21 and 22 May 2015
During an inspection looking at part of the service
This unannounced inspection took place on 21 and 22 May 2015. Beech Tree Care Home provides accommodation and nursing care for up to 60 people who have nursing needs. At the time of our inspection there were 25 people living at the service. The home consisted of three floors, with bedrooms and bathrooms on each floor, and a communal lounge on the ground floor. Stairs and a lift provided access between floors. At the time of our inspection the third floor was closed for refurbishment.
The previous registered manager resigned in January 2015 and there was no registered manager in post at the time of our inspection. The provider appointed an interim manager to replace the registered manager and a new home manager was appointed on 2 March 2015. The newly appointed home manager has begun the process to become registered with the Care Quality Commission (CQC), which was confirmed by records. A registered manager is a person who has registered with the CQC 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.
We last inspected Beech Tree Care Home on 8 and 9 December 2014 and judged the provider to be in breach of 10 regulations. We issued warning notices for the breaches in relation to staffing, cleanliness and infection control, meeting people’s nutritional needs and assessing and monitoring the quality of the service. We issued compliance actions for breaches relating to the care and welfare of people, people’s consent to care, respecting and involving people, supporting workers, complaints and records. The provider was required to meet the regulations relating to the warning notices by 31 March 2015. The provider informed us that they would meet the requirements of the breaches relating to the compliance actions by 31 March 2015. During this inspection we found the provider had taken action to ensure the requirements of the Regulations had been met.
The provider had taken action to keep the home clean and hygienic. Cleaning staff were diligent and understood how their role was important to people’s safety. People were protected from the harm of acquired infections.
There was a robust system to ensure staffing levels were always appropriate to meet people’s needs. The provider had recruited more nurses and had not used agency nurses since January 2015. The home manager completed a weekly staffing analysis based on people’s dependency and changing needs. They ensured that staffing deployed was now at least 10% above that identified as a requirement to meet people’s needs. This ensured short notice absences did not affect people’s support.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. DoLS provide a lawful way to deprive someone of their liberty, where it is in their best interests or is necessary to protect them from harm. The Mental Capacity Act 2005 (MCA) provides a legal framework that sets out how to support people who do not have capacity to make a specific decision. We found that staff had completed training in relation to DoLS and MCA 2005. The provider ensured that people understood and had given valid consent to their care and treatment. Where people lacked the capacity to consent to their care, legal requirements were followed by staff when decisions were made on their behalf. The home manager had taken the necessary action to ensure staff recognised and maintained people’s rights.
People’s needs and risks had been identified and care was planned and delivered to meet them, with the exception of the management of diabetes. The provider had not taken all practical steps to manage identified risks to people. The safety of people living with diabetes had been compromised because staff had not made appropriate referrals to health professionals in response to results from blood glucose monitoring. People identified to be at risk of pressure ulcers, falls and malnutrition had specific plans to manage these risks, which had been reviewed by senior staff monthly or more frequently where required. These plans were effective in addressing people’s identified health needs.
People were protected from the risks of malnutrition and dehydration. People’s nutritional needs were assessed and there was guidance for staff to support people in the way they required. Where necessary people had been referred to appropriate health professionals for dietary advice, which was then implemented by staff. All care and catering staff had received training in relation to managing the risks of malnutrition and dehydration from a dietician in January 2015.
The provider had deployed sufficient staff to provide stimulating activities for people. The activities programme had been revised, and there were a range of events arranged. This ensured people were supported to pursue social activities and protected from social isolation.
Staff had completed training in relation to meeting people’s nutritional needs, MCA and infection control, in addition to other required training. The provider supported staff to meet people’s needs with an effective programme of supervision and appraisal.
People told us they knew how to complain and that the new home manager encouraged them to raise concerns with her. When complaints were made they were investigated and action was taken by the provider in response. Complaints were analysed by the home manager to identify themes, and where these had been identified action had been taken to address concerns raised.
The home manager was providing clear and direct leadership and was effectively operating systems to assure the quality of the service and the health and safety of people.
People at Beech Tree Care Home told us they trusted all the staff and said they made them feel safe. Staff had completed safeguarding training and had access to relevant guidance. They were able to recognise if people were at risk and knew the actions to follow to address safeguarding concerns.
People’s safety was promoted through individualised risk assessments. Risks had been identified, and plans were in place to manage these effectively. Staff understood the risks to people’s health and welfare, and followed guidance to safely manage them.
Staff recruitment processes were robust. They were responsive to people’s specific needs and tailored the care delivered for each individual to meet their wishes.
We observed medicines were administered safely in a way people preferred, by trained staff who had their competencies assessed by supervisors.
The provider aimed to enable people to maintain their independence as much as possible. People’s dignity and privacy were respected and supported by staff who were skilled in using people’s unique communication methods.
The manager promoted a culture of openness and had made changes in the home to improve people’s care and staff morale. There was a clear management structure and systems in place to drive improvements.
We found a breach 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.