The Beeches Nursing Home

We found the following examples of good practice.

The registered manager was communicating with people, staff and family members regularly to make sure everyone had an understanding of procedures and precautions being taken, and how to keep people safe. The registered manager worked with the care staff and housekeeping team to ensure infection prevention and control measures were followed.

The service had a committed staff team to ensure people received care and support in a safe and hygienic environment. People were supported in the service in accordance with national guidance. The staff team supported people and their relatives to understand the policies and procedures surrounding protection against COVID-19.

Additional measures had been put in place to increase cleaning schedules and regular cleaning of touch points around the service. Personal protective equipment (PPE) was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19.

We spoke with the head of housekeeping and looked at cleaning schedules and audits which showed additional systems had been added to increase infection control procedures during COVID-19 pandemic. Staff were satisfied with the systems in place to protect people. People were satisfied with the systems in place at the service.

The service was following current guidance in relation to visiting care homes during outbreaks of COVID-19. There were no current essential care givers [A relative or friend who may provide emotional support, or be there to support, when care tasks being carried out, are beneficial to the person’s wellbeing]. Where people were in receipt of end of life care visitors were not restricted. Visits to other people were arranged by appointment and took place in people’s rooms rather than communal areas.

The Beeches is a residential home providing personal and nursing care for up to 28 predominantly older people. At the time of this inspection there were 26 people living at the service. Some of these people were living with dementia or were receiving end of life care.

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

Some people were not able to tell us verbally about their experience of living at The Beeches. Therefore, we observed the interactions between people and the staff supporting them.

People felt safe using the service. Staff had been trained to understand how to manage risks to people and how to report any concerns they had about people. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. Where equipment was needed to be used this was done safely.

People's nutrition and hydration needs were met. People generally received their medicines as prescribed. However, we found some gaps in records. We discussed this with the registered manager who took immediate action to address this.

People’s needs had been assessed and the registered manager ensured this information was made available to all staff. 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.

People were supported by a staff team that were both caring and compassionate and treated them with dignity and respect. People received person centred care and support based on their individual needs and preferences. Staff knew about people's life history, and their communication needs.

People’s health needs were being met. The service worked in partnership with a range of healthcare professionals and followed their advice.

People were offered opportunities to engage in activities and events they were interested in. The registered manager understood their regulatory responsibilities and shared information with stakeholders in a timely way.

The provider and registered manager reviewed records regularly to identify ways to improve the service.

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

Rating at last inspection: At the last inspection the service was rated as Good (report published 29 December 2016)

Why we inspected

This was a planned inspection based on the previous rating.

The Beeches is a care home which offers nursing care and support for up to 28 predominantly older people. At the time of this inspection there were 26 people living at the service. Some of these people were living with dementia.

The service had a registered manager in post. 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.

We walked around the service which was comfortable and bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. From the medication administration records (MAR) we found it was possible to establish if people had received their medicine as prescribed. However, some handwritten entries on to medicine records had not always been signed and witnessed to help reduce potential errors. Some prescribed creams had not been dated when opened. The registered manager addressed these concerns during the inspection. Regular medicines audits were consistently identifying when errors occurred.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Staff were supported by a system of induction, training, supervision and appraisals. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were good opportunities for on-going training support and development. More specialised training specific to the needs of people using the service was being provided. For example, dementia care. The nursing team had developed specific skills and knowledge to provide specialist care for people at the service. For example, the treatment of leg ulcers.

The registered manager was a registered nurse with experience in providing care for the elderly and those suffering with complex chronic conditions. They had experience in the field of palliative care and acted as education lead within the service. The registered manager had the responsibility for ensuring all members of staff were provided with moving and handling training, as well as all aspects of their continuing development.

The registered manager was a clinical mentor with links to Plymouth University. The service benefited from this relationship by having student nurses on their clinical placements, working regularly alongside the qualified nurses and care workers on shift. This led to the sharing of best practice.

