What our icons mean
|Outstanding – the service is performing exceptionally well.|
|Good – the service is performing well and meeting our expectations.|
Ticks and crosses
|The service must make improvements.|
Beech House provides residential care for up to 36 older people. The home is situated in Salford, Greater Manchester and is located near to local transport routes. Car parking is available at the front of the home or in nearby side streets a short distance away. The home is owned by Akari Care Limited.
Beech House is a 'care home'. People in care homes receive accommodation and nursing or 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.
At the last comprehensive inspection of Beech House in January 2017, we rated the service as ‘Requires Improvement’ overall and in four of the five key questions we inspected against (Safe, Effective, Responsive and Well-led). The Caring domain was rated as Good. During that inspection, we identified breaches of the regulations with regards to person centred care, safe care and treatment, nutrition/hydration and good governance. We also issued two warning notices regarding nutrition/hydration and good governance following the inspection telling the home they must improve. The provider then sent us an action plan, informing us of the planned improvements they intended to make. We also held meetings with the provider to discuss the concerns, with the local authority also in attendance.
To follow up on these concerns and due to receiving a number of safeguarding alerts about the home, we undertook a further comprehensive inspection on 13, 14 and 20 February 2018. The first day of the inspection was unannounced, however we informed staff at the home we would be returning for a second and third day to complete the inspection. At this inspection, we identified multiple breaches of the regulations regarding person centred care, safe care and treatment, safeguarding people from abuse and improper treatment, nutrition/hydration, good governance and staffing. You can see what action we have asked the provider to take at the back of the full version of this report.
Medication was not being administered to people safely. We identified multiple instances where people did not receive their medication because it was not available in the home to be given to them by staff as prescribed.
People’s skin integrity was not always being well managed and we found guidance from district nursing staff was not being followed. We also observed one person sat in a chair without appropriate pressure relieving equipment in place which could have placed their skin at risk.
We found people were being placed at risk because they were not always receiving food and drink of correct consistency which could place them at risk of choking/aspiration.
We found several environmental risks around the home such as the kitchen area not being secure and people’s thickened drinks left unattended in the lounge area.
People were not always referred through to the falls service for further assessment when necessary. The deputy manager told us people were referred once they suffered two falls or more, however we found this had not been done for one person living at the home in a timely manner. The deputy manager made this referral during the second day of the inspection.
Staff did not always receive the appropriate training, supervision and appraisal to support them in their role.
We identified concerns relating to people’s nutrition and hydration needs with advice and guidance from other health care professionals not being followed. Drinks were not easily accessible for people in communal areas who were at risk of dehydration and one person had run out of their nutritional supplements, despite needing them following weight loss.
The home did not have a system in place to monitor which people were currently subject to deprivation of liberty safeguards (DoLS) authorisations. We found instances where mental capacity assessments had not been undertaken, despite their being concerns about people’s capacity during soc
This unannounced inspection took place on Thursday 19 January 2017. The second day of the inspection on 20 January 2017 was announced.
Beech House is a residential care home which provides care for up to 36 older people and is owned by Akari Care Limited. The home is situated in Salford, Greater Manchester and is located near to local transport routes. Car parking is available at the front of the home or in nearby side streets a short distance away.
Our last inspection of Beech House was in March 2015. Although no regulatory breaches were identified, the home was rated as ‘Requires Improvement’ overall and in the ‘Safe and ‘Effective key questions. This was due to concerns regarding the length of medication rounds, safety gates on stairwells being left open and unlocked and also a lack of dementia friendly environments to help people orientate themselves around the building. The domains for ‘Caring, ‘Responsive’ and ‘Well-led’ were rated as ‘Good’.
During this inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centered care, safe care and treatment, meeting nutritional and hydration needs and good governance. We are currently considering our regulatory response to these issues.
We identified concerns with how risks were mitigated at the home. For example, risk assessments were not reviewed on a consistent basis and trends analysis following accidents and incidents had not been completed since October 2016. Two people, who had been admitted to home in recent months did not have any risk assessments in place. This meant staff did not have sufficient information available to them about how to keep people safe.
