Beechdale Manor Care Home

Beechdale Manor is a residential care home providing personal and nursing care for up to 65 people. The service accommodates people in one adapted building which is set out across three floors. The ground floor accommodates people who have a higher level of mobility and less complex needs. The first floor provides care and support for people with more complex and palliative care requirements. At the time of our inspection there were 43 people using the service. At the time of our inspection the second floor was undergoing refurbishment and was unoccupied.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Beechdale Manor was well led by a registered manager who showed strong leadership qualities. The staff team were respectful and kind. They understood people and their identified needs well.

Risks associated with people's care and support and the environment were safely managed. People were protected from the risk of harm. Opportunities to learn from incidents was shared across the staff team to ensure improvements in service delivery were made.

Medicines were received, stored, administered and disposed of safely by staff trained and competent in this area. The home was clean and hygienic. The provider was following best practice guidance in infection control standards.

There were sufficient staff deployed across the service to meet people's needs and ensure their safety. Safe recruitment practices were followed, and staff were trained and competent to carry out their roles.

People were supported with their health needs and had access to healthcare services. Care plans contained personalised health information. The service was well adapted and being refurbished to meet people's needs.

The provider and registered manager operated effective governance systems to ensure the quality,

safety and improvement of people's care when needed. Audit systems were robust, and there were opportunities for people, relatives and staff to get involved in driving improvements.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Mental Capacity Act: People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

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

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Rating at last inspection and update: The last rating for this service was Inadequate (published 18 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider made improvements to infection control within the service, safeguarding people from abuse, medications management, pressure area care management, the quality of risk assessments for service users, and improving the level of governance at the service. At this inspection we found the provider had acted on any recommendations and had made improvements in these areas.

This service has been in Special Measures since 18 March 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as Inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

The overall rating for the service has changed from Inadequate to Good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The provider had robust policies and procedures in place to ensure staff and visitors followed effective infection control guidance, whilst considering any potential impact on people living at the service. Staff and visitors had access to personal protective equipment (PPE). Staff were observed wearing PPE in line with current guidance.

Visiting professionals were required to show a negative lateral flow test and evidence of their COVID-19 vaccination status. Visiting arrangements were clearly displayed and in accordance with the most recent Government guidance. Staff and people using the service were participating in a regular COVID-19 testing programme.

The service was clean throughout and was undergoing a full refurbishment to ensure the environment could better meet people’s needs in future. Increased cleaning of high touch point measures which were in place.

Social distancing was observed wherever possible and staff were updating their training in infection control and COVID-19. Guidance was displayed around the home on how to use PPE and maintain good hand hygiene.

Beechdale Manor is a residential care home providing personal and nursing care for up to 65 people. The service accommodates people in one adapted building which is set out across three floors. The ground floor accommodates people who have a higher level of mobility and less complex needs. The first floor specialises in providing care to people living with dementia. The second floor provides care and support for people with more complex and palliative care requirements. At the time of our inspection there were 61 people using the service.

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

Risks associated with people’s care and support and the environment were not managed safely. This placed people at risk of harm. Opportunities to learn from incidents had been missed. Medicines were not always stored or managed safely. There were not always enough staff to meet people’s needs and ensure their safety.

Safe recruitment practices were followed, however, staff lacked effective support to carry out their roles.

The home was not clean or hygienic. Infection prevention and control practises were ineffective and the risk of cross contamination was high.

People were at risk of dehydration and malnutrition due to poor monitoring and failure to follow nationally recognised guidance.

Overall, people were supported with their health needs and had access to healthcare services, although care plans did not always contain personalised health information. The service was adapted to meet people’s needs. People were not always supported by staff who had training to meet their needs.

Relatives often struggled to contact the home for updates on loved ones.

Beechdale Manor was not well led. The manager failed to identify major concerns about health and safety and infection control. The provider did not operate effective governance systems to ensure the quality, safety or improvement of people’s care when needed. There had been a failure to identify and address issues with the health, safety and quality of care provided. Audits were not always effective, and the provider did not have sufficient oversight of the running of the home. There were limited opportunities for people and staff to get involved in driving improvements.

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 Good (Published 1 September 2020)

Why we inspected

The inspection was prompted in part due to concerns received regarding medicines management, safe care and dignity and respect for those using the service. As a result, we undertook a focused inspection to review the key questions of Safe and well-led only.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this report.

You can see what action we have asked the provider to take at the end of this report. The provider did send an action plan to give assurance that serious risk had been mitigated. The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beechdale Manor 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 risk management, the environment, safeguarding, staffing, how people are treated and leadership and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We will work alongside the provider and 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Beechdale Manor is a residential care home providing personal and nursing care to 60 people aged 50 and over at the time of the inspection. The service can support up to 65 people. The service accommodates people in one adapted building which is set out across three floors, with wheelchair accessible ramps leading onto a communal garden area with seating. The ground floor accommodates people who have a higher level of mobility and less complex needs. The first floor specialises in providing care to people living with dementia. The second floor provides care and support for people with more complex and palliative care requirements.

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

At the last inspection we had concerns about the deployment of sufficient numbers of competent staff across the service, the management of medicines and the assessment of risk for people using the service. These concerns have now been addressed. The registered manager had a clear action plan to continue to improve in these areas.

At the last inspection we found that staff were not sufficiently deployed across the service. People told us, and records showed us that this had improved. Staff were recruited safely to ensure they were of good character.

People's health and social care needs were clearly documented on a new electronic system. This allowed clear guidance for staff to follow. The registered manager had a plan in place to improve the use of this system and use more effective electronic auditing.

