Beeston Rise Care Home Also known as Origin Care Homes (Beeston) Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There were systems and processes in place to review incidents, accidents and safeguarding concerns. The provider analysed events, took action where needed and shared the information with staff. Referrals to external support services, such as the falls team or district nurses were completed where required.

Staff, people using the service and those important to them felt able to raise concerns and that these would be addressed. One staff member told us, “There are always areas where we can improve, but I feel the team are encouraged to raise concerns and contribute to improving the service we give to our residents.”

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We received feedback from external professionals that the provider did not always follow advice given to them or provide them with the updates requested. This included tasks such as providing blood pressure readings for ongoing health monitoring. This meant people were at risk of not receiving timely medical interventions.

The provider told us they had been working with healthcare professionals and had established an action plan on how to improve communication and systems in place to develop the level of care and support people received.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had received safeguarding training, could identify types of abuse and knew the process for reported safeguarding concerns.

People and their relatives told us they felt the service was safe. A person living at the service told us, “I do feel safe here. When I am in my room, I like to have my door open and then close it when I am out. They abide by that. It is the general atmosphere here that makes me feel safe.” One relative told us, “I do think [person] is safe there. They have the pressure mat next to [their] bed so [staff] know if [they] gets out of bed. [Person] does wander and [they] has fallen. [Staff] have let me know when that has happened.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The provider followed the principles of the MCA and had systems in place to track and monitor when a DoLs authorisation was in place.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments were completed and reflected people’s needs and changing circumstances, However, people told us they were not included in the development of the plans or were not informed of the risk strategies which had been implemented.

Risks were not always managed well. Call bells were not responded to effectively. People told us staff turned call bells off and said they would return shortly. People did not always feel listened to when they expressed concerns regarding risks and the service provided.

Staff and service users told us an increase of staff would help manage risk. One staff member told us, “Residents have made comments to staff about us being short staffed resulting in the residents often waiting along time for assistance.”

Care staff and kitchen staff demonstrated an understanding of modified diets and why this was important.

People also had personalised emergency evacuation plans, which detailed the level of support they would require to evacuate the building safely in the event of an emergency.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We found topical creams were not always stored safely and were not labelled with open or disposal dates. The provider took immediate action and were exploring options to safely store topical medicines.

We found accessible cupboards in communal areas where people walked with purpose. Inside of these were electrical cables and pipes which posed a potential risk of injury and harm. We fed this back to the provider who took immediate action and by the end of the day action.

The environment supported people living with dementia. Clear signage helped people find bathrooms and communal areas. There was a lounge area as well as smaller areas such as a garden room, cinema room or games room, meaning people has different areas to spend their time if they wished to do so.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

At the time of the assessment there were insufficient staff on duty to ensure people received timely care and support to ensure their safety was maintained. The home was staffed according to their calculation, however we observed people being told to sit down and wait. People using the service told us they often had to wait for help. One person told us, “To be honest, they haven't got enough staff here. I could have to wait 20 minutes [for help]. They come and say 'will be there in a minute' then leave.”

Professionals told us they also found the home to be short staffed and often struggled to find staff when they needed information.

This was shared with the provider on the day of the assessment who took action. They agreed to review this regularly to ensure staffing levels met the needs and requirements of people living at the service.

Staff were safely recruited and are provided with opportunities to develop and learn.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

There were policies, risk assessments and regular audits in place in or to monitor the cleanliness of the service to ensure any issues were addressed.

Staff had completed infection prevention and control training. Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment in a safe way. This protected people from the spread of infection.

The kitchen was clean and well maintained.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medicines safely and in line with prescribed guidance. Medicines were administered by trained staff who had completed up‑to‑date medication competency assessments.

We observed a medicine round where we found the senior staff member administering medicines to be polite and patient and observed people taking the medicine before moving on.

Medicines rooms on all 3 floors were clean, with temperature checks in place. Medicines were stored securely.

Medicine administration records (MARs) were completed accurately, with clear staff signatures, and reasons for medicines not being administered were recorded. ‘As required’ (PRN) medicine protocols were in place and provided clear guidance for staff on when and how these medicines should be administered.

Audits were completed regularly with any discrepancies being reported and investigated. However, improvements were needed to make sure issues did not continue to arise. For example, there were a number of incidents where people ran out of medicines. Although action was taken to source medicines, more robust plans were needed to prevent reoccurrence.