The Beeches

The Beeches is a residential home providing accommodation for persons who require nursing or personal care for up to 23 people. The service provides support to people who have physical health needs and conditions such as Dementia. At the time of our inspection there were 18 people using the service.

The home is set out across 2 floors, each of which has adapted facilities. There were communal areas, a dining room and individual bedrooms, some of which had en-suite facilities.

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

People and relatives spoke positively about the care received from the staff team and the registered manager. People said they felt safe and happy.

Sufficient numbers of staff were available in line with people’s needs. Feedback suggested on occasion staff were busy and the service could benefit from additional staffing. The provider reviewed the staffing levels to improve people’s experience and ensure staff were available to support with activities.

People were protected from the risk of abuse by staff who were trained. One person said, “I do feel safe here.” Improvements had been made to records associated with risks to people’s care. Peoples care plans and risk assessments were detailed and person-centred.

People were supported by staff in a kind, caring and dignified way. Staff sought consent from people when offering care and people were encouraged to express their views and be involved in decisions about their care. Interactions with staff and people were positive and supportive. One person said, “It’s the way they [staff] all talk very nicely to you, its lovely.”

The provider continued to make improvements to the home environment and people had been actively involved in these decisions. One person said, “I was given a choice of wallpapers to choose from for my room.”

Governance processes had been imbedded into practice and the registered manager was using them effectively to drive service improvement. Any concerns or complaints were promptly investigated, and lessons learnt were shared with staff.

People, staff and relatives spoke positively about the culture of the service, the registered manager and the directors. The management team were present throughout the service and feedback indicated they promoted an open and supportive culture.

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

Rating at the last inspection

The last rating for this service was Requires Improvement (Published 8 June 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to management oversight, staffing, recording issues and poor care. During the inspection, we found improvements had been made across key questions of Caring and Responsive and focussed the inspection on Safe, Caring, Responsive and Well-led.

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

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 the service can respond to COVID-19 and other infection outbreaks effectively.

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

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

Follow up

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

The Beeches Care Home is a residential care home providing accommodation, personal and nursing care for up to 23 people aged 65 and over, some of whom are living with dementia. At the time of inspection 20 people were living at the home.

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

People said they felt safe and happy living at The Beeches. They said the food was good and they liked the staff.

The provider had improved the management of people’s medicines. We saw improvement in the assessment, recording and management of risks related to people's health and the environment. Although there was a need to continue to develop people’s risk assessments.

The provider had made real improvements to the oversight and governance arrangements. The audit systems were effective in highlighting and addressing shortfalls and concerns. The improvements spanned medicines management, care planning, record keeping and fire safety. Some improvements were relatively recent and needed embedding into practice.

The provider had made improvements to the home environment. This included refurbishing and replacing bathrooms and toilets, making improvements to the garden. Refurbishing and redecorating in some areas and replacing floor coverings. Signage and decoration had been improved to support the needs of people living with dementia.

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. Mental capacity assessments and documentation had been improved. Staff received the training and support they needed to care for the people using the service.

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 Inadequate (published 20 August 2021) and there were multiple 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 enough improvement had been made and sustained, and the provider was no longer in breach of regulations.

This service has been in Special Measures since 14 April 2021. 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 prompted by a review of the information we held about this service. We reviewed the key questions of safe, effective and well-led only.

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.

We undertook this focused inspection to check the provider 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, Effective and Well-led which contain those requirements.

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 inadequate to 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 The Beeches Care Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss 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.

The Beeches Care Home is a residential care home providing accommodation, personal and nursing care for up to 23 people aged 65 and over, some of whom are living with dementia. At the time of inspection 17 people were living at the home.

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

The provider did not have effective systems in place to ensure all risks were identified and medicines were managed safely. We found failings regarding risks related to people's health and the environment.

We found no evidence people had been harmed but they were at risk of avoidable harm due to the

ineffective governance arrangements in place. Records were not always accurate and completed in line with people's assessed needs. Audit systems failed to highlight the concerns we found around, medicines management, care planning, risk management and fire safety.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments had not been documented for some key decisions when people lacked capacity. Staff had not received all the training required to support people using the service.

