Beech Tree House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. There was a positive learning culture. Staff were encouraged to report incidents and near misses, and lessons learned were shared through meetings and supervisions. People and relatives knew who to contact if they had any issues or did not feel safe. They told us they would contact the registered manager for support. Relatives told us the manager was approachable and responsive. One relative commented the manager was, “good and resolves any issues promptly”.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s records of care were stored electronically which enabled the service to provide up to date information to healthcare partners when required. People had updated hospital passports that included information about their physical and mental health, communication, emotional and behavioural support needs, and any reasonable adjustments the person required to ensure hospital staff had the information they needed should the person be admitted to hospital. Professionals were kept informed appropriately to ensure health checks were up to date and relevant information was shared. One professional told us, “They communicate effectively via email, phone calls and by visiting the surgery with residents”.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider acted promptly and appropriately when concerns were raised. There were effective systems in place to identify safeguarding issues and provide robust oversight. These systems enabled the provider to monitor any emerging themes or trends. Staff received training in safeguarding and demonstrated an awareness and understanding of the types of abuse people may experience. Staff told us they would report any concerns to the registered manager. There was a noticeboard in the dining room with information on keeping safe, this was for people, and in an easy read format. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found people who needed to be deprived of their liberty for their own safety had appropriate authorisations in place. Staff were aware of any specific conditions in place for people. Sexual safety was considered, and people’s sexual health and sexual needs were considered and supported.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments were individualised and took into account people’s communication needs, health needs, personal routines and what was important to them. Where people had specific health conditions, such as diabetes or epilepsy, their risk assessments included guidance from professionals involved with managing people’s care and treatment. Staff involved people, those close to them and relevant professionals in managing risks as much as possible. We saw staff supported people to take positive risks where possible to increase people’s skills and independence. For example, one person found it overwhelming to go into the community when they first moved into the home. The staff supported them to gradually increase their exposure to people and environments which they weren’t familiar with, which meant the person was now able to visit community facilities such as the trampoline park, restaurants and shops. Staff understood there were times when people became distressed and took steps to understand why a person was distressed and what support they needed to express their emotions. Staff spoke to and about people at times of distress in a respectful way. People were consistently supported when they were distressed. Care plans were in place to support people to have a good day, and strategies were in place to prevent distress. Reactive strategies were available and followed by staff when necessary. Some people had been assessed as being at high risk of choking. This was documented and strategies were in place to reduce this risk. We observed a mealtime and saw staff followed people’s eating and drinking guidelines, including using special chairs, cutlery and crockery, cutting people’s food to the appropriate size, ensuring people maintained an appropriate seating position while they ate, and 1:1 staffing to observe and respond should people experience choking.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff supported people in a clean and safe home. The communal areas of the home were quite minimalist to ensure that people were not overwhelmed, and to reduce the risks associated with eating non-edible items. Each person’s individual sensory needs had been assessed and considered, so the environment could be adapted. People’s sensory needs were met in a way that prevented sensory overload and promoted relaxation within their home environment. Staff supported people to maintain and decorate their own personal spaces as they wished. The outdoor spaces of the home were clean and well-maintained. The equipment used outside (swings, trampoline, outdoor furniture) were safe for people to use freely. The service used keypad door locks to restrict people’s access from areas of the home that may not be safe for them without staff support. We saw people who were able to use these areas safely without staff support knew the codes so they could move freely about the house. We observed a staff member checking water temperatures during our visit.

The provider ensured there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staff told us they received training and ongoing support from the service to carry out their roles safely. People were supported by staff who had been safely recruited. This included a check for any criminal convictions, gaps in their employment history and uptake of references. People told us staff were competent in their roles and had appropriate training. Staff received regular supervision and training to maintain and develop their skills. They were supported and encouraged to progress in their roles and develop their careers. One member of staff told us, “There is a database, and we can just choose the training we think will help us”.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The home was clean and well maintained. Staff confirmed they always had access to sufficient personal protective equipment (PPE). Staff had received infection prevention and control training. A cleaning rota was in place to ensure the home was cleaned daily and a monthly infection control audit took place. We saw the provider's infection prevention and control policy was up to date.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were stored securely and at appropriate temperatures. There was an adequate stock of prescribed medicines.Our observations and the records we checked showed people were having their medicines administered as prescribed.

Medicine care plans were not always in place or accurate. There were care plans in place; however, for one person who was recently prescribed insulin for their diabetes, there was no diabetes care plan in place. The registered manager took immediate action during the inspection and put the diabetes care plan in place. For another person, their care plan included medicines which were no longer prescribed. People were prescribed medicines to be administered on a when-required basis for health conditions such as constipation, pain, and anxiety. There were care plans and protocols in place to administer these medicines consistently. There were person-centred positive behaviour support (PBS) care plans in place. A PBS is a person-centred framework used to understand, prevent, and manage challenging behaviours by focusing on an individual's needs. The records we reviewed assured us medicines were not used to control people’s behaviour. People's medicines were clinically reviewed regularly.

Staff members received training, and their competencies were assessed to handle medicines safely. Regular audits were carried out to identify gaps and make improvements.

There was a medicine management policy in place. However, the policy did not include guidance about medicine alerts which is an official communication issued by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) to notify healthcare providers, professionals, and the public of critical safety information. At the home, there was no process in place to receive and act on medicine alerts. The registered manager took immediate action during the inspection to put appropriate systems in place.