Beechwood Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

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 people’s needs were not always met.

This service scored 61 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care was not always delivered in a way that reflected people's individual needs, preferences and choices. While care plans contained information about people's backgrounds, routines and support needs, staff did not consistently use this information to personalise care or ensure people received support in line with their preferences and assessed needs.

We observed occasions where care appeared task-focused rather than person-centred. People were not always offered meaningful choices about food, drinks or daily activities, and staff did not always take opportunities to engage with people or respond to what they were communicating. Some people experienced delays in receiving support with eating and drinking, while others spent extended periods without meaningful interaction or stimulation.

There was evidence that some staff knew people well and understood what mattered to them. People and relatives spoke positively about aspects of care and support, and some described staff respecting personal routines and preferences. One person told us, "I chose to come here. I love it here." Relatives also gave examples of staff recognising when people preferred to remain in bed or follow their usual routines. However, care was not consistently delivered in accordance with planned support arrangements, and people's individual needs and preferences were not always reflected in day-to-day practice. This meant people did not always receive care that was fully personalised, responsive or centred around what mattered most to them.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

There was evidence of effective communication and coordination between staff, healthcare professionals and relatives to support people's changing needs. The service had introduced daily flash meetings, weekly wound clinics and weekly weight reviews to improve oversight and continuity of care, and staff described a greater focus on sharing information about people's wellbeing and any emerging concerns.

People benefited from input from a range of health and social care professionals where required. Records demonstrated joint working with external agencies, including healthcare services and local authority professionals, to review and respond to people's needs. Information relating to areas such as nutrition, hydration and health monitoring was shared between relevant staff and departments to support continuity of care.

Relatives spoke positively about communication with the service and described being kept informed about their family member's wellbeing. One relative told us, "They [staff] always update us on how [relative] has been, whether they have eaten anything etc." Another said, "They [staff] are brilliant. Very attentive. It's not just clinical updates but also how they have been."

While some recently introduced systems were still becoming embedded, there was evidence that care was increasingly organised in a coordinated way that supported continuity and enabled staff to respond to changes in people's needs.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The provider did not always ensure people received information in a way they could easily access, understand or use. We found examples of information displays that were incomplete, unclear or not maintained, including information intended to support people’s wellbeing, daily choices and understanding of the service. Some information was handwritten, difficult to read or lacked sufficient detail to effectively meet people’s needs.

Although information such as complaints procedures, newsletters and other service information was available, this was not always presented in a clear, consistent or accessible way. Care plans and records contained some information relating to people's communication needs and Accessible Information Standard (AIS) requirements. However, these were not always clearly reflected in the information available within the service. As a result, we could not be assured people always had access to accurate, meaningful and accessible information to support their involvement in decisions about their care and daily lives.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The interim manager had taken steps to listen to and involve people and their relatives in the development of the service. Recent improvements included greater involvement in menu planning, care reviews and activity planning. Relatives described feeling listened to when they raised concerns or suggestions. One relative told us, “I have made comments more than complaints and I feel they have been addressed.” People and relatives also reported improvements in communication, with 1 person commenting, “Initially things were not as good but are getting better. The communication is good.”

However, opportunities to listen and respond to people were not always consistently recognised in day-to-day care. During our observations, staff did not always acknowledge or respond promptly when people expressed needs, discomfort or distress. This meant that while formal mechanisms for gathering feedback were improving, people's voices were not always acted upon consistently in the moment.

Overall, there were positive signs that the service was becoming more responsive to feedback and involving people more in decisions about care and support. However, these improvements were recent and had not yet been fully embedded across all areas of the service.

The provider had taken steps to make the service accessible for people with different needs.

The environment included dementia-friendly signage, coloured bedroom doors, photo cues, reminiscence displays and specialist equipment to support people's safety and independence. Care plans and records reflected individual needs and preferences, including information about communication, dietary requirements, swallowing difficulties and personal approaches known to support people's wellbeing.

These arrangements helped staff to understand and respond to people's needs and enabled people to access care and support in ways that were tailored to them. The environment and care planning systems contained a range of adaptations designed to promote inclusion, understanding and independence.

Staff and leaders did not always listen to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

People's experiences were not always consistent across the service. We observed variations in the way care and support were provided, particularly on the nursing unit, where some people did not always receive the same level of responsive support as others. Whilst, the interim manager had started to make changes to address these, it meant not everyone living at the service had the same opportunities or outcomes from their care.

The provider had arrangements in place to support people to experience fair, personalised and inclusive care. Care records contained information about people's individual needs, preferences and risks, including dietary requirements, allergies, communication needs and approaches known to support their wellbeing. The service also used a range of environmental adaptations and accessible information to help people access care and support in ways that reflected their individual needs. However, this did not always mitigate the lack of equity in how people experienced the service.

People and relatives generally described positive experiences of care and support. Observations showed warm and respectful interactions between staff and people, and there was evidence that reasonable adjustments were made to meet individual needs. One relative told us, "They manage really well. Some days [relative] doesn't want to get up so they leave them a bit longer. We think they enable [relative] to make decisions themselves." Another person said, "I have absolutely no regrets. All the care staff here are amazing, and they feel like a second family."

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider had arrangements in place to help plan future care and support for people. Leaders described six-monthly care reviews with relatives, regular discussions about people's changing needs, and action planning to drive improvements within the service. There was evidence of forward planning, including proposed developments to the environment, activities and dining experiences in response to feedback and identified needs.

Records demonstrated anticipatory planning for individual people, including collaborative reviews with external professionals, when needs changed. These arrangements supported the provider to plan ahead and adapt care and support in response to people's evolving circumstances.