Beechfields Nursing Home Limited

Beechfields Nursing Home is a nursing home providing personal and nursing care to up to 35 people. The service provides support to older people some of whom are living with dementia, physical disabilities, and sensory impairments. At the time of our inspection there were 30 people using the service. The care home accommodates people in 1 adapted building across 2 floors.

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

People were not protected from incidents of harm and abuse. The provider failed to submit safeguarding referrals to the local authority safeguarding team in accordance with their regulatory responsibility. Incidents involving distressed behaviours were not investigated and action to reduce incidents of distressed behaviour was not taken. Risk assessments were not always completed, and medicines were not always safely managed or stored. Clinical and environmental risks were not always monitored safely. Staff were not competently trained to understand people’s health conditions.

The provider failed to ensure governance systems were robust and quality systems did not safely monitor risks to people. Lessons were not learnt from the last inspection to ensure people remained safe from harm.

People were not always treated with dignity and respect. However, people told us they were happy living in the home and felt supported by the staff team. People told us they felt included in decision making in the home and staff told us they felt able to raise concerns or make suggestions with the registered manager.

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.

The registered manager understood the duty of candour and was receptive to all concerns raised in the inspection. New systems and processes were introduced to monitor the care and support people received.

The provider worked in partnership with other health and social care agencies, including the local authority quality team who were supporting the provider to make improvements regarding their overall governance.

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 27 May 2020). 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about neglect and failure to escalate concerns to health professionals. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We inspected and found there was a concern regarding people’s dignity, so we widened the scope of the inspection and reviewed the key question of caring.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this full report.

The provider responded to all concerns raised in this inspection and implemented new systems and processes to improve the overall governance and support provided to people. We will review the success of these systems at the next inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Beechfields Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding, risk management, respecting people’s dignity and the governance of the home 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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.

Beechfields Nursing Home is a care home providing personal and nursing care for up to 35 people aged 65 and over at the time of the inspection. Some people living at the home had dementia, physical disabilities or sensory impairment. At the time of our inspection there were 22 people who lived at the home. The accommodation is provided in one building over two floors. There are three communal lounges, a dining area, a conservatory and a garden area that people can access.

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

People were not always supported by staff to have their medicines in a safe way.

The provider’s systems for governance were not always robust enough to ensure care was consistently safe. The provider had undertaken some regular checks to monitor the quality of the care that people received and consulted people to gain their views through meetings. Actions identified in some of the provider’s audits had not always been actioned despite some improvement since the previous inspection. In addition the provider had not always followed their own complaints procedure.

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.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise concerns about people's safety and share information so that people were safe. Accidents and incidents were monitored so any trends could be identified, and action taken to reduce any risks.

Staff were available to people and demonstrated good knowledge about people living at the home. Staff maintained good hygiene and used protective clothing when appropriate.

People told us, and staff confirmed they were trained for their role, and this helped them meet people’s needs. They said training updates were regular, so their knowledge was up to date. Staff understood the importance of ensuring people consented to the care and support they received, or where they lacked capacity was in their best interests. The registered manager was aware of their responsibilities regarding the action they should take if there were any restrictions needed to promote people’s safety and the person may lack capacity to consent to these.

People enjoyed a choice of meals and were supported to access professional healthcare outside of the home, for example, visits from or to their doctor and community health teams. Any changes to their care needs due to healthcare involvement were noted and usually followed through by staff.

We saw people were relaxed around the staff supporting them. We saw positive interactions and staff showed us that they knew the interests, likes and dislikes of people. People told us and staff demonstrated they were caring and kind to people in their care. People were supported to enjoy activities and staff ensured that they were respectful of people's choices and decisions.

People and staff told us that the management team were approachable and if they had any concerns they would be listened to. People and staff and were positive about the overall service.

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 23 February 2019). Since this rating was awarded the provider has altered its legal entity. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the quality and competence of nursing care following a safeguarding alert, and subsequent notification from the Nursing and Midwifery Council that they were gathering evidence in respect of some specific nurses’ competence. A decision was made for us to inspect and examine those risks through completion of a full inspection.

We have found evidence that the provider needs to make improvements. Please see safe 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.

The provider took action to identify immediate concerns we identified in respect of administration of a specific medicine, but concerns remained as to the clinical oversight that was in place, and how this practice occurred.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beechfields Nursing Home Limited our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines management and good governance at this inspection.

We will request an action plan for 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.