Archived: Beechcare Care Home

Updated 21 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 23 and 24 October 2018. The inspection was unannounced. The inspection was carried out by two inspectors, one assistant inspector, a nurse who had specific experience of providing nursing care to people living with dementia and an expert by experience. The expert by experience had personal experience of using or caring for someone who uses this type of care service.

We carried out this inspection as we had received information of concern from the Local Authority safeguarding team about the care provided. There had been an allegation of neglect. Before the inspection, we reviewed the information received from the local authority and asked for their feedback. We used this information to help us plan our inspection. Although the local authority investigated and closed the case, we carried out this inspection to make sure people were safe and were receiving the care they needed. We also looked at notifications about important events that had taken place in the service which the provider is required to tell us by law.

We spoke with five people who lived at the service and four relatives, to gain their views and experience of the service provided. We also spoke to the registered manager and seven staff including nurses, care staff, domestic staff and the chef. We received feedback from two health care professionals, a local authority commissioner and the local Kent Healthwatch.

We spent time observing the care provided and the interaction between staff and people in the communal areas such as lounges and dining room. We looked at nine people’s care files, medicine administration records, eight staff records including recruitment and training, as well as staff training records, the staff rota and staff team meeting minutes. We spent time looking at the provider’s records such as; policies and procedures, auditing and monitoring systems, complaints and incident and accident recording systems. We also looked at residents and relatives meeting minutes and surveys.

In addition, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who lived with dementia and who could not speak with us.

We asked the registered manager to send us some information by email after the inspection and they did this in a timely fashion, within the time limits requested.

Updated 21 December 2018

The inspection took place on 23 and 24 October 2018. The inspection was unannounced.

Beechcare Care Home is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Beechcare Care Home provides accommodation and support for up to 40 older people. The provider was in the process of refurbishment and one whole area with 10 bedrooms was undergoing significant changes to provide more accessible accommodation. There were 27 people living at the service at the time of our inspection due to the refurbishment work. People had varying care needs. Some people were living with dementia, some people had diabetes, had suffered a stroke or had Parkinson’s disease. Most people required some support with their mobility around the home and some people were nursed in bed due to their poor health.

A registered manager was employed at 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.

At our last inspection on 12 and 13 September 2017, the service was rated as ‘Good’. At this inspection, we found improvements were needed.

People did not always receive care and treatment that was responsive to their needs or that took into account their personal preferences. Care plans did not always detail the individual and personal information needed about people, using a consistent approach. Activities did not always suit the needs of people who had greater difficulties with understanding or who were at risk of social isolation.

People’s records such as daily records and care recording charts, including nutrition and fluid charts were not always completed accurately to show that people had received the care they needed to maintain their health and well being.

The provider had a range of audits to monitor the quality and ongoing safety of people, with an identified route for action and improvement. However, some of these were not robust enough and did not identify the areas of concern found during this inspection.

The provider had a dependency assessment tool to evidence the amount of staff needed each week to provide the assessed care needs of people living in the service. However, people, their relatives and staff told us there were not enough staff to give time to chat and engage in activity other than care tasks.

Processes were in place to maintain people’s basic rights within the principles of the Mental Capacity Act 2005. The processes were not always appropriately followed to ensure people’s rights were upheld at all times. Staff understood what the Act meant for them within their role supporting people on a daily basis.

Staff had the personal equipment to prevent the risk of cross infection. Laundry bags were in use in the communal corridors throughout the inspection which increased the risk of infection. We have identified this as an area that needs improvement.

Documentary evidence was not available to show staff had received the one to one supervision they needed to carry out their role and to support their personal development as set out in the provider’s policy. We have identified this as an area that needs improvement.

The registered manager investigated, recorded and responded to formal complaints by following the provider’s policy. Verbal complaints were not always recorded to show where lessons had been learnt and improvements made as a result. We have identified this as an area that needs improvement.

People felt safe and were protected from the potential risk of harm and abuse. Nurses and care staff had been trained to understand the potential signs of abuse and knew the action to take if they thought abuse had taken place.

Potential risks to people to maintain their safety had been assessed and mitigated. The premises were well maintained and equipment had been regularly serviced to ensure it was in good working order.

Medicines were observed to be administered safely by registered nurses and senior care staff. Systems were in place for the ordering, obtaining and returning of people’s medicines. Nurses and senior care staff had received training in the safe administration of medicines and their competency had been assessed.

People’s needs were assessed prior to them receiving a service. Guidance was in place to inform staff of how to meet people’s needs whilst encouraging and promoting their independence.

People were supported to maintain contact with people that mattered to them. People’s relatives were invited to eat a meal with their loved one if they wished and were able to stay overnight if their relative was unwell or near the end of their life.

Nurses and staff knew people well and were able to describe their care. People thought staff were kind and caring and there were affectionate interactions between staff and people. Staff respected people’s privacy and dignity.

Appropriate referrals were made to health care professionals when concerns had been identified. The nurses and management team worked in partnership with external organisations to ensure people remained as healthy as possible.

People were supported to express their views and the provider analysed the results, developing actions to take to make improvements as a result.

People, their relatives and staff described the management team as approachable and were known to people. The registered manager and management team worked in partnership with external organisations to promote best practice.

We found four breaches 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 the full version of this report.