The Beeches Nursing Home

The Beeches Nursing Home is a residential care home providing personal and nursing care to up to 40 people aged 65 and over with a range of health needs. At the time of the inspection, there were 28 people living at the home. Accommodation was provided over three floors which were accessible via stairs and a lift which was being upgraded. There was also a large communal area and a secure garden.

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

People were safe and well cared for at the home. Staff had a good knowledge of safeguarding, how to recognise abuse and risks, and how to minimise these for people. People told us they were able to discuss any concerns they had openly with staff and management.

Staff were well trained, kind and compassionate. Throughout the inspection we saw warm and friendly interactions between staff and people. Staff knew people well and were respectful of their needs and wishes, promoting independence as much as possible.

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.

The home was clean and tidy, and there was a relaxed atmosphere. There were activities available during the morning and afternoon. People were encouraged to maintain any hobbies and interests they had. Visits were also enabled in line with the current government guidelines. One relative told us, “They have been really good at arranging visits, there’s always something going on and [relative] seems to enjoy it.”

People’s needs were assessed and reviewed regularly. People were involved in decision making regarding their care and were supported to access external professionals, such as opticians, when this was required.

The home was well-led by a registered manager who was visible and active throughout the inspection. A number of audits were undertaken to monitor quality of care and drive improvement. People, relatives and staff were given frequent opportunities to give feedback and felt confident that any concerns would be appropriately addressed.

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 9 April 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach. 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.

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.

We found the following examples of good practice.

People had individual COVID-19 risk assessments. These included a section around visiting. Individual arrangements had been made to ensure all people who wished to could see their visitors.

The service was clean and tidy. One person told us, “I feel safe, they keep it beautifully clean here.” There was a cleaning system in place, including a checklist in each room to ensure all areas were regularly and thoroughly cleaned.

Staff provided a wide variety of activities for people. This included personalised activities offered in individual rooms to reduce the risk of isolation. People were supported to safely access the community, if they wished, with appropriate infection control measures in place.

Further information is in the detailed findings below.

The Beeches Nursing Home is registered to provide accommodation for up to 40 older people and people with physical disabilities who require nursing or personal care. At the time of the inspection there were 38 people living at The Beeches.

The Beeches had 38 bedrooms located over three floors which are accessible via stairs or lifts. The home had a large communal area which opened out to a garden at the rear of the home.

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

People’s experience of using this service:

•Whilst people’s care records did not always reflect current practice and we have asked the registered manager to improve in this area. People and their relatives told us, they thought the home was well run and spoke positively about the culture of the home. One relative said, “We would recommend this home to others.”

•People told us they felt safe from the risk of abuse and staff followed the local authority’s policy and procedure to raise concerns. One person told us, “Yes, I’ve felt safe, it’s home from home”

•People received their medicines safely and on time and staff were trained in administering medicines.

•Relatives and visitors were welcomed to visit people and given the privacy to talk. One relative told us, “I am always made to feel welcome.”

•The home was clean and people were protected from the risk of infection.

•People were supported by trained staff who were knowledgeable and knew how to care for people in line with their needs and preferences.

•People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

•People were happy with the food and told us they were given a choice of home cooked meals. One person told us, “The meals are good here”.

•People were respected as an individual, with their own social and cultural diversity, values and beliefs.

•People and relatives told us, they received kind and compassionate care and we observed friendly interactions throughout the day.

•There was a complaints procedure in place which was accessible to people and relatives.

•People’s wishes for end of life care were recorded where appropriately.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement (report published on 6 March 2018)

Why we inspected: This was an unannounced scheduled inspection based on the previous rating.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

We carried out a comprehensive inspection of The Beeches on 4 and 7 December 2017. The inspection was unannounced.

The Beeches Nursing Home is a care home with nursing care. 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.

The Beeches Nursing Home is registered to provide accommodation for up to 40 older people and people with physical disabilities who require nursing or personal care. At the time of the inspection there were 35 people living at The Beeches.

There were two registered managers permanently in post who shared joint responsibility for managing the regulated activities at the service. 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.

This was the first inspection of The Beeches Nursing Home since a change to the provider’s legal entity in August 2015.

People told using the service said they felt safe. There were systems in place for ordering, transporting, storing, disposing and administrating medicines safely and securely. However, these systems were not always effective, which left people at risk of possible harm.

The service had quality assurance and information governance systems in place to monitor the quality and safety of the service. However, it was not always evident the service had taken effective action to rectify identified issues.

The service provided training and support for staff to meet people’s needs. Some people had courses that required updating. The service had a plan in place to address this.

People’s care plans identified the support people required to meet their individual needs. Staff knew people well. However, care plans sometimes lacked details about people’s individual preferences and aspirations. The service was aware of this and management were in the process of reviewing and updating care plans.

The service was committed to upholding the principles of the Accessible Information Standard (AIS) and took steps to do so. The service was currently developing different care plan formats to ensure better accessibility of information for people with a disability, or sensory loss related communication needs.

People had appropriate support with any dietary or health related food and drink needs. Some people complained about the choice and quality of the food. The service was aware of people’s feedback and was taking action to improve these issues.

There were risk assessments in place for people to provide the right support to keep people safe. People were involved in this process and restrictions on their independence were minimised.

There were enough staff with the right skills and experience to meet people’s needs. Safe recruitment practices were followed. Staff knew the correct systems and processes to follow if they suspected abuse. People and staff were protected from discrimination which might amount to abuse or psychological harm.

Accident and incidents were recorded and actions were promptly taken to keep people safe in response. Management reviewed and communicated learning with staff following safety incidents and worked with relevant partnership agencies to agree any necessary actions needed in order to keep people safe.

Risks of infection to people were effectively prevented and controlled and the premises were clean and hygienic. Staff had received food hygiene training and the correct procedures were followed when preparing and storing food.

The service had control measures in place to keep people safe in the event of a fire. People had a personal emergency evacuation plan (PEEP) and checks on fire alarm systems and evacuation drills occurred regularly.

People, or people acting in their best interests, had consented to their care and support in line with the principles of the Mental Capacity Act 2005 (MCA).The registered manager was aware of their responsibilities for assessing and submitting applications for Deprivation of Liberty Safeguards (DoLS) for people who might require this.

People had support to access and receive appropriate health care support and services. People were involved in any changes to their healthcare and treatment. Staff liaised with appropriate people, used appropriate equipment and followed relevant professional guidance when assessing people’s needs, to ensure the right support was put in place.

When people had a support need, or made a particular decision, related to any protected characteristics under the Equality Act 2010 this was respected. Staff treated people with kindness and compassion. People’s privacy, dignity and independence were respected. People’s personal information was treated confidentially and in compliance with the Data Protection Act.

The service provided a range of activities both at the service and in the wider community. People had an active input in requesting activities that were socially and culturally relevant to them. People were aware of how to raise a complaint and felt confident to do so. Complaints were responded to appropriately and used as a way to learn and improve people’s support.

People’s wishes and preferences for their end of life care was respected, including any relevant spiritual and cultural needs. People, their relatives and staff had sensitive support during the end of life process. The service provided the right support, equipment or medicines if someone’s end of life condition was changing rapidly.

The registered managers had a clear vision for the service and were committed to creating a culture of delivering high quality care. There were effective management processes to outline expectations for staff responsibility and accountability. Staff, people and their relatives were involved in developing the service.

The service was committed to protecting the rights and well-being of its staff, including any protection from any form of work related discrimination. Staff told us they felt there was an open and positive team culture that protected their rights and well-being. The registered managers had shared information and worked in partnership with outside agencies in an open and honest way.

During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of this report.