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 Inadequate (published 24 April 2021) and there were multiple 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 enough improvement had not been made/ sustained, and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines, people’s care needs, nutrition, competency of staff and fire safety. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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.

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.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

The provider took immediate actions to mitigate the risks we identified.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Beeches Care Home 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 safe care and treatment, safeguarding service users from abuse and improper treatment, person centred care, and governance.

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 meet with the provider following this report being published to discuss 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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.

The Beeches Care Home is a residential care home providing personal and nursing care for up to 23 people aged 65 and over, some of whom are living with dementia. At the time of inspection 17 people were living at the home.

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

People did not always receive safe care. During this inspection, we identified and reported several

safeguarding concerns. People's medicines were not managed safely. There were inaccuracies and omissions with the administration and recording of medicines. Medicines administration records (MARs)did not always demonstrate that medicines had been administered appropriately and as prescribed. Risks to people's care were not managed safely. The environment was clean and free of odours. Staff were recruited safely.

People’s needs were not always assessed prior to moving into the home. Although the service worked with other organisations to ensure they delivered joined-up care and support, records suggested people did not always have access to healthcare services when needed. Systems were not in place to ensure people were not deprived of their liberty. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff training was up to date however, there were gaps in the skills and knowledge across multiple areas of the service. The provider had arranged to use a new training company.

People were happy in the home and relatives spoke positively about the caring nature of staff. The language used by some staff in care records did not always promote people's dignity. We have made a recommendation that the provider ensures best practice guidance is followed with regards to the language used within care records.

People did not always receive person centred and dignified care. Some people's care plans were inaccurate and lacked information about people's needs, which meant staff were not provided with clear guidance to support and care for people. People's end of life wishes was not documented appropriately. People were offered opportunities to interact when the activities coordinator was working. However, there were no structured activities during our inspection.

Quality assurance processes were not effective in identifying the issues found at this inspection and in driving improvements. Records were not always accurate and complete. We found widespread shortfalls in the way the service was managed, a lack of management oversight and accountability. There was a risk of people receiving inappropriate care. There was a new manager who had been recently recruited. The nominated individual had a good presence in the home; however, the systems did not provide a good oversight of the day to day running of the service.

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

Rating at last inspection

Under the previous provider the service was rated good, published on 6 December 2018. The provider changed on 27 November 2020.

Why we inspected

The inspection was prompted in part by notification of a specific incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstance of the incident.

The information CQC received about the incident indicated concerns about the management of falls from moving and handling equipment and unsafe medicines management.

The provider took immediate actions to mitigate the risks we identified. You can see what action we have asked the provider to take at the end of this full report.

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.

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 safe care and treatment, safeguarding service users from abuse and improper treatment, person centred care, and governance.

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 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.

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.

We identified infection control systems could be improved in the home.

• We were not assured that the provider was promoting safety through the layout and hygiene practices of the premises. We found the provider could not demonstrate appropriate storage, segregation and colour-coding of cleaning equipment in line with national guidance.

• There was unnecessary clutter in storage areas for cleaning and laundry services, and walls and floors in these areas were in a poor state of repair. Some wipeable seating was damaged and posed an infection control risk. We have also signposted the provider to resources to develop their approach.

• We found some standard infection prevention and control (IPC) concerns and staff we spoke with were unsure of some IPC guidance, despite it being cited in local policies and procedures. We have also signposted the provider to resources to develop their approach.

• The service undertook regular internal IPC audits. However, these were not always effective.

We found some examples of good practice:

• The provider had systems and processes in place in line with guidance to ensure visitors to the home did not introduce and spread Covid-19. Information and instructions for visitors was explained via telephone prior to a visit. Personal protective equipment (PPE) was provided for visitors.

• Staff followed government guidance in relation to PPE. The home had sufficient supplies of PPE.

• All staff and people living at the service received weekly Covid-19 testing. Appropriate processes were in place should anyone display any symptoms of Covid-19.

• Staff supported people’s social and emotional wellbeing. The manager kept family members up-to-date about their relative’s health via regular telephone calls.

• The provider ensured staff who were more vulnerable to Covid-19 had been risk assessed, and where it was not safe for staff to be at work they had utilised furlough schemes to protect staff and people.

• All staff had undertaken training in infection prevention and control (IPC) and PPE.