The Beeches

The Beeches Care Home provides accommodation for people who require personal care. The service can accommodate up to 44 people. At the time of our inspection there were 37 people using the service. The care provided is for people who have needs associated with those of older people. Some people residing at the home were living with dementia.

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

Provider oversights needed to be strengthened to ensure compliance with legislation and fundamental standards. The provider had systems and processes in place to monitor the quality and safety of the service, but they had not always been effective in driving improvements and compliance. Due to shortfalls with systems, processes and recording information the provider had not been able to identify and respond to accidents and incidents effectively to ensure lessons were learnt. Sufficient prompt action was not taken to ensure fire safety issues were addressed in line with the seriousness of the concerns. Staff told us they felt supported by the management team.

Risks were assessed but not always detailed enough to ensure all risks were mitigated. Accident and incident analysis was in place but had been ineffective in identifying themes and trends. Some shortfalls were identified in relation to the management of medicines. We found some shortfalls in the management of the cleanliness of the home which were promptly addressed. Staff had received training in safeguarding and were aware of how to report concerns. People told us they were safe. Staffing levels were maintained but staff needed to be effectively redeployed to ensure they were responsive to people’s needs.

Care plans were in place for people but required further detail to ensure they reflected all care needs. Complaints policies and procedures were in place; however, they had not been effective in capturing how complaints were handled. We made a recommendation regarding complaints. Activities were taking place to meet people’s social and cultural needs.

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. We made a recommendation about the Mental Capacity Act (MCA).

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 22 February 2020).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about management and safety. This was a focused inspection used to examine those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this report.

The provider was open and transparent throughout the inspection and took effective action to strengthen their systems and processes and to mitigate risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Beeches on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safety and governance at this inspection. We made recommendations in relation to complaints and mental capacity.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had a process in place to enable relatives to visit their family members in a safe way and in line with government guidance. Relatives were required to show a negative lateral flow test prior to entering the home.

Professional visitors were required to show a negative lateral flow test and evidence of COVID-19 vaccination. Visitors had their temperature taken in the entrance area and completed a form to ensure they are not showing any symptoms of illness.

Staff and people using the service took part in the home’s testing programme. This enabled the provider to take swift action if they tested positive with COVID-19.

We observed staff wearing appropriate PPE and had access to hand sanitiser. Staff had completed training in infection control, COVID-19 and donning and doffing PPE.

The home was clean and there were no malodours. Staff had access to cleaning products and cleaning schedules were in place. The registered manager completed infection control audits to ensure the home remained clean and well maintained.

We found the following examples of good practice.

Staff had a caring and compassionate manner and interactions were upbeat to boost morale in the home. Staff were dedicated to resident’s health and wellbeing.

The provider is looking at ways for people to have safe visits with their loved ones. Plans were underway to install a 14ft summer house. When completed, it will be heated and enable comfortable visits.

The registered manager had carried out distress risk assessments to assess and monitor how people were coping emotionally with the pandemic.

Staff had good knowledge on how to recognise the signs and symptoms of someone becoming unwell, and they knew what action to take to keep everyone safe.

Staff were well supported through the pandemic, by the management team. All the staff we spoke with praised the registered manager’s dedication and said they all worked well together as a great team.

Safe staffing levels were maintained by creative use of staff from the providers other homes.

Further information is in the detailed findings below.

The Beeches is a care home providing accommodation for up to 44 people who require personal care. At the time of our inspection there were 43 people using the service. The care provided is for people who have needs associated with those of older people and people living with dementia.

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

The service was extremely responsive and outcomes for people were excellent. People were supported in line with their needs and preferences and were involved as partners in their care. People enjoyed a range of social activities which were meaningful and gave them purpose. The provider was extremely thoughtful and compassionate about how they supported people receiving end of life care.

People who used the service had access to a complaints procedure and were encouraged to make complaints where required. Complaints were followed up and responded to in line with the providers policy.

Risks associated with people's care and support had been identified and actions taken to minimise risks. Staff we spoke with confirmed they had received training in safeguarding and knew what action to take if they felt people were being abused. Staff confirmed that they had been safely recruited and had employment checks and references prior to commencing employment. Accidents and incidents were analysed, and trends and patterns were identified. Medicines were managed in a safe way to ensure people received their medicines as prescribed.