We also observed one bedroom door was propped open with a chair which presented the risk of the door not closing in the event of a fire. We raised this with the manager on the first day of the inspection, however we observed the door to still be propped open the following day. We also checked upper level bedroom windows to see if window restrictors were used. We found one bedroom and two corridor windows did not have window restrictors on, with two of the windows opening a considerable length, presenting the risk of a person potentially leaving in an unsafe manner or falling. The provider immediately ordered window restrictors to be fitted and we checked these on the second day of the inspection. However we noted from looking at the maintenance book that the bedroom window restrictor was noted in July 2016 as being missing. This still had not been replaced at the time of our inspection in January 2017.
One person’s care plan also identified them as needing to be sat a pressure relieving cushion during the day, however staff did not ensure this was provided for this person on both days of the inspection. Although this person was mobile, there was a lack of oversight in communal areas to ensure this task was completed.
People living at the home told us they felt safe living at the home. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.
We found that medicines were given to people safely, with staff receiving appropriate training. Medicines were stored in a secure treatment room, with only staff responsible for administering medicines having access to the room.
Staff were recruited safely with references from previous employers being sought and DBS (Disclosure Barring Service) checks undertaken.
We had concerns about how the service monitored and responded to people who were at risk of losing weight. For example, one person who had suffered recent weight loss had been referred to a dietician in December 2016. This person was noted to have lost 9 kilograms between August 2016 and November 2016. Whilst waiting to be assessed, the dietician service had sent an action plan to the home, with specific instructions about how to monitor this person’s weight. This included
This unannounced inspection was carried out on 23 March 2015.
Beech House is a care home in the Salford Area of Greater Manchester and is owned by Akari Care Limited. The home is registered with the Care Quality Commission (CQC) to provide care for up to 36 people. The home provides care to those with residential care needs only. We last visited the home on 22 July 2013 and found the home was meeting the requirements of the regulations, in all the areas we looked at.
There was a registered manager in post. 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.
Staff spoke positively about the management and leadership of the home. One member of staff said; “The leadership here is second to none here”.
During the inspection we spoke with eight people who lived at the home as well as three relatives. People living in the home told us they felt safe. One person said; “The atmosphere makes me feel safe. Staff are always looking out for me they are always on the ball”. Another person said; “I have no reason to ever think I wasn’t safe. I simply never think about it.”
We looked at how the service managed risk. We found individual risks had been identified and recorded in each person’s care plan. These covered areas such as pressure sores, continence, falls and nutrition. Where people were at risk, clear guidelines were recorded in people’s care plans for staff to follow.
People were protected against the risks of abuse because the home had a robust recruitment procedure in place. Appropriate checks were carried out before staff began work at the home to ensure they were fit to work with vulnerable adults. During the inspection we looked at five staff personnel files. Each file contained job application forms, interview notes, a minimum of two references and evidence of either a CRB or DBS (Criminal Records Bureau or Disclosure Barring Service) check being undertaken. This evidenced to us that that staff had been recruited safely.
We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. We looked at staff rotas. We found the home had sufficient skilled staff to meet people's needs. Staff working on the day of our inspection included the manager, deputy manager, one senior carer and three care assistants. Other staff included kitchen, domestic maintenance staff and the activities coordinator. We were told staffing levels would be altered in line with occupancy levels.
All staff were given the training and support they needed to help them look after people properly. There was a staff induction in place and any training undertaken was clearly recorded on the homes training matrix. The atmosphere in the home was relaxed and the staff spoken with had a good knowledge of the people they supported.
During the inspection, we observed that a safety gate on the stairs leading to the second floor of the home was left open on several occasions by staff. This was in close proximity to the lounge area where a large number of people spent their day and could be easily accessed. On closer inspection, the lock on the gate was broken, which prevented it from closing properly. We raised this with the manager who contacted the homes maintenance team to arrange for them to visit the home to fix it. This had the potential to place people at risk.
Although medicines were handled safely, we observed that the morning medication round did not commence until approximately 9.30am and did not conclude until approximately 11.40am. This meant that morning medication was given late and therefore effected what time other medicines could be given later in the day, as four hours is usually required to be left in between doses. We raised this issue with the manager who told us they would ensure the morning medication round was started earlier on in the day.
