Beechwood Nursing Home

Beechwood Nursing Home is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 32 people.

The care home is in one adapted building with accommodation over five floors.

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

We reviewed the provider's infection and prevention control processes and found, whilst there were protocols and procedures in place, further action was required to ensure the risk of the spread of infection was being managed robustly.

We have recommended the provider ensure staff use personal protective equipment (PPE) consistently and that the policies be regularly reviewed to ensure they reflect current government guidance.

People received safe care. There were systems in place to safeguard people from harm or abuse. Risk assessments were in place to support people to be as independent as possible. Staff were aware of their responsibility to keep people safe and were confident that any concerns raised would be acted upon by the manager.

There were enough staff to meet people's care needs. The service followed safe recruitment practices.

There was a registered manager for the home who was not in the service daily. There was also a new manager with daily oversight of the service who was applying to be registered with CQC. The manager was supported by the registered manager and the provider. Quality assurance systems were in place but needed further development to ensure actions were measurable and met in a timely way.

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 6 March 2020).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received. The inspection was prompted due to concerns about the provider’s systems to safeguard people from abuse, including safe recruitment. Also, how risks to people were managed and the management oversight of the home. A decision was made for us to inspect and examine those risks. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We inspected and found there was no evidence to support the specific concerns that prompted the inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. We made recommendations about this.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beechwood Nursing Home is a residential care home providing personal and nursing care to 15 people aged 65 and over at the time of the inspection. The service can support up to 32 people.

The care home is in one adapted building with accommodation over three floors.

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

Since our last inspection the management team included a new deputy manager who was also a nurse. They supported a new manager at the service to maintain oversight of the nursing care. The provider visited regularly to maintain oversight and offer support to the management team. Quality assurance processes had been improved and audits identified where improvements were needed. Action plans were in place which supported staff to address issues and drive improvements. Training had been increased and the service was working in partnership with external health professionals to improve people’s experience and the quality of care.

Risks to people's health and wellbeing were documented. Staff followed detailed guidance in people’s care records to minimise these risks. Staff had completed training and knew how to identify symptoms and what actions to take. For example, if someone with diabetes had a hyperglycaemic attack. This is a medical term for high blood sugar levels, which can occur when people have a diagnosis of diabetes.

Staff ensured people's medicines were administered safely, monitored and disposed of appropriately. Infection prevention and control measures had been improved and effective arrangements were now in place. People told us they felt safe and that staff worked well together to support them. Dependency tools had been improved to ensure staffing levels could meet the needs of people living at the service.

Staff knew people’s needs well and how best to support them. Care plans were detailed and included people’s preferences and how to promote their independence. Staff respected people’s dignity and considered their privacy. This included when supporting them with personal care or to eat and drink during mealtimes.

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.

Care records accurately reflected people’s needs and were regularly reviewed to guide staff when those needs changed. Records were in place detailing those involved in making decisions relating to people’s care and support needs. People were supported to access activities in line with their hobbies and interests. They had a range of activities available to them and one to one social time in their bedrooms. Staff helped people to access the wider community when they expressed a wish to do so.

The leadership and governance structures in place provided additional support to the manager. Positive feedback was received from people and their relatives about the visibility and approachability of the management team. Staff felt the manager was extremely supportive and the clinical governance advice and guidance had improved.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 23 July 2019) and there were multiple breaches of regulation. These related to person-centred care, consent, dignity and respect, safe care and treatment, staffing and governance. We spoke with the provider following our last inspection and they provided regular actions plans, 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.

This service has been in Special Measures since 19 July 2019. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People's experience of using this service: Risks which affected people’s health and wellbeing were not always documented. This meant that staff did not always have adequate information to manage and mitigate risks to people.

Staff did not always receive training in relation to people's specific health conditions and risks associated to them. Staff were unable to describe how they would support people should an incident associated to these risks occur.

Staff did not always ensure people's medicines were administered safely and monitored effectively.

