Beeches Care Home

Beeches Care Home is a care home providing personal care for up to 64 people aged 65 and over, some of whom were living with a dementia. The home is purpose-built and accommodation is provided across two floors. 37 people were using the service when we inspected.

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

Risk and medicines management had improved, but further and sustained improvements were needed.

Infection prevention and control systems were in place, but improvement was needed in some areas. Staff were able to spend more time interacting with people. People were safeguarded from abuse.

The support people received with eating and drinking needed ongoing improvement. Some redecoration of the service had taken place since our last inspection, but further improvement was needed.

Staff were supported with regular training, supervision and appraisal. 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.

Governance systems had not always lead to improvements at the service. Feedback was sought, but improvements were still needed on how it was acted on. We received positive feedback on the leadership of the registered manager. Staff worked effectively with a wide range of external professionals.

We received mixed feedback on whether people’s and relatives’ views were sought and acted on. People said they were happy at the service and spoke positively about the staff. We observed kind and caring support being delivered.

Care plans had been improved to make them more personalised and reflective of people’s needs and preferences. Activities were taking place, and we received positive feedback about these. The provider had systems in place to investigate and respond to complaints.

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 requires improvement (published 28 April 2022). 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.

At our last inspection we recommended that the provider review staffing levels at the service. At this inspection we found that the provider had acted on this recommendation and improvements had been made to staffing.

The last rating for this service was requires improvement. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Recommendations

We have made recommendations about medicines management and involving people in decisions about their care.

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.

Beeches Care Home is a care home providing personal care for up to 64 people aged 65 and over, some of whom were living with a dementia. The home is purpose-built and accommodation provided across two floors. 43 people were using the service when we inspected.

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

People were not always treated with dignity and respect, and staff did not always have time to check on their general wellbeing.

Medicines were not always managed safely at the home. Risks were not always effectively assessed or addressed. Systems had not been established to ensure effective risk management or infection prevention and control measures.

Systems had not been established to monitor and improve the safety and quality of the support people received with eating and drinking. Some areas of the home were in need of redecoration, and plans were in place to do this. Training was not always current, and the provider was working on improving this.

Systems had not been established to monitor and improve the safety and quality of the service.

Care was not always responsive to people’s assessed choices and support needs. Activities took place but these were limited and not taking place when the activities co-ordinator was not present.

We made a recommendation around staffing levels.

Accidents and incidents were monitored and people were safeguarded from abuse.

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. People were supported to access external professionals.

The provider had a clear complaints procedure in place. End of life care was provided in line with people’s assessed needs and preferences.

People, relatives and staff spoke positively about the culture and values of the service. Staff worked effectively with a wide range of external professionals.

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 16 December 2017)

Why we inspected

The inspection was prompted due to concerns received about medicines management, the environment and the care provided.

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.

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

Enforcement and Recommendations

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 medicines management, the premises and governance processes 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. 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.

The provider had followed current guidance in relation to infection prevention and control. The home was currently closed to non-essential visitors and admissions. Measures had been implemented to ensure people entering the home did so following current guidance regarding personal protective equipment (PPE) and social distancing. This included temperatures being taken on arrival and PPE being used.

The home was clean and tidy and had designated cleaning staff. Housekeeping and care staff were documenting cleaning being carried out within the home. All staff ensured regular disinfection of frequently touched surfaces of the home for example handrails and banisters.

COVID-19 testing was taking place regularly for people and staff. Staff had access to guidance and policies regarding COVID-19 and infection prevention and control. People who had tested positive for COVID-19 were cared for, as far as possible, in their bedrooms to minimise the risk of spreading the virus.

Staff had received training and ongoing guidance about COVID - 19 and how to safely provide care and support to people. This included how to use and discard PPE safely. There was a good supply of PPE available to staff. PPE was placed throughout the corridors of the home, to enable easy access for staff. However, the PPE was not stored safely. The management team had already recognised this and had ordered PPE storage stations.

Further information is in the detailed findings below.

The Beeches was last inspected by CQC on 3 May 2016 and was rated Requires Improvement overall and in four areas; Safe, Effective, Responsive and Well-led. We informed the provider they were in breach of regulation 12 regarding the safe management of medicines and the management of risk assessments.

Whilst completing this visit we reviewed the action the provider had taken to address the above breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the provider had ensured improvements were made in these areas and this had led the home to meeting the above regulation.

The Beeches is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Beeches provides personal care for up to 64 people. At the time of our inspection there were 59 people living at the home, some of whom were living with dementia.

There was a registered manager in place. 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.

At the last inspection we found that the service didn’t have appropriate arrangements in place for the safe handling of medicines. Stock checks of controlled drugs were not always recorded accurately and room and medicine temperatures were not always recorded. People’s medicines records were not always person centred and lacked detail and audits of medicines did not identify issues. Records for people who took medicines ‘as and when required’ were not detailed enough to give staff enough guidance. At this inspection we observed actions had been taken and sustained improvements were achieved in this area including improved records.

