The inspection was unannounced and carried out by two inspectors over two days on 19 January 2015 and 20 January 2015.
Beechtree House Limited provides care and accommodation for up to 24 older people, some of whom are living with dementia. The property is a period building with more modern adaptations. The majority of bedrooms are for single occupancy, with two that can be shared. Most bedrooms have en-suite facilities. Accommodation is over three floors accessed by a passenger lift. There is an enclosed patio area and small car park. Beechtree House is close to Maidstone town centre and local and mainline rail stations.
People had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people’s behaviour presented challenges and was responded to with one to one support from staff.
The provider had notified us that the registered manager had left their post in July 2014 and that the interim management of the service was carried out from August 2014 by an acting manager. The registered manager was in the process of de-registering with the CQC. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert with the provider and local authority if they had any concerns. Staff had completed training in many areas that were essential for their role including dementia care and diabetes. Other training in essential skills had not been arranged for all the staff therefore people could not be assured their care was delivered by skilled and knowledgeable staff.
Risk assessments were centred on the needs of the individual and included assessed risks to people when they were outside the home using local facilities. Each risk assessment included a risk management plan for staff to follow to make sure people were protected from harm.
There were sufficient staff on duty to meet people’s needs. Staff had sufficient time to support people in a way that respected individual needs. Staffing levels were calculated according to people’s changing needs and dependency levels.
There were robust staff recruitment procedures in place. These included the checking of references and carrying out criminal records checks for prospective employees before they started work. All staff were subject to a probation period and to disciplinary procedures if they did not meet the required standards of practice. All members of staff received one to one supervision sessions every three months and were scheduled for an annual appraisal. Staff told us, “We get good support”. This ensured people received care from staff who were appropriately supported in their role.
People’s medicines were stored and administered correctly. Staff were trained in the safe administration of medicines and kept medicines administration records that were accurate. The acting manager observed staff practice to check good standards were maintained.
Staff communicated effectively with people, responded to their needs promptly and treated them with kindness and respect. Staff communicated with each person in a way that met their needs and helped them to understand their care and the choices they could make. There was an effective system of communication between staff to make sure they were all aware when people’s care needs or health changed.
People’s needs were met by adaptations to the service. The building was adapted to provide spacious bedrooms, bathrooms and communal area. The fabric of the building showed signs of wear and tear. The owner discussed with us the improvements that had been carried out and told us about further improvements such as repairs, carpet replacement and re-decoration that were scheduled.
The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). We found the service to be meeting the requirements of the DoLS. Assessments of people’s mental capacity were carried out when necessary and meetings were held appropriately to discuss decisions in people’s best interest. Staff sought and obtained people’s consent before they provided their support.
People were very complimentary about the food provided. The food was home-made, well presented, hot and in sufficient amounts. People were consulted and participated in the planning of menus. People’s weight was monitored and people’s specific dietary needs were respected. Staff assisted people to eat when necessary at a pace that suited them.
Prompt referrals were made to relevant health services when people’s health needs changed. People were referred to health care professionals such as a GP, dietician, psychiatrist, specialist nurses and an occupational therapist when necessary. A chiropodist, an optician and a dentist also visited the service to see people.
People told us they were satisfied with the way staff cared for them. Two people told us, “The staff are very kind and friendly” and, “Everyone is part of a good bunch here”. People’s diverse needs were accommodated and they were involved in their day to day care. A member of staff said, “We encourage them to speak up and we listen to what they have to say”.
Information about the service was provided to people and visitors and included information about how to complain. Staff were aware of the importance of maintaining confidentiality.
People’s privacy was respected and people were assisted with their personal care needs in a way that respected their dignity. The staff promoted people’s independence and encouraged people to do as much as possible for themselves when it was safe for them to do so.
Staff responded positively and warmly to people. People were involved in their day-to-day care. People’s requests for help were responded to without unnecessary delay by staff.
The acting manager ensured that care plans were written taking into account people’s life history, preferences and what was important to them. People’s individual assessments and care plans were reviewed monthly and updated when people’s needs had changed. The staff were made aware of initial assessments of people’s needs to ensure they were knowledgeable about people’s individual requirements as soon as they came into the service.
There was no activities co-ordinator in post. This vacancy was advertised and the acting manager was interviewing candidates at the time of our inspection. However, in the meantime staff were entertaining people in the afternoons engaging them in indoors activities.
The acting manager sought people’s feedback during residents meetings and sent annual questionnaires to people’s relatives or representatives to gather their impressions of the service. The acting manager had written an improvement plan that was informed by these surveys. They had implemented changes in the service and carried out audits to further monitor the quality of the service and identify how it could improve. Regular staff meetings were held to discuss the running of the service.
We have made a recommendation about staff training.