Beechwood Care Home

About the service

Beechwood Care Home is a nursing home providing personal and nursing care for up to 60 older people, some of whom may be living with a dementia. At the time of our inspection there were 24 people using the service. The home has two floors. The ground floor is for people who require residential care and the first floor for people who require nursing care.

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

People were safe. Risks to people's health, safety and wellbeing were managed by staff with the relevant skills and knowledge to meet their needs. Any accidents or incidents were appropriately responded to and were monitored and learned from to reduce the risk of them happening again. The service had made vast improvements, and this was evident in the positive feedback received from people and their relatives.

Medicines were managed and administered safely. Improvements had been made in this area since our last inspection however, a review of medicine guidance was required, and we have made a recommendation regarding this.

People received appropriate support to meet their nutritional and hydration needs. We receive positive feedback about improvements to the food. People were supported appropriately to maintain or improve their weight.

Staff were familiar with people’s needs and care records were up to date. Person-centred support was being provided. Communication between staff and people had improved due to the reduction in agency staff use and people were treated with dignity and respect. Support provided to staff had improved and the provider ensured staff training was up to date.

There was a noted improvement in management and provider oversight. The quality assurance processes in place were more effective. More opportunities for people and their relatives to engage with management were put in place. Complaints were managed well and recorded appropriately.

People were supported to have maximum choice and control of their lives and staff always supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Safe recruitment processes had been followed and people told us they felt safe living at the service.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 19 July 2022) and there were breaches of regulation. 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 has been in Special Measures since 12 June 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 25,30 and 31 May 2022. Breaches of legal requirements were found. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

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

Beechwood Care Home is a nursing home providing personal and nursing care to up to 60 older people, some of whom may be living with a dementia. At the time of our inspection there were 40 people using the service. The home has two units. The ground floor unit is for people who require residential care and the first-floor unit provides nursing care.

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

The service was not safe. Risk assessment were either not in place or were not accurate. Monitoring records had not been completed consistently and we could not be assured people were receiving appropriate care and support.

Medicines had not been managed, stored or administered safely. Insufficient systems to monitor medicines had resulted in numerous medicine errors.

People did not receive appropriate support with meals and had not been provided with enough to drink to maintain their health. Timely action had not always been taken where people had begun to lose weight.

Staff were unfamiliar with people’s needs and care records were not up to date. This had caused delays with treatment and a lack of person-centred support being provided.

Communication between staff and people was poor and people were not treated with dignity and respect. Support provided to staff was inconsistent and the provider had failed to ensure staff training was up to date.

There was a significant lack of provider oversight. The quality assurance processes in place were not effective and failed to identify and address shortfalls in a timely manner. Complaints had not always been investigated thoroughly.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Safe recruitment processes had been followed and people told us they felt safe living at the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 July 2020)

The provider completed an action plan after the last comprehensive inspection in September 2019.

A further focused inspection took place in July 2020. However, not all the breaches identified in the September 2019 inspection were reviewed at this inspection and therefore some of the breaches still remained.

At this inspection we reviewed the remaining breaches found during the inspection in September 2019. We found the provider remained in breach of these regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care being provided to people and staffing levels. 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider acknowledged the significant shortfalls found during this inspection. They took action following the first day of inspection to begin to address some of the shortfalls found. They produced an action plan and began to work with the local authority to make improvements.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, dignity and respect, assessing and managing risks, medicine management, infection control, staff training and support and provider oversight and monitoring at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Beechwood Care Home provides accommodation with personal and or nursing care for up to 60 people aged 65 and over some of whom may be living with dementia. At the time of the inspection 37 people were receiving support. People living on the ground floor of the service receive residential care and those living on the first floor receive nursing care.

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

People have benefited from the improvements made since the last inspection. Their staff were more organised and confident. Their was a positive culture in the staff team where they felt confident to speak up and knew they would be listened to. Staff were appreciative of the support they received.

People lived in a cleaner environment. People were safer because the leadership of the staff team had led to significant changes to care plans, risk management and staff knowledge about the people they support. People and their families were listened to and involved in their care.

A positive recruitment process had led to a reduction in the use of agency workers. People were therefore supported by a consistent group of staff who knew them. This had enabled positive relationships to develop. One relative told us, “The staff are brilliant and picked up on my family members personality. They like to joke and kid.”

