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Inspection carried out on 19 December 2016

During a routine inspection

This inspection took place on 19 December 2016 and was unannounced.

Becket House nursing home provides accommodation and support for people who require nursing and personal care and may have a range of social, physical and dementia care needs.

At the time of our inspection the provider confirmed they were providing support to 21 people.

There was a registered manager 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.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse. Staff were comfortable in raising concerns and felt that appropriate actions would always be taken.

People had risk assessments in place to enable to make sure that they were as safe as possible. Staff were confident that the risk assessments enabled them to support people in a positive and safe manner.

Staffing levels were adequate to meet people's current needs. There were a consistent amount of staff on duty and people told us they received the support they needed promptly.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

Staff induction training and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles. Staff were provided with the opportunity to gain qualifications and extra skills and knowledge within care.

People told us that their medicines were administered safely and on time. We saw that medication was stored securely and appropriately, and that regular audits took place. Only trained staff took part in the administration of medicines.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions. The registered manager carried out regular observations of staff to ensure good practice.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. People told us that staff spoke with them and gained their consent on a regular basis.

People were able to choose the food and drink they wanted and staff supported people with this. Fresh food was cooked and served to people either in communal areas or within their rooms.

People were supported to maintain their health. Health professionals visited the service as required, and people were supported to book and attend appointments outside of the service as needed.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Staff interacted with people in a positive manner, and had a good knowledge of the things people liked.

People were involved in their own care planning and were able to contribute to the way in which they were supported.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The people we spoke with knew how to use it.

Quality monitoring systems and processes were used effectively to drive future improvement and identify where action was needed.

Inspection carried out on 15 January 2015

During a routine inspection

Becket House Nursing Home is registered to provide accommodation and support for up to 23 people who require nursing and personal care and may have a range of social, physical and dementia care needs. On the day of our visit, there were 20 people using the service.

The inspection was unannounced and took place on 15 January 2015.

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.

During our inspection in May 2014, we found minimal evidence that people were involved in decisions about their care and treatment. There was a lack of choice in meals for people and fresh fruit and vegetables were not used to ensure that meals were nutritionally balanced. One safeguarding incident had not been reported to the Care Quality Commission (CQC) in respect of an incident of alleged abuse which had taken place. Following the inspection the provider sent us an action plan detailing the improvements they were going to make and stating that improvements would be achieved by November 2014.

During this inspection, staff were aware of their responsibilities to keep people safe and report any allegations of abuse.

Action was taken to keep people safe, minimising any risks to health and safety. Staff knew how to manage risks to promote people’s safety.

There was sufficient staff on duty to meet people’s needs and keep them safe. Staff numbers were based upon people’s dependency levels and were flexible if people’s needs changed.

Staff had been recruited using a robust process, with effective recruitment checks completed.

Systems were in place to ensure that medicines were stored, administered and handled safely.

Staff were knowledgeable about the specific needs of the people in their care because they had received appropriate training and support.

There were policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguard (DoLS) to ensure that people who could make decisions for themselves were protected.

People were given the opportunity to make choices about their food and drink and were provided with support to eat and drink, where this was needed.

People had access to health and social care professionals when they needed, and prompt action had been taken in response to illness or changes in people’s physical and mental health.

People and their relatives were happy with the care they received from staff, and were involved in decisions about their care and day to day choices.

People’s personal views and preferences were responded to and staff supported people to do the things they wanted to do.

The home had an effective complaints procedure in place. Staff were responsive to concerns and when issues were raised these were acted upon promptly.

The service was well-led and staff were well supported and motivated to do a good job. The registered manager and senior staff consistently monitored and reviewed the quality of care people received and encouraged feedback from people and their representatives, to identify, plan and make improvements to the service.

Inspection carried out on 16 May 2014

During a routine inspection

Becket House Nursing Home provides nursing and residential care to people, some of whom are living with dementia. The service can accommodate 23 people. At the time of our inspection there were 19 people living at the service, although one person was in hospital when we visited. The home had 13 people who required nursing care and five people who received personal care.

There was no registered manager at the service at the time of our inspection due to a change in management. The current manager had applied for registration with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found that people’s care needs were being met by staff who were adequately trained to do so. Staff told us that they felt supported, however, some staff said that they were rushed in their work and that they would benefit from more staff. We observed staff to be task focussed during our inspection and saw that they lacked time to spend with people using the service. Staff did not have time to engage with people who used the service and spend meaningful time with them. People were happy living at the home. They told us staff treated them with kindness and that they responded to their needs. Some people told us that there was a lack of activities at the home and we observed this during our visit. We found that people sat for long periods with little to do and we found no evidence that people were encouraged to remain independent and access the local community. We found there a breach of Regulation 17 of the Health and Social Care Act 2008 which we have detailed in this report.

