Beechwood Specialist Services

Beechwood Specialist Services is a care home. The service is registered to provide personal and nursing care to up to 60 people with a variety of mental and physical health needs. At the time of our inspection, there were 33 people living at the service.

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

Staff followed good infection control practices and used personal protective equipment (PPE) to help prevent the spread of infection. People and staff were tested regularly for COVID-19 in line with current guidance.

The registered manager demonstrated a commitment to ensuring the service was safe and had worked hard to implement checks on safety and quality.

Records relating to the management of risk were clear and guided staff in their practice to keep people safe from avoidable harm. We noted improvements to the number of staff trained to safely intervene when people were at risk of harm.

The registered manager kept records of all accidents and incidents. All relevant incidents or concerns were communicated to the local authority and CQC as required by law.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a targeted inspection that considered the management of risk, infection control and governance. Based on our inspection of these areas, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People's care records were person-centred. Staff had a positive attitude and were trained to support people in the least restrictive way possible. People had access to the community and the service recognised the importance of facilitating outward visits with friends and relatives.

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 requires improvement (published 1 October 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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.

Beechwood Specialist Services is registered to provide nursing and residential care to up to 60 people with a variety of mental and physical health needs. At the time of our inspection 33 people were living at the service.

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

At our last inspection the provider had failed to robustly assess the risks relating to the health safety and welfare of people. We also found governance systems were not effective at ensuring regulations were met. Not enough improvement had been made at this inspection and the provider was still in breach of Regulations 12 and 17. An additional breach of regulation relating to consent was identified at the last inspection but not considered as part of this process.

The environment and systems in relation to fire had not been safely managed. Staff did not consistently adhere to the relevant guidance for the use of personal protective equipment (PPE). Some staff failed to wear face masks correctly and maintain social distancing as required. Evidence of appropriate review of risk following incidents was missing from care records. Staff had not received recent training to ensure they could safely intervene when people were at risk of harm. Action was taken by the provider when these concerns were shared.

The service did not have robust and effective systems in place to monitor, assess and improve the safety and quality of service being provided. This placed people at unnecessary and avoidable risk of harm. Because some records were not sufficiently completed, it was unclear if the manager and provider had notified The Care Quality Commission (CQC) of all significant events which had recently occurred. Some aspects of the service had improved since our last inspection but, further improvement is still required to meet regulations.

Staff demonstrated kindness and respect in their interactions with people. It was clear they provided care in an individualised manner. Staff and relatives spoke positively about the level of communication from managers at the service.

Some aspects of environmental safety had improved following the last inspection. For example, the building was noticeably clean. Cleaning schedules had been increased to address the additional risk posed by COVID-19. Medicines were managed safely at the service and people received their medicines as prescribed by competent staff.

The people we spoke with and their relatives told us they felt the service was safe. Staff were safely recruited subject to the relevant checks.

Rating at last inspection and update:

At the last inspection the service was rated requires improvement (report published 28 June 2019).

During the last inspection we found breaches of Regulations 11, 12, and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 28 June 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 29 and 30 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve consent, safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The Key Question Effective which contains the breach of regulation 11 was not inspected at this time.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

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

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safety and management of the service.

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

Follow up:

We will meet with the provider to discuss our findings and how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Beechwood Specialist Services is registered to provide nursing and residential care to up to 60 people with a variety of mental and physical health needs. At the time of our inspection 48 people were living at the service.

People’s experience of using this service:

People told us they felt safe living at the service. People and their relatives also there were enough staff on duty to help them when they needed it.

Some aspects of environmental safety were managed well, but some parts of the environment were not well-maintained

There was a poor standard of hygiene and cleanliness across the service and the condition of some parts of the service were undignified.

The home did not always act in line with principles of The Mental Capacity Act 2005. This meant there was risk inappropriate decisions could be made on a person’s behalf if they lacked capacity to make the decision for themselves.

People were well-supported with their nutrition and hydration needs. Overall the feedback about the food at the service was positive. However, there was limited nutritional value to some of the meals served and a lack of healthier choices for people. People were also not being given the opportunity to make informed choices about what they ate, as the options were not clearly and effectively communicated.

People told us the staff were kind and caring and they got on well with them. However, the service relied heavily on agency staff, which inevitably put continuity of care at risk and potentially limited people’s ability to develop meaningful relationships with staff.

Care planning at the service was inconsistent. Some aspects were good and gave staff the information they needed to get to know and support people well. However, the service did not always effectively consider and plan to meet all of people’s support needs or ensure information in people’s care plans was kept up-to-date.

There was a limited range of activities on offer to people living at the home. People were largely restricted to spending their time watching television or listening to the radio.