People were not afforded dignity and respect by staff when they carried out personal care and other supporting roles.

Infection control procedures and audits required improvement to ensure people were protected from the risk of infection.

Quality assurance systems and audits did not effectively identify where improvements were needed.

The leadership and governance of the service needed to ensure lessons were learnt, improvements embedded and sustained to ensure people receive a good quality service.

Care records were not always up-to-date and did not encourage delivery of person-centred care. It was not always clear from records who should be consulted about decisions regarding people’s care and finances.

People had social goals they wanted to achieve; the provider explored these options to try and help people meet their goals, however, people felt staff were often too busy to support them to access the wider community.

Health professionals raised concerns about low staffing levels during busy periods. Dependency tools were not always calculated correctly to include people's current needs. We could not be sure the dependency tools accurately reflected appropriate staffing levels.

Staff did not always know people well and told us they worked in different areas of the home depending on the rota. For those people unable to express their views verbally, staff were unable to tell us of any alternative methods used to support their communication needs. After the inspection the provider sent us information around communication methods used to support one person.

People were able to express their views to us and raised concerns that they were not always supported to make their own choices and felt at times they were not involved in decisions around their care needs.

Some health professionals raised concerns that the service did not engage with them. During the inspection we raised concerns about the lack of input from some health professionals in terms of people's safety and comfort.

Care plans provided some guidance for staff to promote people's independence.

Staff had completed safeguarding training and could tell us what actions they would take if they had concerns about people's safety. People told us they felt safe living in the care home.

Audits were ineffective in identifying areas that required improvement. A lack of support was in place for the registered manager and senior management oversight was not in place to drive improvements in the service.

The provider failed to ensure improvements were made. This is the third time the service has been rated overall as below ‘Good.’ The provider had submitted an action plan after the last inspection, which told us about the improvements they planned to make. Some of these measures had not been effective, and we found continued breaches of regulation.

The overall rating for this registered provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Another inspection will be conducted within six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection: Requires Improvement. (Report published on 25 April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. The provider will continue providing regular updates to their action plan. If any concerning information is received, we may inspect sooner.

Beechwood Nursing Home is registered to provide nursing care for up to 32 older people. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is provided in one adapted building spread across three floors. At the time of our inspection 27 older people with nursing needs were using the service.

The service had a registered manager. They had been the registered manager since December 2017. A registered manager is a person who has registered with the 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.

At the last inspection in December 2016, we asked the provider to take action to make improvements to ensure the service was person-centred and to improve governance and quality assurance at the service. At this inspection, improvement had been made in some areas and the service was person-centred. However, we identified new concerns regarding safe care and treatment, staffing and on-going concerns about the governance of the service.

The provider did not have an infection prevention and control lead. The sluice room and laundry were unclean and robust systems were not in place to ensure and evidence all areas of the service were regularly cleaned and deep cleaned.

There were a number of maintenance and health and safety issues. Risks had not been adequately assessed to ensure appropriate control measures were in place to keep people safe. For example, the need for window opening restrictors had not been adequately assessed and regular checks had not been completed to ensure these were in place. Concerns identified at our last inspection about doors being left unlocked and cleaning chemicals left in accessible places had not been addressed.

Staff had not always received appropriate training. Staff had not received regular supervisions; annual appraisals had not been completed. The provider had not ensured competency checks were consistently completed to evidence staff had the necessary skills to safely meet people’s needs.

The concerns identified during our inspection showed us effective systems were not in place to monitor the quality and safety of the service provided and to maintain consistent standards of care. This was the third consecutive inspection where we identified a breach of regulation and the second time the service has been rated Requires Improvement.

We found breaches of regulation relating to safe care and treatment, staffing and the governance of the service. You can see the action we asked the registered provider to take at the back of the full version of this report.

People who used the service told us they felt safe. Staff were safely recruited and sufficient staff were deployed to meet people’s needs.

Care plans and risk assessments were person-centred and generally contained proportionate information about how staff should support people to maintain their safety. Accidents and incidents were recorded and actions taken to reduce risk and prevent reoccurrences.