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 registered manager and provider had a clear picture of where improvements were still required to embed the systems of monitoring people’s health and wellbeing and around the medicines system. There was a positive approach to continuous improvement in the staff team and where required staff were challenged about their performance appropriately.

The leadership of the service has improved since the last inspection and this has impacted on both safety and quality of the service people received.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 28 October 2019) and there were multiple breaches of regulations. 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 did not inspect all key questions. We found improvements had been made regarding the breaches of regulation noted in the safe and well-led key questions and the provider was no longer in breach of regulations in these areas.

This service has been in Special Measures since October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in August 2019. Breaches of legal requirements were found.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well-led. Breaches contained in the last report found in the effective and responsive key questions have not been reviewed at this inspection and remain as a breach of legal requirement.

The ratings from the previous comprehensive inspection for those key questions were not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to communicate with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beechwood Care Home is a residential care home providing personal and nursing care to people aged 65 and over, some of whom were living with dementia. The service has two separate wings, each of which has separate adapted facilities. Beechwood Care Home can accommodate up to 60 people. At the time of this inspection, 52 people lived at the service.

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

Risks which affected people's health and wellbeing were not always documented. This meant that staff did not always have adequate information to manage and mitigate risks to people. Accidents and incidents had not been thoroughly recorded and senior management had not always been notified when they occurred.

The service was not sufficiently clean. There was a strong smell of urine at the service and cleaning schedules were not in place which increased the risk of infection.

Medicines had not been managed safely. Room and fridge temperatures were not kept, and staff had not received appropriate training and competency assessments. Medication was found on the floor during the inspection.

Staff had not been deployed effectively. There was a high use of agency staff who were not familiar with people and their needs. Thorough recruitment checks had not been completed and agency profiles were insufficient.

Safeguarding concerns had not been reported by staff and management. Staff were not clear of their roles and responsibilities in relation to safeguarding.

Staff had not been provided with mandatory and refresher training to ensure they had the skills and knowledge to carry out their roles. Staff did not feel supported by management.

Staff did not always have the time needed to support people with meals; this compromised people’s dignity. Where people required their fluid monitoring, appropriate records were not kept. Professionals raised concerns that they were not always contacted in a timely way, when advice or guidance was needed.

Staff were task orientated and did not always communicate appropriately with people. Staff did not consistently offer people choice and the opportunity to make their own decisions. People’s independence was not always promoted.

Care plans contained some person-centred information, but these had not been updated when changes in people’s needs occurred. Staff were unfamiliar with the content of peoples care plans. There was a lack of stimulation and activities on offer.

Complaints had been responded to, but records did not demonstrate that thorough investigations had taken place. Lessons learnt were lacking.

The quality assurance processes in place were ineffective. There was a clear lack of provider oversight and a poor staff culture within the service. Staff did not feel supported by management. Records that contained personal information had not been stored appropriately.

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 (published 22 April 2017).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service and staff not reporting safeguarding concerns. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to infection control, assessing risk, staff deployment, training and support, safeguarding, person-centred care and effective governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Beechwood care home is registered to provide accommodation for up to 60 older people some of whom are living with dementia . There were 56 people living at the service when we inspected. The service cared for people with predominantly residential care needs on the ground floor and nursing needs on the upper floor. The service was purpose built and had several communal areas and gardens. It had specialist equipment to assist people with mobility problems and was close to local transport links.

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.

Staff were able to tell us what they would do to ensure people were safe and people told us they felt safe at the service. The registered provider had sufficient suitable staff to care for people safely however the registered manager had experienced difficulty recruiting sufficient suitable staff which meant that staffing levels were sometimes not at an optimum level.

Care plans were kept up to date when needs changed, however staff did not always have sufficient information about people preferences and what was important to them to ensure they gave people personalised care. Medicines were safely handled and risks were well assessed to protect people.People’s individual risk management plans were in place. However, these sometimes focused on recording information and did not always give clear instructions to staff on how to translate the information into clear management plans to protect people around risk.

The environment was safe for people and monitoring checks were regularly carried out. People were protected by the infection control procedures in the service.

Staff had received training to ensure that people received care appropriate for their needs. Training was up to date across a range of relevant areas.

Staff had received up to date training in Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood that people should be consulted about their care and they understood the principles of the MCA and DoLS authorisations. People who lacked capacity were supported to make decisions and where necessary protected from making unwise choices.

People’s nutrition and hydration needs were met. People enjoyed the meals. Specialist advice around people’s health care was sought and followed.