The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. From our discussions with managers and staff and from looking at records we found staff had received training in relation to MCA and DoLS. The manager and staff spoken with expressed a good understanding of the processes relating to DoLS. At the time of our inspection, three people living at the home were subject to a DoLS.
A large number of people at the home were living with dementia and we found the environment had not been suitably adapted to meet their needs. For example, signage around the building was poor with nothing displayed to help people correctly locate the lounges or dining room. The corridors were at times, difficult to negotiate and walls were very similar in colour to doors. Although people’s bedroom doors were numbered, there were no fixtures and fittings for them to specifically remember their bedrooms by. We raised this with the manager and area manager who acknowledged that this could be improved.
We have made a recommendation in relation to this within the detailed findings of the report.
As part of our inspection we asked the people who lived at the home for their views on what the care was like at the home. One person said to us; “The staff are lovely they are all very kind but rushed off their feet even so are always gentle and kind. They are fantastic nothing is too much trouble”.
We spent time speaking with the activities coordinator during the inspection and also observed some of the activities which took place which included bingo and a quiz for people who wished to participate. There was also music playing in the background which we observed some people singing along to.
There was a complaints policy and procedure in place. This clearly explained the process people could follow if they were unhappy with aspects of their care. There had been no formal complaints made since our last inspection.
The home regularly sought the views and opinions of both people who lived at the home, their relatives and staff. This asked for their views of cleanliness, responsiveness, staff training and dignity.
There were effective systems in place to regularly assess and monitor the quality of the service. They included audits of the medication, catering, infection control, complaints and compliments and hygiene. Team meetings were held at regular intervals as well as monitoring visits from the area manager of the home.
On the day of our inspection there were 28 people living at Beech House. As part of our inspection we spoke to four people who used the service, three members of staff, two relatives, two social workers and a district nurse, all of whom expressed their satisfaction at the standards of care that were delivered.
At our last inspection we had some concerns in relation to referrals being made to external agencies such as General Practitioner (GP's), dieticians and the falls team, as we couldnï¿½t see any evidence that these referrals had been made. During this inspection we saw improvements in this area and we were shown documentation to show that people had been referred appropriately when there had been any concerns.
We looked at how the home ordered, stored, administered and disposed of peopleï¿½s medication and we found that this had been done safely and effectively.
At our last inspection we had some concerns in relation staff not being appropriately supported to carry out their job role effectively. This was because not all training and supervisions were up to date and there was no overall training matrix to identify training requirements for staff. We saw improvements during this inspection.The area manager told us that mandatory training will be completed for all staff by September 2013 and we could see that this had been pre-planned.
We found that the home had appropriate systems in place to monitor the quality of service provision effectively.
Before our visit to Beech House we had received a number of concerns. These concerns had been received anonymously by another health care agency and the details were then passed on to us. The concerns identified related to alleged poor nutrition and hydration, staffing and poor cleanliness and hygiene around the home. During our inspection we reviewed those areas of regulation that related to those concerns.
People told us what it was like to live in Beech House and how the staff cared for them and supported their needs. One person told us, ï¿½This is a nice place to live. The staff are really very good and they help you when you need itï¿½. Another person said ï¿½I am treated really well by all the staff hereï¿½ and, ï¿½They always check with me before they do somethingï¿½.
We found everywhere to be clean, tidy and comfortably furnished, although all areas and furnishings were showing significant signs of wear and tear. The manager told us that a full re-furbishment programme was due to start in early January 2013.
Each person using the service had a care plan in place. These were person centred and the staff had made an effort to create a ï¿½This is my lifeï¿½ section for each person by capturing background information such as hobbies and interests, work background and family information.
The manager told us that the ratios of night staff had recently been increased to make sure peopleï¿½s needs were met by sufficient numbers of appropriate staff at all times.
What our icons mean
|Outstanding – the service is performing exceptionally well.|
|Good – the service is performing well and meeting our expectations.|
|The service must make improvements.|
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