Archived: Beechwood House

This inspection took place on 14 June 2016. The inspection was unannounced.

There was a registered manager 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.

People’s records were not always up to date and did not always indicate what action had been taken when people required positive behaviour support. There was also inconsistent practice in the use of alarms intended to keep one person safe.

The service was following the guidance in people’s risk assessments and care plans and the risk of unsafe care was reduced. Care provided was in line with people’s assessed needs. People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure.

There were sufficient, well trained staff to keep people safe. Recruitment procedures ensured suitable staff were employed to work with people at the service.

Consent to care and support had been sought and staff acted in accordance with people’s wishes. Legal requirements had been followed consistently where people were potentially restricted.

People told us they enjoyed their food and we saw meals were nutritious. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. They were involved in the planning of their care and support. People were able to take part in hobbies and interests of their choice.

Complaints were well managed. Systems to monitor the quality of the service identified issues for improvement. These were resolved in a timely manner and the provider had obtained feedback about the quality of the service from people, their relatives and staff.

We last inspected this service on 6 December 2013. At that time we found that care plans did not always contain appropriate guidance to ensure people's welfare and safety and people were not fully protected from the risk of receiving unsafe care. At this inspection we found that staff care plans had been revised and contained comprehensive, relevant information about peoples' needs and plans for their care. A summary of what we found is set out below.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

We spoke with three care staff who understood the systems in place to protect people who received care from abuse or neglect. They told us they received training in how to protect people. Training records showed care staff had received training in how to protect people from the risk of abuse.

We saw individual evacuation plans were in place for each person. These identified the level of support the person needed to evacuate the building in an emergency for example a fire.

There were no Deprivation of Liberty Safeguards (DoLS) in place at the time of our inspection. The Deprivation of Liberty Safeguards are a legal framework designed to ensure that the care people receive does not unlawfully deprive someone of their liberty. Some people were not able to make decisions because of their condition. We found the service had taken decisions in people's best interests for example to ensure one person underwent a medical procedure. The process followed by the service met the requirements of the Mental Capacity Act 2005.

The service had policies in place for managing medicines safely. Care staff followed these and they were audited and checked.

Is the service effective?

People's needs were assessed and we saw support plans had been reviewed and updated. The manager told us they had reviewed the content of the plans since our last visit to remove any unnecessary information.

Team leaders told us they ensured care staff were familiar with the content of people's support plans and ensured the care delivered was consistent with the person's assessed needs. Risk assessments had been carried out and were reviewed. Care staff told us each person had a key worker whose role was to check and update support needs. Support plans described people's personal care needs and how these should be met. Plans to support people's behaviour were also in place. Care staff had the appropriate training and experience to enable them to carry out their role effectively. Care staff told us they received regular supervision and appraisal.

Is the service caring?

One person we spoke with was shortly to go on holiday. They told us how much they were looking forward to it and how staff had helped them get ready. They told us they like to spend time in their room listening to music but that staff checked they were okay. They said they had lived somewhere else but preferred living at Beechwood House because the staff were really nice.

We observed care staff providing support and saw that they had a good rapport with people. Care staff we spoke with told us they knew people well and were able to respond to people's needs. They also told us it was important to protect people from harm and ensure they were able to engage in a wide range of activities.

Is the service responsive?

We saw examples of care staff obtaining professional advice about from a centre which specialised in supporting people with a learning disability. The service had also put arrangements in place to ensure one person was able to undergo a medical procedure. The service had made a decision in the persons best interests because they did not have the mental capacity to make a decision about their treatment.

Is the service well-led?

Care staff told us the manager was supportive and approachable. The manager and one of the company directors carried out regular checks to identify things which could be improved. The service also obtained the views of people who used the service and used these views to discuss improvements to the service.

The manager told us they had reviewed people's support plans following our previous inspection to ensure they contained the most relevant information for supporting people. The manager showed us the records of meetings with directors which took place service every week to discuss the implementation of policies and the quality of services.

We found that people's needs were assessed and care and treatment was delivered in line with their individual care plan.

They told us they knew how to raise concerns if they needed to. Staff we spoke with were generally knowledgeable about people's care needs and described appropriate ways of supporting them. However, people's care files contained some conflicting information and did not always provide the right guidance for staff.

We saw that staff working at Beechwood House were recruited through proper procedures and were given suitable training and support to provide care for people living at Beechwood House.

We were told that care staff are going to have training in IT, which will ensure that all records care up date and relevant information is available to care staff.

We found that a new manager has been appointed and registered with the Care Quality Commission (CQC) since we last visited. Care staff we spoke with told us it was better now they had a registered manager who they could go and who can lead change where required.

People we spoke with told us that they now enjoyed living at Beechwood House and they were happy with the care they received. We were told that they liked being independent and going to the bank for their money and being able to spend this on items from their wish list.

People were involved, as far as possible, in planning their care. Staff respected their personal preferences and people thought that their needs were met. One person told us, "I'm happy here." People were asked for their views, and comments that they made were acted on.

We found that improvements had been made to the way that staff were recruited to work at the home and that the procedures were now appropriate.

We found that the planning and delivery of people's care was not ensuring their welfare and safety at Beechwood House. This was because care plans and risk assessments did not contain sufficient information and guidance about people's needs or about risks that could affect them.

We found that people who had needs described as 'challenging' and also people with communication and sensory difficulties were not receiving appropriate care and support at the home.