People were treated with kindness and compassion. We saw staff had a good rapport with people whilst treating them with dignity and respect. Staff had knowledge and understanding of people’s needs and worked together well as a team. Care plans provided detailed information about people’s individual needs and preferences. Records and observations provided evidence that people were treated in a way which encouraged them to feel valued and cared about.

People told us their complaints were responded to and the results of complaint investigations were clearly recorded. Everyone we spoke with told us that if they had concerns they were addressed by the registered manager who responded quickly.

The registered provider had an effective quality assurance system in place and was well supported by the senior management of the organisation.

The service was well managed and staff were well supported in their role. The registered manager had a clear understanding of their role. They consulted appropriately with people who lived at the service, people who were important to them, staff and health care professionals, in order to identify required improvements and put these in place. The registered manager was improving the way in which the quality assurance system informed improvements and effective governance systems were in place to protect people.

This inspection took place on 26 January 2016 and was unannounced. This inspection was a re-rating inspection carried out to review the rating under the Care Act 2014 and to see if the registered provider and registered manager had made the improvements we required during our last inspection.

During this inspection we found the provider was now meeting the regulations and had made significant improvement to the service and the care people received.

Beechwood Care Home is a purpose built home. It is registered to care for up to 60 people who need nursing or personal care some of whom may also be living with dementia. It is located close to the town of Northallerton and is convenient for the shops and other facilities. The home is over two floors and has a passenger lift. All bedrooms are single with en-suite toilets and wash hand basins. There are secure gardens to the front of the home. At the time of this inspection the service was providing care/nursing care for 50 people.

The home employed a registered manager who had worked at the home for over a year. 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 told us they felt safe. Staff knew the correct procedures to follow if they considered someone was at risk of harm or abuse. They received appropriate safeguarding training and there were policies and procedures to support them in their role.

People’s needs were regularly assessed, monitored and reviewed to make sure the care met people’s individual needs. Risk assessments were completed so that risks to people could be minimised whilst still supporting people to remain independent. The service had systems in place for recording and analysing incidents and accidents so that action could be taken to reduce risk to people’s safety. People had good access to health care services and the service was committed to

working in partnership with healthcare professionals. However, people did not always have access to their call bells and people were restrained by safety gates that were fitted to several bedroom doors.

Medication was managed safely and people received their prescribed medication on time. Staff had information about how to support people with their medicines.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. The service recruited staff in a safe way making sure all necessary background checks had been carried out.

The home’s infection control procedures had improved as there were no unpleasant odours in any of the communal areas we saw on the day. The home was clean and the domestic team followed cleaning schedules to maintain a good standard of cleanliness. We saw that new furnishings had been purchased and flooring in some of the communal areas had been replaced.

The principles of the Mental Capacity Act 2005 were consistently followed by staff. Consent to care and treatment was sought. When people were unable to make informed decisions we saw a record of best interest decisions. There was a record of the person’s views and other relevant people in their life. The registered manager had a clear understanding of the Deprivation of Liberty Safeguards (DoLS).

We saw people had access to regular drinks, snacks and a varied and nutritious diet. If people were at risk of losing weight we saw plans were in place to manage this. People had good access to health care services and the service was committed to working in partnership with both healthcare and social care professionals.

People who used the service and their relatives were positive in their comments about staff and the service they received from Beechwood Care Home. People described staff as being ‘lovely, caring and kind.’

People had various activities available to them although the suitability of activities and how this impacted on people’s occupation and wellbeing had not always been considered.

The provider completed a range of audits in order to monitor and improve service delivery. There were good auditing and monitoring systems in place to identify where improvements were required and the service had an action plan to address these.

Improvements were also required to the medication system at the service. This was regarding the storage and recording of medicines.

One inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

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

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

Is the service safe?

We inspected the medication system at the service to ensure that improvements had been made in this area following our last inspection. We found that improvements had been made to the storage and recording of medicines.

Staff involved in giving people their medication had received training to ensure they did this in a safe and effective way

Is the service effective?

People's nutritional needs were known by the staff and were being monitored. Effective monitoring systems were in place to make sure that everyone received the support they required to ensure they received the nutrition and hydration they required for their general health and well-being.

Is the service caring?

Not applicable. We did not inspect this area.

Is the service responsive?

Not applicable. We did not inspect this area.

Is the service well-led?

Not applicable. We did not inspect this area.

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

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

Is the service safe?