The registered manager assured us that all training and supervision requirements had been provided to staff. We were told all staff received supervision six times a year. However, at the time of the inspection visit the staff training and supervision records were not up to date. This meant the registered manager did not have an overview of when staff were due updates in specific training and when their supervision was due. It was not possible for the inspector to judge what training and support staff had been provided with. However, following the inspection visit this was updated and sent to the inspector. It showed that most staff had received mandatory training as required by the service.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service. However, some staff told us they felt a specific concern which had been raised remained unresolved by the provider. They told us the registered manager had 'tried hard' to raise the concern with the providers but nothing had changed.

Meals were apetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

The Beeches were clear on their responsibilities regarding the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. Appropriate applications had been made to the local authority and one authorisation had been granted.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews. Nursing care plans were comprehensive and regularly updated.

Activities were provided by the activity co ordinator during weekdays. Records were seen in some care files of people’s involvement in such activities.

The registered manager was supported by two deputy managers, a team of registered nurses, team leaders and care staff. All the staff we spoke with were positive about the support provided by the registered manager who regularly worked shifts alongside the care team.

The service had taken action and addressed the recommendations made in the last inspection report regarding the condition of the premises. A programme of refurbishment of the service was on going.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post. 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.

Water temperatures were checked and regulated at baths and showers. However hot water temperatures being discharged at wash hand basins was hot as there were no water temperature regulators in place. This was not safe practice.

There were suitable facilities available to store medication safely however the medicine room could not be locked due to it accessing a fire exit. Medicine records showed that people received their medicines as prescribed. However some people’s medication was not always being delivered to the service by the supplying pharmacist when it should. This resulted in gaps when people received their medicines. We have made a recommendation about this to the provider.

The home was an older building with a more recent extension of rooms. The environment of the older part of The Beeches needed maintenance and redecoration in some areas. Internally corridors and paintwork in some bedrooms were damaged having been dented by wheelchairs and hoists. A carpet at the entrance to the lounge area was badly stained. The provider was aware of the issues and taking steps to address them.

Storage facilities for equipment were limited resulting in hoists being stored in corridors or peoples rooms. An industrial rotary iron was stored and used at the end of a corridor where people had access. Suitable storage facilities for these items had been identified in the basement however this had not yet been actioned.

The rear lounge was also used as a dining room. However there was only one dining table reducing the availability of dining spaces for people to take their meals. Other people had their meals from side table or in their rooms. This area was a thoroughfare to people’s rooms. When fully occupied it was cluttered and restricted movement. The provider was aware of the current restrictions and was planning action to improve this.

A double room was accessed from the lounge and dining room. There were times during the inspection visit when the door was open and whilst the room was not occupied it impacted on the privacy of their belongings.

Staff working at the service understood the needs of people they supported so they could respond to them effectively. The service training matrix was being updated. Staff told us they received training and support which enabled them to be effective in their care and support of people at the service. Training certificates were also on some files to support this.

Visitors reported good relationships with staff and said the management were approachable. Families told us, “Every time we visit staff always make sure we get an update” and “It’s a busy place but staff are always around when you need them”.

Staff supported people to be involved in and make decisions about their daily lives. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were protected from the risk of abuse because staff had a good understanding of what might constitute abuse and how to report it. All were confident that any allegations would be fully investigated and action would be taken to make sure people were safe.

Staff recruitment files contained the relevant recruitment checks, to show staff were suitable and safe to work in a care environment, including Disclosure and Barring Service (DBS) checks. Pre-employment checks had been completed to help ensure staff had the appropriate skills and knowledge required, to provide care to meet people’s needs. There were enough skilled and experienced staff to help ensure the safety of people who used the service.

People told us they knew how to complain and would be happy to speak with the registered manager if they had any concerns.

There were a variety of methods in use to assess and monitor the quality of the service. Meetings and surveys had taken place and showed people were engaged with and listened to.

Service certificates were in place to make sure equipment and supply services including electricity, fire systems and gas were kept safe.

We identified a breach of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.