Staff supported people to ensure they ate and drank enough. Staff worked with healthcare professionals and supported people to see their GP or attend appointments when necessary.

Consent to care was considered and documented in line with relevant legislation and best practice guidance.

Staff were kind and caring. Staff respected people’s privacy, dignity and personal space. People made choices about their care and support and staff respected people’s decisions.

The registered manager had a system in place to gather feedback and manage and respond to any complaints about the service.

Regular activities provided the opportunity for meaningful stimulation. Staff knew people who used the service well. Care plans contained person-centred information to support staff to provide care and support to meet people’s individual needs.

We received consistently good feedback about the new registered manager and the positive changes they had made to improve morale and organisation.

The home is registered to provide accommodation and nursing care for up to 32 older people, including people who are living with dementia. On the day of the inspection there were 26 people already living at the home, and one person was due to be admitted. The home is situated in Scarborough, a seaside town in North Yorkshire. The home has three floors and a passenger lift operates between all levels.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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. The manager was registered with CQC on 28 October 2016 and prior to that had been the registered manager for two other services within the organisation.

Some records were not up to date, some information was missing from care plans and some care plans included contradictory information. In addition to this, food and fluid charts and positional change charts had not been consistently completed. This meant there was a risk that people’s up to date care needs might not be met. This was a repeat breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance.

Although people had care plans in place, we saw that some information that should have been recorded in these plans was missing and some was contradictory. This could have led to people not receiving person-centred care. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Person-centred care.

People were protected from the risk of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Discussion with staff showed they understood their responsibilities in respect of protecting people from the risk of harm or abuse.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and the registered manager had informed the Care Quality Commission when DoLS applications had been authorised.

There were recruitment and selection policies in place and these had been followed to ensure that only people considered suitable to work with vulnerable people had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. Staff told us that they were well supported by the registered manager and they were happy with the training provided for them.

We checked medication systems and saw that medicines were stored, recorded and administered safely.

People who lived at the home and relatives told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff, and that staff had a good understanding of people’s individual care and support needs.

People’s family and friends were made welcome at the home. A variety of activities were provided and people were encouraged to take part, although we considered that more one to one time needed to be spent with people who remained in their own room. We have made a recommendation about this in the report.

People told us that they were happy with the food provided and we observed that there were choices available for them. We saw that people’s nutritional needs had been assessed and individual food and drink requirements were met. However, we found that some people required more assistance from staff to eat their meals to ensure they had enough to eat and drink. We have made a recommendation about this in the report.

People told us they were confident their complaints and concerns would be listened to. Any complaints made to the home had been investigated and appropriate action had been taken to make any required improvements. There were systems in place to seek feedback from people who lived at the home, relatives and staff.

Quality audits were undertaken by the registered manager to ensure that systems at the home were protecting people’s safety and well-being.

The home was clean and hygienic on the day of the inspection but we noted the laundry room required refurbishment as it was difficult to keep clean. Work had commenced to refurbish the laundry room and we asked the registered provider to let us know when this work is complete.

We found two breaches of regulation during this inspection. You can see the action we asked the registered provider to take at the back of the full version of this report.

Beechwood Nursing Home is registered to provide accommodation to up to 32 people who require nursing or personal care. On the day of the inspection visit the service was caring for twenty five people. The home is situated in a residential area of the seaside town of Scarborough.The home is fully accessible for those with mobility needs. There are several communal areas for residents to use.

At the time of this inspection the home had a registered manager but this person had left their post and was no longer employed by the service. 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. The service was managed by the area manager on the day we carried out the inspection visit.

Overall, medicines were safely handled, though there were a number of areas for improvement which did not impact directly on the safely of people's care. People told us they felt safe in relation to their medicines and their care.

Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe.

The home was clean and staff understood infection control procedures.

Staff were safely recruited and trained. They had regular supervision and appraisal to support them in their role.