There were safe and suitable arrangements and protocols in place for the ordering, receiving, storing and disposal of medicines. Staff were trained in the use of and dispensing of medicines.

People felt safe using the service. Staff knew who to contact if they were concerned about abuse. Staff were confident that the management team would respond to their concerns but knew how to use whistleblowing procedures if needed.

People told us they were happy with their care. Records showed that people were supported by a competent, well trained staff team.

The registered manager understood the requirements of their role. Staff and the registered manager had a clear vision to provide good quality care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 October 2019) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on previous inspection risks

At the last inspection we had concerns about the deployment of competent staff across the service, proper and safe management and administration of medicines and not ensuring the effective assessment and management of risks to the health and safety of people using the service. We identified breaches of Regulation 12 (Safe care and treatment) and Regulation 18 (Staffing).

We completed this inspection, to assess if required improvements had been made. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Enforcement and follow up

At the last inspection we identified breaches of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found sufficient improvements had been made at this inspection, so the service was no longer in breach of these regulations.

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Beechdale Manor is a residential care home providing personal and nursing care to 44 people aged 60 and over at the time of the inspection. The service can support up to 65 people. The service accommodates people in one adapted building which is set out across three floors, with wheelchair accessible ramps leading onto a pleasant garden area. The ground floor accommodates people who have a higher level of mobility and less complex needs. The first floor specialises in providing care to people living with dementia. The second floor provides care and support for people with more complex and palliative care requirements.

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

There were concerns regarding the appropriate deployment of competent staff across the service in relation to the complexity of people’s assessed needs.

People's weights, diabetes management and tissue viability were not always effectively monitored so that staff could identify early signs of people becoming unwell. We found that risk assessments were in place for these, although they were not always robust.

We found that not all medications were given in a timely, safe way for people using the service.

Quality assurance systems had improved since the last inspection in identifying any shortfalls in the service. Staff knew how to identify, report and respond to safeguarding concerns.

People told us they were supported by a registered manager and staff team who knew them well and who were caring. People were treated with dignity and respect.

People and their relatives were involved in planning their own care. People's care plans were detailed and gave staff clear guidance about how people liked to be supported. People were given the opportunity to take part in a range of activities and be active participants within the local community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff felt well supported, and that they had the knowledge and skills to perform their roles and worked well as a team.

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

Rating at last inspection and update.

The last rating for this service was Requires Improvement (report published 22 November 2018) and there were two breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found although one of these regulations had been met, the provider was in still in breach of one regulation and a different regulation.

This is the second time the service has been rated Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We have identified breaches in relation to the deployment of competent staff across the service, proper and safe management and administration of medicines and not ensuring the effective assessment and management of risks to the health and safety of service users at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Beechdale Manor 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. Beechdale Manor provides personal and nursing care for up to 65 people over three floors. At the time of our inspection, there were 28 people living at the service.

A registered manager was in place but they were unavailable on the day 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 2008 and associated Regulations about how the service is run.

Staffing levels and deployment of staff were found to not meet people’s needs and safety. People had experienced falls and sustained injuries at times when staffing levels were lower at night. Action to manage and mitigate risks had not always been completed in a timely manner. Risk assessments reviewed and guidance updated to reduce reoccurrence.

The audits and checks in place to assess, monitor and review risks were insufficient to protect people’s safety. There was no analysis of falls, accidents and incidents to review for themes, patterns and lessons learnt. This lack of oversight impacted on people’s safety.

The provider had failed to notify CQC of all reportable incidents they are legally required to do. Where they had completed notifications, these were inaccurate in detail and had not been submitted in a timely manner as required.

The prevention and control measures for infection and cross contamination were not fully met. Equipment was found to be dirty due to a lack of cleaning and there was a lack of oversight of cleaning schedules.

Staff were aware of the action to protect people from abuse and had received safeguarding training. However, safeguarding incidents had not always been reported to the local authority responsible for investigating safeguarding in a timely manner. This was a requirement under the multi-agency safeguarding procedures.

Safe staff recruitment checks were used to assist the provider in making safe recruitment decisions. People received their prescribed medicines and these were stored and managed in line with best practice guidance.

National best practice guidance was used in the form of recognised assessment tools to assess people’s needs. Staff received an induction on commencement of their employment and ongoing training and opportunities to discuss their training and development needs. Processes were being implemented to check staff’s competency.

People received a choice of meals and drinks and their nutritional needs were known, understood and monitored. Staff worked with healthcare professionals in managing people’s healthcare needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of the principles of the Mental Capacity Act 2005 and further work was in progress to review how best interest decisions were made.

The environment met people’s needs and ensured people did not experience any discrimination due to their disability. Equipment to support people’s needs was provided and available.

Staff were caring, compassionate and knew people’s needs, preferences and what was important to them. Staff respected people’s privacy and dignity, encouraged people with choice making, and promoted independence. Independent advocacy support was provided. People and or their relative where appropriate, were involved in their care and treatment as fully as possible.

People’s diverse needs, routines, preferences and what was important to them had in the main been assessed. However, care plans that provided staff with guidance was limited in places, such information relating to healthcare needs. When people’s needs had changed, care plans had not always been updated to reflect changes in the care and treatment required.

People received opportunities to participate in a choice of social activities including community visits.

People who used the service, relatives, staff and external professionals raised some concerns about the leadership of the service. People received opportunities to share their feedback about the service they received, but it was not clear how this was responded to. Staff meeting records did not show how discussions and actions were agreed to improve the service. The provider had an action plan to improve the service, whilst this was ongoing, some areas identified to have been completed in September 2018 had not been achieved.