues they had were dealt with quickly. We saw that a record of complaints was kept by the provider, however the recording of these could have been clearer.

Is the service well led?

We found that the service was being managed by two care managers who were not registered with the Care Quality Commission (CQC). We have asked the provider to notify CQC about the recent change in registered manager so that we can update the information we hold about the service.

We found sufficient evidence to indicate that the care managers had made a start on developing an effective quality assurance system within the service, so that people who used the service were not at immediate risk. However, we also saw that further work was needed to develop the audit paperwork and action plans in order to move the service forward and enable the provider to sustain their compliance.

We wrote to the provider following our inspection. We asked the provider to send us additional information on a fortnightly basis to evidence how the service was being assessed and monitored and how risks were being managed.

People we spoke with did not raise any concerns and told us they were happy in the home.

We found that the provider had taken action to address the previous areas of non-compliance, this included additions to the policies in the home, the introduction of a cleaning schedule and the purchasing of new washing and drying machines.

Staff teams had been developed and roles amended to ensure that cleaning took place and people who lived in the home were now more involved in the daily maintenance.

Some work was still required to ensure that the cleaning of the pet areas was to an acceptable standard. Formal audits in relation to infection control were not yet in place.

We found that medication systems were established in the home but improvements were required to ensure that people continued to receive their medication in a timely manner. This included improvements to the recording systems in use to reduce risks.

There was clear evidence of the provider working co-operatively with other services and appropriate referrals were made when people required input from health and social care professionals. Staff showed a good understanding of infection control procedures. The service required some improvements and development to ensure cleanliness and hygiene were improved and infection control was maximised.

We saw evidence that staff received effective development, supervision and training. Staff told us they felt well supported. One staff member told us 'I feel well supported in my role and get the help I need from managers'. There was a robust system in place for quality assurance and this was being further developed by the managers. People who used the service and staff were given opportunities to give feedback and this was acted upon.

People were supported with decision making in their lives and were able to live their lives as they wished. People had choices in their days and felt that they had plenty of activities to undertake and their needs were met.

Staff were recruited through a formal recruitment process and had been trained in and were aware of the safeguarding of vulnerable adults.

There was a quality assurance system in the home and records of any accidents or incidents were kept.