Beechwood Specialist Services

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 requires improvement. At this assessment the rating has remained the same. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

At our last inspection the provider was in breach of regulation in relation to safe care and treatment. At this inspection, enough improvement had been made to ensure the breach was met, however there were still some areas which required further improvement throughout this key question.

This service scored 59 (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 learning log for incidents and accidents. People’s care plans were updated following any incidents and incident forms were scrutinised to ensure any learning, for example, following a recent fall for 1 person.

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 services. People were assessed by the team at Beechwood to ensure compatibility and to ensure their outcomes could be met. Staff told us how sometimes this could be challenging with people when exploring their backstories or life history. The registered manager discussed how in particular for 1 person, the transition to a nursing home at a younger age had been difficult for them, so they had to ensure support was adapted to fully meet their needs whilst also promoting their independence.

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 shared concerns quickly and appropriately. Staff understood the correct course of action to take if someone was being harmed and had all received training in this area. We checked people’s DoLs and saw any conditions were being routinely reviewed and people were not unlawfully being deprived of their liberty, although some DoLs applications had been requested, they had not yet been authorised. The registered manager was chasing this up.

Despite the registered manager having a good oversight of risk, more improvement was needed to 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. However, there were some areas which lacked detail around potential risks people could potentially be exposed to and were not always easy to find in people’s records.

For example, a person who was at risk of choking, did not have a separate choking risk assessment in place which explained the mitigation process clearly. We did see some information recorded in a nutrition care plan, around the type of food consistency the person was assessed as needing, and any specific instructions for staff, such as ‘sit them up at 90 degrees’. We fed back how it might be difficult for agency staff or a staff member who does not know the person well support them effectively as choking was not highlighted as a risk. Additionally, another person’s care plan stated ‘modified diet, level 5 or 6.’ However there was no rationale as to whether the staff should give level 5 or 6. We did see this was a recorded SALT recommendation, however, queried how staff would make the decision to choose between level 5 or 6.

We fed all of this information back to the registered manager who accepted our feedback and who made immediate changes.

The provider had now made sure the environment was safe and fire doors had all been replaced, however there was still some improvement needed to the décor of the home. Some areas were in a poor state of repair, and we saw a sensory room which was not being used for its intended purpose, but more of a storeroom, despite 1 persons care plan stating they enjoyed the sensory room. Walls and ceilings were in need of repainting in some areas, and some bathrooms required modernisation. The registered manager shared a home improvement plan which was in the process of being agreed and we saw these tasks were included. All maintenance checks on the environment, were in good order and there was detailed records kept by the maintenance people. Any repairs were actioned straight away.

The provider did make sure there were enough staff on duty to support people. However, some improvement was required around training to ensure staff were experienced to work at Beechwood. For example, we saw how some people had specific conditions which required in depth knowledge. Despite there being a mixture of nursing staff on duty who were trained in these conditions, some care workers did not have a higher level of training with regards to specific conditions to ensure they could support people effectively. One staff member told us “I think some of the training could be more in depth, in can be hard here at times.” We did observe staff interacting with people appropriately throughout the day. The registered manager informed us of a new programme they were already looking into around making the training more robust and tailored to meet individual people’s needs. Staff did have some training in supporting people with a learning disability or autistic people.

There were adequate systems in place to assess and manage the risk of infection. Concerns around IPC were shared appropriately, and there were cleaning schedule in place. We did, however, observe due to some of the fixtures and fittings of the home such as grab rails being chipped, a shower chair being worn and some other lounge chairs having some small tears in them, these could not always be cleaned appropriately to minimise the risk of cross contamination. We fed this back to the registered manager who had already escalated this to the provider and there was a plan in place to address these issues.

The provider did make sure that medicines and treatments were safe, people were involved in this process, and it met people’s needs, capacities and preferences. However, some information with regards to medicines was not always clear. For example, we looked at a range of liquid medicines and saw where they had been opened there was no date recorded on the bottle. When we checked the providers records, we saw all liquid medicine was replaced every 28 days, therefore there was no risk of anyone receiving expired medicine. However, the provider’s audits systems stated liquid medicines should be dated when opened. The registered manager showed us an audit from the month before which had highlighted this, however staff had still not recorded dates. This was rectified straight away. All other medicine was given safely. We did raise some more information was needed in people’s PRN plans to ensure staff knew when to give these. PRN is medicine which is given as and when required. The staff team worked within the guidelines of STOMP [Stopping over medication of people with a learning disability and autistic people] to ensure people were being given PRN medicines appropriately.The management team were in the process of making improvements to the management of people's medicines.