People we spoke with said they felt safe at the home and were respected by the staff. A person we spoke with said 'I am taken care of.' Relatives told us they were happy with the care and support their loved ones received at the home.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). Senior staff had been trained in this area to help to protect people.

We had received a higher number of safeguarding notifications from this service which prompted us to undertake this scheduled inspection. The issues raised were being looked into by the relevant authorities. The provider had notified us of these issues and were cooperating with the relevant authorities to help to protect people. Safeguarding policies and procedures were in place for staff to follow. Staff we spoke with told us that they knew what action they must take if they suspected abuse was occurring. A member of staff said 'If I saw a safeguarding issue I would go to the manager. I have had safeguarding training.'

Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints and concerns. This helped to reduce the risk to people and helped the service to look at ways to improve.

Staff involved in giving people their medication had received training to assist them to do this safely. However, we found that there were some minor issues to address. We have asked the provider to address the issues found.

Is the service effective?

People's health and care needs were assessed with them or with their chosen representative. People were encouraged to live their life even if there were risks attached to this, which promoted their independence.

Help and advice was gained from relevant health care professionals in regard to people currently living at the home. We spoke with two visiting health care professional on our visit, both spoke positively about how staff listened to their advice and acted upon it to enhance people's health and wellbeing.

People's nutritional needs were known by the staff and were being monitored. However, effective monitoring systems were not in place to make sure that everyone received the support they required to eat and drink. We have asked the provider to address the issues that we found.

Is the service caring?

People were seen to be supported by staff who appeared to be patient and kind. We saw that people were visited by a range of relevant health care professionals. This helped to maintain people's health and wellbeing.

We saw staff spent time with people, for example we saw staff undertaking a board game with people in the downstairs lounge. People we spoke during our visit said staff were pleasant and kind. Relatives we spoke with said 'Everything is as good as it can be, I have no concerns. I feel X is safe and well looked after. The staff are really friendly they do everything they can for the people in here.' and 'The staff are good. They are very skilled. They are very good with X.'

People using the service were asked to complete a satisfaction survey. The manager told us that the results of this survey had not been received yet. However, they said that any shortfalls or concerns raised would be addressed.

Is the service responsive?

We saw the manager had an 'open door' policy in place. In her absence the Area Manager was there to listen to and take on board issues raised by people or their relatives.

The management team took action to help to protect people's wellbeing when safeguarding issues were reported to them.

Is the service well led?

The service worked well with other health care professionals to ensure that people could receive the care they needed. Quality assurance systems were in place. The quality of the service provided was being monitored and was under review to ensure shortfalls found could be addressed. The management team told us they were about to look at how mealtimes could be improved for people.

Staff were clear about their roles and responsibilities. Staff we spoke with said they were happy working at the home. They said they would not want to work anywhere else. The ethos of the home was to continue to improve all areas of the service over time.

The manager of the service told us that there had been a lot of changes undertaken to the quality of the service over the last few months. They were determined to continue to make positive changes to the service to enhance people's quality of life at the home.

We spoke with eight people who used the service and six relatives. Everyone told us they were satisfied with the care they or their relative received. People told us that they were treated with respect and were able to make choices and decisions about their care. One person told us 'Wonderful people in here, you get help when you need it, but they encourage you to help yourself to be independent.'

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. One relative told us 'I can go home and sleep at night knowing she is being well looked after.'

People who use the service were protected from the risk of infection as the provider had good systems in place to prevent the spread of any infection.

Records we looked at also confirmed that staff received appropriate training in areas such as dementia awareness, infection control and safeguarding. Staff we spoke with told us that they received 'really good support from the manager' and that they received good training.

There was a range of effective quality management systems in place to assess and monitor the quality of service that people received.

We were told that people who lived at the home had bruising and skin damage. We asked the manager about this. They told us that currently nobody at the home had any pressure damage to their skin. We looked in someone's care records who the manager identified had previously had some pressure damage. We read that this had now healed and preventative measures such as pressure relieving equipment were in place to avoid this happening again.

We were told that there had been an issue with the laundry arrangements between Christmas and the New Year because both of the washing machines had broken down. However contingency plans were put in place until the machines were fixed. The laundry was fully functional on the day of inspection.

We observed how staff supported people with their mobility and how they used moving and handling equipment such as hoists to move people safely. Staff confirmed that they had been trained in moving people safely. Staff reported that although the work was hard and tiring staff moral was improving and they felt supported by the home manager to carry out their roles and responsibilities fully.