At the last inspection risk assessments for people were not updated regularly and some lacked detail. At this inspection we found people were supported to take risks in everyday living and individualised risk assessments were in place and updated regularly.

Accidents and incidents were monitored by the registered manager to monitor any trends and to ensure appropriate referrals to other healthcare professionals were made if needed.

The premises were clean and tidy. However we observed a malodour on the first floor of the building and this was addressed by the registered manager.

Throughout the inspection we saw staff cleaning communal areas, and we noted that people’s rooms were also tidy. Staff had access to personal protective equipment.

People who used the service were supported by sufficient numbers of staff to meet their individual needs and wishes.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation. Robust recruitment processes were in place.

People’s health was monitored and referrals were made to other health care professionals where necessary, for example, their GP, community nurse or dentist.

Staff were supported to maintain and develop their skills through training and development opportunities..

Staff had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further training needs.

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.’

Where people lacked the mental capacity to make decisions about aspects of their care staff were guided by the principles of the MCA to make decisions in the person’s best interest. For those people that did not always have capacity, mental capacity assessments and best interest decisions had been completed for them. Records of best interest decisions showed involvement from people’s family and staff.

Consent to care and treatment records were signed by people where they were able.

At the last inspection records for people’s fluid and food intake were not always completed. At this inspection people were supported to maintain a healthy diet, and records to support this had improved and were now detailed.

At the last inspection people didn’t always have a positive dining experience and at times had to wait for their meal to be served. At this inspection this had improved and anew system was in place to reduce peoples wait and the feedback from people was positive.

Throughout the day we saw that people who used the service, relatives and staff were comfortable, relaxed and had a positive rapport with the registered manager and also with each other.

The service supported people to access advocacy services. Procedures were in place to provide people with appropriate end of life care.

People’s needs were assessed before they moved into the service. Care plans were then developed to meet people’s daily needs on the basis of their assessed preferences. Plans were improved and included more person centred details regarding people s preferences and were updated regularly.

The Beeches Care Home can accommodate up to 64 people. The building is on two floors and is located in a residential area of Newtown, Stockton. At the time of our inspection 52 people were using the service, some of whom were living with a dementia.

There was a registered manager in place. 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.

Appropriate arrangements for the safe handling of medicines were not always in place. Controlled drugs were regularly assessed however stocks were not always recorded accurately. Room and fridge temperatures were not recorded on the ground floor and not recorded accurately on the upper floor. Care plans were not person centred for medicines administration as they did not have information about a person’s preference for taking medicines. Medicines audits were completed however they lacked detail. ‘As required’ (PRN) medicine care plans were not always sufficiently detailed. People managing their own medicines did not always have completed risk assessments. The frequency of medicine administration was not always safely managed.

Risks to people were assessed and plans put in place to minimise the chances of them occurring. The service used recognised risk assessment tools to do this. Most risk assessments were specific and detailed how the risk could be minimised and how often it should be reviewed. However, we did see that some risk assessments for one person were lacking in detail and the registered manager said this would be reviewed.

Risks to people arising out of the premises were regularly reviewed, and remedial action taken where needed. Accidents and incidents were monitored by the registered manager to see if any trends were emerging and to ensure appropriate referrals where made if needed. The registered manager described how they used their accident analysis to make referrals to external professionals such as the falls team.

Plans were in place to evacuate people safely in case of emergency. A business continuity plan was in place in to help staff organise a continuity of care in a range of situations where the premises could not be used.

The premises were clean and tidy. Throughout the inspection we saw staff cleaning communal areas, and we noted that people’s rooms were also tidy. Equipment was generally suitably stored, though we did see some continence pads being stored in a communal lounge. The area manager said these would be moved immediately. Throughout the inspection we saw staff using personal protective equipment (PPE) such as gloves and aprons to assist with infection control.

The registered manager and area manager both monitored staffing levels at the service. The registered provider had three other services in the region and these were used to provide staff to cover absences. Housekeeping and kitchen staff completed the same training as care staff, so were able to provide care support in emergency situations.

The registered provider’s recruitment procedures minimised the risks of unsuitable staff being employed. Applicants completed an application form requiring them to detail their employment history and provide details of two referees. Written references were sought and Disclosure and Barring Service (DBS) checks carried out before applicants were employed.

Staff understood safeguarding issues and procedures were in place to minimise the risk of abuse occurring. Where concerns had been raised we saw they had been referred to the relevant safeguarding department for investigation.

Staff said they received the training needed to support people effectively. Staff received mandatory training in areas including manual handling, safeguarding, health and safety, infection control, pressure ulcer care, fire training, the Mental Capacity Act 2005 and nutrition. Training was regularly refreshed to ensure it reflected the latest best practice. Newly recruited staff completed induction training. This covered areas including the service’s policies and procedures, health and safety and delivering care.

Staff felt supported by regular supervisions and appraisals. Records confirmed that staff were able to raise issues at supervision and appraisal meetings, which were used to discuss any training or support needs staff had.

