Archived: Beechwood Care Home

We conducted a further inspection on 10, 11and 15 October 2013 to check appropriate action had been taken to meet the regulations. During the inspection we identified concerns relating to care and welfare, the suitability of the premises and equipment, and the assessing and monitoring of the quality of service provision.

We spoke to five people who told us the staff were 'very nice' and they liked the food. One person said staff 'look after me well'. We spoke with four external healthcare professionals who told us staff were very caring. However, three of them raised concerns about a lack of awareness by staff of people's care needs. One said staff 'did not identify problems and changes in people's condition' in order to safeguard them from harm.

We found serious concerns about the management of pressure injuries. There were no plans in place to support people who had lost weight and one person who had been prescribed a food supplement had not received it for 10 days as it was out of stock.

Although improvements had been made to the environment, we found some areas of the home were not clean and guidance was not being followed by staff. Effective systems were not in place to reduce the risk and spread of infection.

We found continuing concerns about the management of medicines. Controlled drugs and other medication were not stored securely. Staff did not follow clear procedures and people did not always receive their medicines as prescribed.

A lounge in the building was being used as a temporary bedroom for one person. This was not suitable as it provided no privacy. We saw a ramp had been installed on the upstairs landing that was too steep and put people at high risk of falling. New beds and mattresses had been purchased which were highly unsuitable and had led to six people developing pressure injuries.

There was no effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service. The records management system was disorganised and did not protect people from receiving unsafe or inappropriate care.

During our last inspection on 6 and 7 June 2013 we found effective cleaning arrangements were not in place to ensure people were cared for in a clean and hygienic environment. Medication administration records (MAR) for topical creams were incomplete and inaccurate. The provider wrote to us and told us they would address the issues and become compliant by 7 July 2013.

On this occasion, we found the laundry had been improved, the bathrooms were clean and two bedrooms had been refurbished. However, other areas of the home, including bedrooms, bed linen and furniture in communal areas were not clean and hygienic.

We found the care plan for one person receiving end of life care had not been updated to reflect their current needs. Other records relating to the checks of bedrooms and mattresses were found to be inaccurate.

We looked at food and fluid charts and found the amount of food and fluid people received was not being monitored effectively. This meant people were at risk of not receiving sufficient food and fluids to meet their needs.

We looked at 11 MAR charts. We saw there were gaps in the records and the quantity of medication in stock did not correspond with the records. Some people had not received medication that had been prescribed. There was no clear management process for 'as required' medicines. The home's procedures for the administration of controlled drugs were not being followed. We saw records for the administration of topical creams had not been completed.

We found the care plan for one person receiving end of life care had not been updated to reflect their current needs. Other records relating to the checks of bedrooms and mattresses were found to be inaccurate.

The service took steps to ensure people were asked for their consent before they were given care or support. Where people lacked capacity to consent, the provider followed legal requirements to safeguard their rights.

The service was introducing a new, more person-centred format for care plans. This supported the assessment of people's different needs and planning of their care and treatment.

We found a number of significant issues concerning infection prevention and control. The provider had not followed appropriate infection control guidance and had not implemented effective practices. Bedrooms were unclean and unhygienic. Facilities and processes for doing laundry and processing contaminated equipment were inadequate and not fit for purpose.

The provider had in place effective recruitment and selection processes, and appropriate pre-employment checks were undertaken.

Our previous inspection found some key records were incomplete and inaccurate. We found the service had made improvements, but there were still some minor outstanding issues regarding accuracy and completeness of records.