We found the service was meeting the legal requirements relating to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The home met people’s nutritional needs and people reported they had a good choice of food. People had a good experience at mealtimes.

People had access to health care professionals when they needed this. The service referred to specialists when necessary and advice was incorportated into care plans. People were supported to attend health care appointments when they needed this.

During our visit we saw people being well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated they knew people’s individual characters, likes and dislikes. Staff were aware of and knew how to respect people’s privacy and dignity.

The service had assessed people’s needs around their social, recreational and spiritual lives. However, for some people, staff had insufficient information about them as individuals to support them to offer personalised care.

The registered provider investigated and responded to people’s complaints, according to the provider’s complaints procedure.

The service was not consistently well led, as records and systems did not fully support the area manager to monitor and mitigate the risks around people's care. This was a breach of regulation 17(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A new manager was in place, who was planning to submit an application for registration with CQC. We saw the provider had a system in place to assess and monitor the quality of the service and they acted on this to improve people's care. Staff told us they were supported and encouraged in their role.

Care was at times task based and care planning documentation was not always sufficient to ensure staff had the information required to provide personalised care. This was in breach of Regulation 9 of the HSCA 2008 (Regulated Activities) Regulations 2010- Care and welfare of people who use services.

Notifications had not been sent to CQC as required or managed appropriately. This was in breach of Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010- Safeguarding people who use services from abuse.

The provider did not always demonstrate learning from incidents to protect people. People's views and staff views had not regularly been sought or acted upon. This was in breach of Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010- Assessing and monitoring the quality of service provision.

An adult social care inspector carried out this inspection. The focus of the inspection was to follow up on the above concerns and to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with three people who used the service, two visitors, a nurse, two care workers and the acting manager. We reviewed four care plans with associated documentation and a range of other documents related to the management of the home. Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe, and they told us they felt safe. One person told us 'Oh yes, the carers are nice and don't leave you.' People's risks were assessed so that freedom and independence were balanced against safety. People were protected by effective whistle blowing procedures. They were cared for by sufficient staff who were well recruited and in sufficient numbers to offer safe care. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People received effective care. Staff had the training and knowledge to offer people the care they needed and were well supervised. Although people's mental capacity was assessed, there was not always sufficient information for staff to ensure people's capacity was maximised. People's nutritional needs were met, and they had access to the health care support they needed.

Is the service caring?

Staff were kind and caring. They involved people in their care, taking time where this was needed and explaining things to people in a way they could understand. People's privacy and dignity were respected.

Is the service responsive?

The service was responsive. People told us that staff understood their care needs and responded to them. The service handled complaints appropriately. Care plans gave information for staff to offer personalised care, however the acting manager was still working on identified improvements.

Is the service well-led?

The service was well led. The registered manager was not managing the home at the time of the inspection. However the home was being managed by an acting manager. Staff reported that they could share their thoughts openly with the acting manager, and raise concerns with confidence. They were clear on the values and ethos of the home. Staff told us the acting manager listened to them, acted on their views and provided a clear lead. Notifications had been sent to CQC as required and incidents were analysed to minimise future risk. Staff were clear about their roles and responsibilities and communication within the staff team had improved with more meetings and informative handovers.

As part of this inspection we looked at records for five people who used the service. We spoke with the general manager. We spoke with a relative of a person who used the service, several people who used the service and six care staff. We reviewed records relating to the management of the service.

Below is a summary of what we found. The summary describes what people who used the service and staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports our summary please read the full report.

Is the service safe?

We carried out an inspection following information received regarding the failure to report and respond appropriately to a safeguarding incident. During the inspection we found that the systems in place were not effective and required improvement to ensure that safeguarding incidents were responded to appropriately. There was a lack of monitoring and auditing that had resulted in failure to respond to issues within the home. These were being reviewed at the time of our visit.

Staff had a good understanding of how to raise concerns and people who used the service felt safe being supported by staff. We observed that care and support was carried out in a safe way. One staff member told us 'I would raise issues with management and I know how to take it higher if I needed to'.

