We carried out a review of the data available to us about Beechcroft Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Beechcroft Residential Home, you can give feedback on this service.
We found the following examples of good practice:
The home had a visitor’s policy in place and guidance notes, explaining the procedures to be followed, were displayed on the front door. All visitors had to have a negative COVID-19 test before entering the home and their temperature was checked. A pre-visit COVID-19 risk assessment was completed and personal protective equipment (PPE) was supplied. In line with current guidance family were only allowed to enter the home if their loved one had end of life care needs. Other visitors used the visitors’ pod that had been erected in the back garden. All visits had to be pre-booked. As from Monday 8th March 2021, one designated family member/friend was able to visit within Beechcroft. Initially two such visits were bookable each day. Alternative arrangements were in place to keep people and their family/friends in contact. For example, telephone, email and video calls.
Visits from healthcare professionals were kept to a minimum, people only being visited if it was essential. Peoples’ health care needs continued to be met with the staff team using telephone calls and emails to share information and gain advice. Every person had received their first dose COVID-19 vaccination as had the majority of the staff team.
The staff team maintained social distance from each other and the people they were looking after as much as they were able. When they were delivering personal care, they wore additional PPE – a face visor, apron and gloves. The home had spacious communal areas, so people were able to spread out from each other. The staff team recognised that for some people, being able to sit and chat with their ‘friend’ was important for their emotional health. All bedrooms were for single occupancy and all but one bedroom had their own en-suite facilities. PPE stations had been set up in various places around the home.
All areas of the home were spotlessly clean, tidy and homely. The service had increased the number of domestic hours since the start of the pandemic. Extra touch-point cleaning tasks (bannister rails, light switches and door handles for example) were carried out during the day and also by the night staff. The registered manager and deputy monitored the staff going about their duties to check staff compliance with wearing PPE and the cleanliness of all areas of the home.
The staff team were tested regularly for COVID-19 – twice a week with a lateral flow test (LFT) and once a week with a full PCR test. People were tested every four weeks. Additional tests were undertaken should anyone become unwell or present with COVID-19 symptoms.
The service had plentiful supplies of PPE. In addition to facemasks and hand sanitising gel, they had a supply of shoe-covers, gowns, face visors and head coverings. This was in preparation for if there was an outbreak of infection. They had an air purifier machine for use when they needed to sanitise a room, for example.
The activities coordinator continued to support people with social activities each afternoon. Celebration days were always marked, and they were getting ready for Mother’s Day. People were helped with setting up video calls with their family and a ‘Wonderwall’ had been set up in the lounge displaying photographs of events that had taken place.
The service had admitted four people since the start of the pandemic. Before they were admitted they had a negative COVID-19 test result and were isolated in their bedroom for a 14-day period and retested after two days. After one person had attended an out-patients appointment, they were isolated and tested regularly.
The home has not had an outbreak of COVID-19 however early in the pandemic one person who was asymptomatic had a positive COVID-19 result. The location of their bedroom meant this area could be zoned off. The area became a ‘red zone’ and access into this part of the home was possible without entering the main building. If the service were to have an outbreak, there are two possible areas that could be zoned off.
Infection control training was part of the provider’s essential training programme which all staff were expected to complete. An additional COVID-19 training programme had been introduced by the provider and this covered PPE, donning and doffing, what to do if feeling unwell and what to look out for if people are unwell.
The provider’s infection prevention and control policies had been revised and updated to include all COVID-19 guidance. The policies were in line with guidance produced by Public Health England, CQC and the Department of Health and Social Care. The local authority COVID-19 team were in regular contact with the service.
Beechcroft 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. Beechcroft provides care for up to 18 people and there were 18 living in the home when we inspected.
The home had a registered manager. 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 and associated Regulations about how the service is run.
At the last inspection in February 2016 the overall rating was good.
At this inspection the overall rating was good.
People told us they felt safe using the service. A range of risk assessments were completed, managed and reviewed regularly. People were involved and made decisions about how they wanted to live their life in the home.
Staff knew how to keep people safe and understood their responsibility to protect people from the risk of abuse. Staff were safely recruited and there were sufficient numbers of staff to provide the care and support people needed.