We looked at nutrition and hydration as part of our inspection and found there to be a lack of choice for people and little fresh fruit and vegetables at the home. We found there to be a breach of Regulation 14 of the Health and Social Care Act 2008 which we have detailed in this report.

The Mental Capacity Act 2005 had been adhered to at the home and there were robust procedures in place that ensured people’s best interests were being considered. Deprivation of Liberty Safeguards had been appropriately applied for.

When we inspected this service in June 2013 we found that staff did not have the required knowledge in relation to protecting people from the risk of abuse. We also found that improvements needed to be made in relation to staff supervisions and appraisals as these had not been taking place at the service. During this inspection we found that the required improvements had been made by the current manager and that the service was now meeting the regulations in these areas.

We found that the manager in post had started to implement some of the changes which needed to take place at the home. The manager showed us an improvement plan they had implemented and were working towards. One safeguarding incident had not been reported to CQC and this was a breach of Regulation 18 of the Health and Social Care Act 2008.

Due to the number of concerns raised during our inspection and the fact that there were insufficient systems in place to monitor the service and identify these concerns we found there to be breach of Regulation 10 of the Health and Social Care Act 2008. There was a lack of management checks to ensure that people were receiving safe, effective, and responsive care.

Inspection carried out on 16 May 2014

During Reference: R6 not found

Inspection carried out on 5 June 2013

During a routine inspection

On the day of our inspection, the provider told us that the manager had resigned and that a new manager was now in place. We received confirmation of this from the former manager after our inspection took place.

We spoke with family members who were happy with the care that their relative had received, one relative told us that “my father has improved since coming to Beckett House”. We found that people’s representatives such as family members were involved in the planning of people’s care and had been involved in decision making discussions.

The people we spoke with told us that they were quite happy with their care and that the staff treated them very well. We saw staff treating people with genuine warmth and compassion.

We found that people’s care plans were regularly updated, but we also found that some care plans did not contain enough detail to inform the staff of specific care requirements such as mobility and falls.

We saw that the provider had suitable recruitment procedures in place and that staff had the right level of experience for their role. However we found that arrangements were not in place to ensure that staff received appropriate professional development, supervision and appraisal. This meant that staff had not benefitted from regular supervision meetings to support their learning and development for a long time. We found that appraisals for staff had not been practiced for a couple of years but are planned to commence later this year.

Inspection carried out on 20 July 2012

During a routine inspection

On the day of our visit to Becket House there were 23 people in residence. We spoke with four people who used the service and two visiting relatives. Many people were unable to speak with us because their dementia had impaired their ability to communicate.

The people we spoke with confirmed that they were happy living at Becket House and that they felt safe. One person said, "I feel free to please myself and I like that."

Other comments included, "All the staff are kind. They know I like to chat and they always have time for me."

A visitor told us, "I visit whenever I like. The staff are always cheerful and helpful."

The people we spoke with also told us they always have plenty to eat and drink. One person said, "I enjoy my meals here."

Inspection carried out on 10 November 2011

During an inspection in response to concerns

People and carers (relatives) gave us good accounts of the care provided at Beckett House.

We heard that staff were responsive to the needs of people using the service and treated them with patience and kindness.

Carers told us that in their opinion people were safe and well looked after. Both a carer and a person using the service compared the home favourably with hospital and another care home.

One person told us that they enjoyed the view from their room. They enjoyed watching the animals in the garden and watching the garden change with the seasons.

Inspection carried out on 22 July 2011

During an inspection in response to concerns

One person said that the food served in the home was very good.

A relative told us that she was happy with the care and support given to her mother.

One person told us that the staff had not done enough to relieve her pain.

Inspection carried out on 16 March 2011

During an inspection in response to concerns

All the people we spoke to told us that they liked the home and were happy living there. They said that the care was good and that the staff were helpful and attentive. One person told us that the home helped them to remain independent. We were told that the food was good. A health professional told us that people’s nutritional needs were met.

A carer who was visiting told us that they found the staff welcoming. They said the staff were caring. They were satisfied with the care provided by the home. They told us that they were aware of the building improvements which were being carried out, and that so far, these did not appear to have had an adverse effect on the people using the service.

Carers told us that they knew who to complain to if they had any concerns.

Carers expressed concern at the lack of activities and also at the lack of opportunities for people to get out and enjoy the garden.

A health professional told us that the home liaised well with GPs and other health professionals. The professional expressed confidence that any treatment they prescribed would be carried out.