There had been some previous staffing level issues but these were being actively addressed within the home to ensure that staffing levels remained at a safe level.

Is the service effective?

People who used the service reported to us that they were given the support they required. We observed that staff were patient and responded to requests for assistance quickly and appropriately. Care needs were recorded in care plan files although these required reviewing to ensure that people's most recent needs were known by all staff. One person who used the service told us 'I am happy living here and although there have been lots of changes I can tell that things are being looked at and improving'.

There were systems in place for monitoring and auditing all elements of care and management of the home although these were not being used to their full capacity at the time of our visit.

There was an effective complaints system in place and people we spoke with felt able to raise concerns and were confident that these would be dealt with in an appropriate way.

Is the service caring?

We observed throughout our inspection that staff were patient and friendly with people when supporting them. Communication was good and people understood what support was available. People who used the service spoke positively about staff and reported that they felt cared for.

There was a lack of activity and social interaction within the home, but staff responded in a timely way to requests for support with daily living tasks. People were given support where required to eat and drink and this was done in an appropriate way. This ensured that people got enough nutrition and hydration to meet their needs.

Is the service responsive?

Although there were systems in place to gather feedback from staff, residents and relatives in order to lead improvements, these had not been used effectively since the last inspection. Where audits had been carried out these had been responded to appropriately through action planning and allocation of responsibilities to staff to make improvements. However this had not been done consistently across the home and there was a lack of evidence that feedback had been gathered and analysed.

There was a robust complaints system in place and people were aware of how to raise issues. All those we spoke with felt that any complaints would be handled effectively and responses would be appropriate. People felt staff were approachable and keen to make improvements. One relative told us 'The staff are very good, they take on a lot'.

When any issues had arisen regarding people's needs, evidence showed that appropriate referrals had made to services such as physiotherapy and the dietician.

Is the service well-led?

At the time of our visit there was a new general manager in post and an interim manager that was overseeing the running of the service while recruitment was being undertaken. Some issues had been highlighted with the previous management of the home and the new management team were undertaking work to identify and address the issues that were present.

The provider and the new general manager were keen to ensure that the home made improvements in several areas and staff reported that morale in the home was improving due to the directive management style being used at the time of our inspection. Staff reported that they felt the general manager and interim manager were approachable and were motivated to improve all elements of the home.

We found during our visit in September 2013 that the manager had implemented systems including extensive cleaning schedules, audits of the environment and cleanliness, medication, care plans, and equipment. Extensive repair and renovation work was underway in the service including redecoration, new flooring and carpets, upgrades to bathrooms and new equipment. This work was on-going.

The manager had arranged for an audit of medication systems from the local authority and had subsequently developed an action plan which was partially completed at the time of our visit. Resident and staff meetings had been held, as well as surveys of satisfaction.

We found that there were deficiencies in the cleanliness of the home and no auditing of this area to ensure that risks were minimised. The environment was not maintained to a high standard and required some further input.

There were issues with the correct and accurate recording of medication administration and storage and no auditing of medication was being done within the home.

There were systems in place for quality assurance of the service but these had not been maintained and opportunities for staff and residents to feedback had not been provided effectively in the last year.

When we visited we saw that there were new care plans in place for people, and these were detailed, person centred and being regularly reviewed. There was evidence of people's involvement in rewriting their plans, and although not all updates were completed, the process was well underway. We spoke with people who used the service and they told us that they had been involved in planning their care. One person told us 'Staff and I have been rewriting my plans together. I have talked to them about how I want to be supported'.

We saw that the manager had developed various quality assurance and audit systems, which were being used effectively to gather both residents and relatives views and input. An activity co-ordinator had been employed by the provider, and a focussed plan for that role was being developed with staff and residents.

During our inspection we observed good interactions between people and staff, and there was evidence that staff had received focussed training around dignity and respect. When we spoke with people who used the service they told us that they were always treated with dignity and respect by staff.