People received their medicines at the right times. People were involved in planning the meals they wanted. People had access to a range of specialist health care support. The registered manager and staff worked closely with relevant health care professionals to ensure people's on-going health needs were met.
Staff received induction and training updates which helped them understand how to meet the needs of the people they were supporting. Staff received support and guidance through supervision and staff meetings.
People received responsive and personalised care. Care records were easy to understand, reviewed and kept up to date. These provided staff with clear guidance and information on meeting people's on-going needs.
People were supported by kind, respectful and caring staff that knew them well. Staff had developed positive trusting relationships with people and whom they interacted well with and focussed on promoting their independence. The design of the environment made it homely for people.
People knew how to raise a concern or make a complaint. The provider had a complaint policy and procedure and there was a range of complimentary correspondence received by the home.
The registered manager was approachable and people felt confident that any issues or concerns raised would be addressed and appropriate action taken. The registered manager and staff team were committed to providing quality care. The registered manager showed an awareness of their legal responsibilities. They kept their knowledge up to date with legislation and best practice and worked with outside agencies to continuously look at ways to improve the experience for people.
The service learnt lessons from incidents and made improvements when things went wrong. The provider's governance system to monitor and assess the quality of the service was used effectively to improve the service and looked at ways in which people were supported to achieve greater independence.
The service had introduced new ideas and was planning to introduce further developments to improve the people's experiences and quality of life in the home.
We carried out this unannounced inspection on 21 December 2015.
The last inspection was in November 2013 There were no breaches of legal requirements identified.
Beechcroft Residential Home is registered to provide personal care and accommodation for up to 18 people. At the time of the inspection there were 18 people living in the care home.
A registered manager was in post at the time of our inspection. 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 and associated regulations about how the service in run.
People and their relatives felt the service was safe. There were sufficient staff on duty to meet people's assessed needs. People were supported by staff who had been recruited after checks were completed to make sure they were suitable to work with vulnerable people.
People received the support they required with their medicines. Medicines were managed safely.
Staff received training in safeguarding adults and were aware of the reporting procedures should they have any concerns. An assessment of people's risks was completed and supporting risk management guidance was recorded where required. The environment and the equipment used to support people was regularly assessed and serviced to ensure it was safe.
New staff received an induction training programme. They were knowledgeable about the signs of abuse and how to report concerns. We have made a recommendation with regard to staff training.
The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.
People were supported as required to eat and drink and had access to health care professionals when required.
People told us staff were kind and supportive. Relatives were welcomed, and appreciated what they described as acts of kindness.
The service was responsive to people's needs. Care records reflected an individualised approach and people's choices and preferences. People enjoyed the various activities which were arranged at the home.
The provider sought the views of people, relatives and staff, and used the feedback to make improvements to the service.
The registered manager had systems in place to monitor the quality of care and auditing systems to monitor records and documentation used by staff.
Significant improvements had been made in care planning and records. Care plans now reflected individualised needs. Comprehensive assessments and care plans had been completed. These had been reviewed and updated to reflect the needs of the individual. Risk assessments set out the area of risk to the individual and provided guidance to staff about how to respond to risk and keeping people safe.
Care plans identifying people's health and social needs had been completed. However there was a lack of information about how staff should respond to care needs and associated risks to people's health and welfare. People had discussed their care needs but were not involved in formal reviews of their care arrangements.
Staff had a good understanding of their responsibilities around identifying possible abuse and responding to concerns. However senior staff did not demonstrate the required knowledge about their responsibilities in reporting and investigating safeguarding concerns.
Staff told us that management were open and approachable. Staff said how they were well supported to undertake their role. There were no arrangements for formal one to one supervision. Staff received the necessary training to fulfil their responsibilities in meeting people's needs effectively.
There were shortfalls in the undertaking of audits to measure the quality and safety of care being provided. People had an opportunity to comment on the quality of the service they received.
Records were not completed so that people's care needs and any risks were clearly identified. Staff did not have written guidance and instructions as to how to respond appropriately and safely to care needs.