Beechwood Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

We did not look at this key question during the last inspection. A rating of good was based on the previous inspection rating. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

People's health, care, wellbeing and communication needs were assessed. However, they were not always reviewed and acted upon effectively. Records contained a range of assessments and information about people's needs, risks and preferences. However, these did not consistently translate into care and support that reflected those needs in practice. As a result, we were not assured the care people received was always based on accurate, up-to-date assessments.

Some assessments and care planning documentation was detailed and included guidance for staff on how to support people safely. However, these were inconsistently completed. This meant it was not always clear whether changes in people's needs, wellbeing or risks had been identified and acted upon in a timely way.

Staff told us new processes had recently been introduced to improve communication, oversight and monitoring, and there was evidence that efforts were being made to strengthen assessment and review arrangements. However, these improvements were still at an early stage and had not yet been embedded sufficiently to ensure people's needs were consistently assessed, reviewed and met through effective care and treatment.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People's care and treatment were not always planned and delivered in line with current evidence-based guidance, best practice or the provider's own policies. While the service used a range of recognised assessment tools and approaches to support care planning and monitoring, these were not consistently applied in practice. This meant we could not always be assured people’s care and treatment reflected their assessed needs, preferences and risks.

There were inconsistencies in the delivery and monitoring of care. Records relating to nutrition, hydration, repositioning and medicines management were not always completed accurately or consistently. We observed some care interventions were not delivered in line with planned arrangements.

The provider had recently introduced additional oversight arrangements, including enhanced monitoring, audits and clinical review processes. There was evidence these measures were beginning to strengthen governance and support improvements in care delivery. However, the systems were not yet sufficiently effective to ensure evidence-based guidance, care plans and policies were consistently translated into safe and effective care and treatment for people.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Leaders described a range of mechanisms to support joined-up working, including daily flash meetings, staff handovers, weekly wound and weight reviews, and engagement with external professionals such as social workers, community mental health teams (CMHT), GPs, speech and language therapists (SALT) and dietitians. This demonstrated that staff and professionals worked together to support people's care and wellbeing.

However, records did not consistently demonstrate that information from assessments, reviews and professional involvement was effectively shared, acted upon and monitored. For example, we identified unclear action tracking following resident-of-the-day reviews, and insufficient evidence regarding how recommendations, such as requests for nursing reviews of wounds, had been followed through. This reduced assurance that agreed actions were consistently completed and reviewed.

Staff feedback also suggested teamwork within the service was not always effective. One staff member said, "This is my job and this is yours [there’s] no teamwork." While there was evidence of collaborative working with external professionals, the provider could not consistently demonstrate effective communication, accountability and shared responsibility across the staff team to ensure actions were followed through and people's needs were met.

The provider did not always support people to manage their health and wellbeing to maximise their independence, choice and control. Staff did not always support people to live healthier lives and where possible, reduce their future needs for care and support.

The provider had systems to monitor people's health, including regular weight monitoring, wound care reviews, nutrition and hydration oversight, and access to a range of healthcare professionals. Records showed involvement from external services where needed, including GPs, dietitians and other health and social care professionals.

However, opportunities to promote and maintain people's health and wellbeing were not always maximised. Monitoring arrangements were not applied consistently, and staff did not always encourage or support people to maintain adequate hydration or engage in meaningful activity. During our observations, some people spent extended periods without stimulation or engagement, and staff did not always recognise when people required encouragement or support with eating and drinking.

Although some positive initiatives had been introduced, including increased oversight of nutrition and wound care, these had not yet resulted in consistently positive outcomes for all people.

Despite these concerns, people and relatives were generally positive about the support provided by staff. One person told us, "If I'm not well, I see a doctor. If I'm a bit down, someone will sit with me and make me feel better." Relatives also described staff as caring and attentive to people's wellbeing, with one saying, "We know the staff genuinely care for them, and they always update us on how they have been."

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

The provider did not always monitor people’s care and treatment so they could consistently improve outcomes. There was evidence of audits, monthly governance meetings, provider reports, weights clinics, wound clinics and resident-of-the-day reviews. However, oversight was not always robust and some systems remained at an early stage of implementation. Inspectors found examples where actions were unclear or incomplete, including resident-of-the-day records with no clear action owner or timescale, medicines audits that lacked full sign-off, and provider reporting that did not clearly evidence consistent validation or follow-through. This meant the provider had some monitoring systems in place, but they were not always effective in identifying issues promptly and driving sustained improvement.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

People's rights to make decisions about their care and treatment were not always fully supported and protected in line with the Mental Capacity Act 2005 (MCA). While there was evidence that consent, mental capacity and best interest decision-making had been considered for some people, arrangements were not always consistently reviewed, maintained or applied in practice.

Care records contained information relating to people's capacity to make decisions, day-to-day choices and best interest decision-making. Staff demonstrated an understanding of seeking consent before providing care and we observed examples of people being treated respectfully, with explanations provided and reassurance offered during support. However, opportunities to involve people meaningfully in choices were not always maximised, particularly when people required support with aspects of daily living.

We identified gaps in the oversight and management of legal frameworks intended to protect people who lacked capacity to make specific decisions. Some records and authorisations had not been kept up to date, and it was not always evident that conditions or decision-making arrangements were being monitored effectively. This meant the provider could not always demonstrate that legal requirements relating to consent and restrictive practices were being consistently met.

The provider had recognised the need for improvement and had included MCA awareness, training and governance oversight within its improvement plans. However, these actions were at an early stage and had not yet resulted in fully embedded practice to ensure people's rights, choices and freedoms were consistently protected.