Archived: Beechcare Care Home

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.

Beechcare Care Home is registered to provide accommodation and personal care with nursing for up to 40 people. There were 33 people living at the service at the time of our inspection.

Most people living in the home had complex health conditions that required nursing care, such as recovering from a stroke, respiratory illnesses or living with dementia. Some people had limited mobility and could walk around with support, whilst others relied on a wheelchair or full staff support to get around. Some people were nursed in bed and some people required support to communicate their needs and wishes.

Beechcare Care Home is a purpose built property that is spacious. The provider has refurbished some areas and had plans for further improvements to the premises. The service is set in a quiet location away from busy main roads and with pleasant gardens with flowers, shrubs and trees.

A manager was in post however, they had not yet registered with the Care Quality Commission (CQC). The manager had made their application and was going through the CQC registered manager application process. 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.

The provider had previously been registered with CQC at this location. However, they had changed the legal entity of this service and this required them to apply for a new registration with CQC, which commenced on 08 July 2016. The service had continued within the same premises and with the same staff team and registered manager. This was the first inspection under the new registration, however, you can find previous inspection reports on the CQC website.

People were kept safe by the provider’s systems and procedures, in place to protect people from abuse. Staff understood their responsibilities in keeping people safe and felt confident to raise any concerns they had with the management team. Staff told us they were sure any concerns they had would be taken seriously but they knew who to go to outside of the organisation if they were worried.

The risks faced by individuals had been identified and control measures put in place to minimise the risk, to help keep people safe. Medicines were managed safely and effectively by registered nurses. People had comprehensive care plans that provided detail of the individual support required to maintain their health and well-being. People and their family members were involved in developing and reviewing their care plan.

Safe recruitment practices were carried out by the provider to ensure people were only supported by staff who were suitable to work with the people living in the service. The service supported people with complex health care needs that required nursing care. There were enough registered nurses and care staff in post to support the assessed care needs of the people using the service at the time of inspection. However, people, relatives and staff gave mixed views about whether they thought there were enough staff.

A timetable of activities was in place that people could take part in, however these were not suitable for some people living in the service and alternatives were not always considered. We have made a recommendation about this.

People were happy with the food provided and could choose to sit in a light and airy dining room to eat their meals. People’s specialist nutritional needs were met and communication was good between the kitchen staff team and the nursing and care team to make sure this happened. People were supported to maintain their health by registered nurses and where they needed extra advice and support this was sought quickly from the appropriate healthcare professional.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider, management team and staff understood their responsibilities under the Mental Capacity Act 2005.

Environmental risks of the premises and grounds had been assessed and measures were in place to minimise risks and keep people, staff and visitors safe. All essential maintenance and servicing of equipment had been carried out. Fire safety had been carefully considered and all appropriate measures to prevent fire and to minimise the risks to people in the event of a fire had been undertaken.

Staff at the service were friendly and welcoming. Staff knew people well and were able to take this into account when providing individual care, supporting people to maintain their independence as long as possible.

Not all staff had received regular one to one supervision with their manager as the manager was new in post. However, this had been identified as an area to improve by the manager and the provider and a plan was in place. Staff had received the training necessary to carry out their role well. Additional training was available to support the development of staff.

People, their relatives, friends and visiting professionals were asked their views on a regular basis. This was made easy to do by an electronic tablet system. Feedback was analysed by the provider and used to improve the service provided.

There were many compliments about the management and leadership of the service. We received positive comments about the manager from people and staff. Improvements had been made and staff felt confident this would continue. Health and social care professionals gave positive feedback about the manager and the improvements made since they were in post.

The provider had a robust approach to quality assurance, making sure systems were in place to check the quality and safety of the service.