The service was working within the principles of the Mental Capacity Act 2005. Where people lacked the mental capacity to make decisions about aspects of their care staff were guided by the principles of the MCA to make decisions in the person’s best interest. For those people that did not always have capacity, mental capacity assessments and best interest decisions had been completed for them. Records of best interest decisions showed involvement from people’s family and staff.

Consent to care and treatment records were signed by people where they were able. If people were unable to sign a relative or representative had signed for them.

People were supported to maintain a healthy diet, though records to support this were not always detailed. Staff monitored some people’s food and fluid intake to minimise the risk of malnutrition or dehydration. The food charts recorded the food a person was taking each day, however portion sizes were not included. Fluid intake charts recorded the fluid a person was taking each day, however fluid intake goals and totals were not recorded.

People appeared to enjoy the dining experience, though there was some delay in people being served their food. We were told flash card menus were used to help people living with a dementia choose their meal, but this did not happen during the inspection.

People were supported to access external professionals to maintain and promote their health. Care records showed details of appointments with and visits by healthcare and social professionals.

People were treated with dignity and respect. Staff were polite and courteous when speaking with people, whilst at the same time being open and friendly. Where staff supported people we saw them asking for permission and working at people’s own pace.

People and their relatives spoke positively about the care they received. Throughout the inspection we saw many examples of kind and friendly interactions between people and staff. Staff tailored their communication approach to ensure people could understand them. Staff said they enjoyed spending quality time with people and getting to know them.

The service supported people to access advocacy services. Procedures were in place to provide people with end of life care.

People’s needs were assessed before they moved into the service. Care plans were then developed to meet people’s daily needs on the basis of their assessed preferences. However, some of the plans we saw contained limited or no detail on how to meet people’s needs and preferences. The registered manager said these would be updated.

The service employed an activities co-ordinator, who assisted people to access activities based upon their needs and preferences. We did note there were no specific activities for people living with a dementia. The activities co-ordinator was on leave during our inspection, and during their absence we noted there was limited activity provision at the service.

There was a complaints policy in place, and where issues had been raised these had been investigated and the outcomes communicated to the people involved.

The registered manager and registered provider carried out a range of quality assurance checks to monitor and improve standards at the service. Where issues had been identified by audits we saw that this usually led to remedial action but we saw this was not always the case.

Staff spoke positively about the culture and values of the service and the support they received from the registered manager. Staff and health and safety meetings took place to share information and allow staff to raise any concerns they had.

Feedback was sought from people using the service and staff through annual questionnaires.

The registered manager told us about the links the service had with the local community. The registered manager understood their role and responsibilities and the types of notifications that should be made to the Commission.

We found one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to medicines management. You can see what action we took at the back of the full version of this report.

We carried out this inspection to check that improvements had been made in respect of shortfalls in the care and treatment that people received identified on our previous visit on 27 November 2013.

During our inspection on 14 February 2015, we spent time speaking with the registered manager, two senior care staff, four care staff, two relatives, four people who lived there and observing people and care staff. We looked at the records that related to people's personal information that we had previously found to be limited in detail. We found that improvements had been made and that people's care plans were robust and contained up to date and relevant information for staff and medical professionals.

A dedicated activities coordinator had been recruited and we found evidence that people were protected from the risks of social isolation because they were encouraged to take part in a variety of activities that were stimulating. We found that staff conducted and recorded hourly checks of communal areas in the home. If you want to see the evidence that supports our summary please read the full report.

People who used the service told us that they were happy with the care and support that they received. One person said, 'It's lovely, relaxed and I'm not worried about pressing my buzzer. If I need help, I get it.' Another person said, 'The staff have a heart of gold they will do anything for you.'

The manager told us that the activity co-ordinator left in October 2013 and since then she had been trying to recruit a new person to plan activities and outings for people who used the service. Seven of the 11 people we spoke with told us that since the activity co-ordinator left, activities carried out on a daily basis have been limited.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. However, we saw that people were let unattended in the residential lounge from 1:40pm until 2:50pm.

People were supported to eat and drink sufficient amounts to meet their needs.

People's health, safety and welfare were protected when more than one provider was involved in their care and treatment.

We saw that the service had appropriate equipment and that regular servicing was undertaken to ensure that it was safe.

We found that appropriate recruitment procedures were in place.

People said they were involved in their care, with their preferences being sought and taken into consideration. This included being helped to live their lives independently and joining in with activities if they wished.

Everybody we spoke with told us they felt safe at Beeches and with the care staff employed by the service. People were also clear about how and who to report any concerns about their safety.

Most people told us they were happy with the staff employed by the service and the care they provided. One person said "They look after me smashing; I have no problems with the staff.' People said the staff knew them well and how best to help and support them in their everyday life. A small number of people were less complimentary of the staff and food at Beeches, but felt the new manager was making improvements to the home.

There were arrangements in place to gain additional feedback about services from user satisfaction surveys, relatives and staff questionnaires.