People's needs were assessed, and care was delivered in line with their preferences and choices. Staff received support, induction and training to ensure they had the skills to carry out their role. Staff were complimentary about the provider and felt they were very supported in their role. People were supported to eat and drink enough to maintain a healthy and balanced diet in line with their dietary requirements. People had access to healthcare professionals.

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.

Staff we spoke with told us how they respected people and ensured their privacy and dignity was maintained. People were involved in the planning of their care and were able to make decisions about the care and support they received. Staff enjoyed their role and were happy to know they had made a difference and supported people to meet their outcomes. We observed staff interacting with people in a positive way. People told us they enjoyed living at the service.

People who used the service had the opportunity to express

their views. The provider had a range of audits in place to monitor the service delivery. Staff were complimentary about the support they received from the registered manager and commented on how approachable they were.

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 15 March 2017). There was also an inspection on 6 August 2019 however, the report following that inspection was withdrawn as there was an issue with some of the information that we gathered.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

The Beeches is a purpose built care home on the outskirts of Wath-upon- Dearne. It provides accommodation for up to 44 people on two floors. Care is provided for people who have needs associated with those of older people, including dementia. There is a small car park at the side of the home, with further roadside parking at the front. At the time of this inspection there were 41 people living at the home.

The service has a registered manager. 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.

People we spoke with said they were very happy with the way staff delivered care, the social activities available and the general facilities at the home. Throughout our inspection we saw positive interactions between staff and people using the service, as well as with visitors.

All the people we spoke with, including staff, told us the home was a safe place to live and work. Staff were knowledgeable about how to recognise signs of potential abuse and the reporting procedures. Assessments identified potential risks to people, and management plans to reduce the risks were in place.

Recruitment processes were thorough, so helped the employer make safer recruitment decisions when employing new staff. At the time of the inspection there was sufficient staff employed to meet people’s needs.

People received their medications safely from staff who had completed medication training.

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 support this practice.

Staff had access to a varied training programme which helped them meet the needs of people using the service and develop their skill and knowledge. Support sessions had been provided to staff, but these were not consistent with the provider’s policy. However, staff said they felt well supported and the registered manager was taking action to address any shortfalls.

People received a well-balanced diet that offered variety and choice. The people we spoke with said they were very happy with the meals provided.

People were treated with dignity, respect, kindness and understanding. Staff demonstrated a good knowledge of the people they cared for, their preferences and abilities.

Each person had a care file which reflected their needs and preferences. Care plans had been evaluated regularly and updated to reflect people’s changing needs.

There was a system in place to tell people how to raise concerns and how these would be managed. People told us the management team were approachable, and always ready to listen and act promptly to address any concerns.

There were systems in place to assess if the home was operating correctly and people were satisfied with the service provided. This included meetings and regular audits. Where necessary action plans had been put in place to address any areas that needed improving.

Further information is in the detailed findings below.

We saw each person had a care plan which in the main detailed people's care needs and identified any risks associated with the care and support.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

People were cared for in a clean, hygienic environment. We saw there were effective systems in place to reduce the risk and spread of infection.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were enough qualified, skilled and experienced staff to meet people's needs. We observed staff were able to meet people's needs in a timely way

There were systems in place to gain people's views and check if staff were following company policies.

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. If anyone was unable to give consent systems were in place to consult other people to make sure things were carried out in their best interest.

People's comments indicated they received the care and support they needed and they were happy with how staff delivered care. One person said, 'The staff are sometimes stretched but they do their job well.' Another person commented, 'The care here is wonderful.'

People received well balanced meals that provided variety and choice. Staff promoted healthy eating and checked people were eating and drinking enough.

We saw the home provided specialist equipment to meet people's needs and keep them safe. There was a system in place to make sure equipment was satisfactorily maintained.

Background checks had been carried out on staff before they started to work at the home. This included ensuring staff underwent a Criminal Records Bureau (CRB) check.

We saw the complaints procedure was available to people who used and visited the service. People told us they felt comfortable taking any concerns to the manager.