We received mixed feedback about the management of the service and people and their relatives did not always feel listened to.

Rating at last inspection:

At the last inspection the service was rated requires improvement (report published 8 June 2018).

During the last inspection we found breaches of Regulations 12, 17 and 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we found the home had addressed the breach of Regulation 19. However, the service remained in breach of Regulation 12 and 17, with an addition breach of Regulation 11.

We have also made recommendations that the service makes improvements relating to the ways it communicates food and drink options to people; adapting the environment for people living with dementia and how it supports people to follow their interests and take part in activities that are relevant and important to them.

This is the service’s second rating of requires improvement.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will meet with the provider to discuss our findings and how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Beechwood Specialist Services provides nursing and residential care to up to 60 people with a variety of mental and physical health needs.

Beechwood Specialist Services is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 time of the inspection there were 45 people living in the home.

A new manager was in post. They had not started the process to become registered with the Commission at the time of the inspection, but since the inspection has confirmed they have submitted an application. 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.

Not all safe staff recruitment practices were followed to ensure staff were suitable to work with vulnerable people.

Plans were in in place to support people who presented with behaviours that could challenge, however some lacked detail as to how risks should be managed.

Chemicals and objects that could pose risks to vulnerable people were not always stored securely. We discussed this with a staff member who arranged for all of the toiletries to be stored securely straight away.

We saw that the electrical certificate had expired. The electrics had been checked recently and following the inspection, we received a copy of the electrical certificate which showed they had been assessed in March 2018 and were un-satisfactory.

Staff were aware of people’s individual dietary needs, however we found that records had not always been updated to reflect current needs. Feedback we received regarding the food varied. Most people told us they enjoyed the meals, but not everybody.

Although staff told us they received regular training, records available did not reflect this as training records had been lost when the provider took over the company in 2017.

There were no records to show that staff had completed a formal induction to ensure they had the required knowledge to fulfil their roles. A new contract had been secured to provide training and induction. Records showed that most staff had received regular supervisions, though not all staff had received a supervision within the past three months.

Care files showed that plans were in place to support people’s needs, however not all plans were detailed. Planned care was not always recorded as provided, such as when people were supported to reposition.

Systems in place to monitor the quality and safety of the service were not always effective as they did not highlight all of the issues we identified during the inspection and did not show what actions had been taken when issues had been highlighted. There was no evidence of provider oversight.

Most people we spoke with told us they felt safe living in Beechwood and their relatives agreed. Staff were knowledgeable about safeguarding and were able to clearly explain how they would report any concerns they had. There were enough staff on duty to meet people’s needs.

Care files showed that risk to people was assessed. This included personal emergency evacuation plans (PEEPs). These were detailed and provided information to staff on what support people would need in the event of an emergency evacuation and what equipment would be needed.

Medicines were stored securely and we saw that they were administered safely and as prescribed.

Staff were able to explain when medicines prescribed as and when required should be given, however this information was not written down to ensure they were administered consistently.

Applications had been made to deprive people of their liberty appropriately and a system was in place to monitor this process. When able, people provided to consent to the care and treatment. When people lacked mental capacity to provide this consent, we saw that the principles of the MCA were followed when seeking consent.

People we spoke with told us staff arranged a doctor quickly if they were unwell and records showed staff made referrals to other healthcare professionals for advice.

People living in Beechwood told us that staff were kind and caring and that they were treated with respect by staff. We observed interactions between staff and people living in the home to be warm and genuine. We heard staff speak to people in ways each person could understand and we saw staff protect people’s dignity when providing care.

Friends and relatives visited throughout the inspection and all those we spoke with told us they were always made welcome. For people who did not have friends or family members to support them, details of advocacy services were available.

Care plans were centred on the person and reflected how they wanted their support to be provided. This enabled staff to get to know people as individuals and provide support based on their needs and preferences.

There was a complaints policy available and the manager maintained a complaints log. People living in the home knew how to raise any concerns and relatives told us their complaints had been dealt with to their satisfaction.

A minibus was available for people to go out on trips and we were told people often went to the city centre or to local pubs. We observed a small group of people going out for a pub lunch on the day of the inspection. External entertainers also regularly attended the home and the manager was in the process of recruiting an activity coordinator.

Staff were trained to support people at the end of their life, as well as their families and discussions regarding care provided to people reflected best practice guidance.

Policies and procedures were available which guided staff in their role. Staff we spoke with were aware of these policies and told us they could access them at any time.

Meetings took place and surveys were completed in order to gather feedback regarding the service. Records showed that actions had been taken based on the feedback received.