Beaumont Park Nursing and Residential Home

Beaumont Park Nursing and Residential Home is a nursing home providing personal and nursing care to up to 46 people. The service provides support to people who may be living with a physical disability or dementia. At the time of our inspection there were 23 people using the service.

Beaumont Park Nursing and Residential home is split across two floors. People have access to their own personalised bedrooms and share communal areas such as lounges, bathrooms, dining areas and a secure garden.

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

People were not always treated with kindness and compassion and staff did not always respect people’s privacy and dignity. Staff were not consistently supporting people in line with their individual preferences, likes and dislikes. People were not being supported to engage in their chosen interests or social pastimes and went for long periods of time without interaction or engagement. Staff did not always support people to communicate and make their needs known effectively. People’s care plans did not contain detailed information about their personal preferences or how they liked to be supported, and in some cases known support needs such as living with dementia, did not have a care plan in place.

The management team completed audits to monitor the quality of the service, but these were not always effective in identifying where improvements were needed. There was a negative culture at the service and staff did not always feel supported by the management team. People. relatives and the staff team told us they felt more regular engagement with them was needed.

People felt safe living at the service, however some risks needed to be assessed more thoroughly and detailed more clearly in care plans. There were enough staff to support people safely, however staff told us they did not have time to support people outside of their essential care needs. We have made a recommendation that staffing be reviewed. The management team did not have formal systems in place to monitor the effectiveness of staff training or supervise them in their jobs. We could not be assured staff had the training to support people to eat and drink according to their needs. People’s changing needs were not always reassessed in a timely fashion.

Despite our findings some people and relatives were positive about their support. One relative said, ‘‘[Staff] always try their best to give [family member] the best experience. The service is everything we needed.’’

People were supported safely with their medicines. The service was clean, and staff followed good infection control processes. Staff were recruited safely. The management team had learnt lessons when things went wrong such as the monitoring of people’s pressure area care. Staff worked with health and social care professionals to promote good outcomes for people. 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.

We observed some kind and compassionate support from the staff team. Some staff knew people well as individuals and we received some positive feedback about staff support from people and relatives. The management and staff team worked well with partners such as the local authority and were keen to drive improvements at the service. They sent us immediate assurances to address the issues we found at this inspection.

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 26 October 2022).

Why we inspected

We received concerns in relation to the management of people’s pressure area care, unsafe staffing levels and a large number of safeguarding concerns being raised about the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We inspected and found there were concerns with how people were treated with dignity, respect and person-centred care. We therefore widened the scope of this inspection to become a fully comprehensive inspection which included all key questions.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

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

Enforcement and Recommendations

We have identified breaches of the regulations in relation to people not being supported with dignity and respect, people not being supported in a person-centred manner and the governance and leadership of the service at this inspection.

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

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 also request an action plan from the provider. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Beaumont Park Nursing and Residential Home is a residential care home providing personal and nursing care to up to 46 people. The service provides support to people who may be living with a physical disability or dementia. At the time of our inspection there were 28 people using the service.

Beaumont Park Nursing and Residential home is split across two floors. People have access to their own personalised bedrooms and shared communal areas such as lounges, bathrooms, dining areas and a garden.

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

People and relatives were positive about their or their family members support. One relative said, ‘‘[Staff] are lovely, kind and helpful and I have no concerns at all.’’

People were safe living at the service and staff had training to recognise and report potential signs of abuse. Risks to people had been assessed and risk assessments were in the process of being reviewed to ensure they were more detailed. There were enough staff to support people safely, although we received mixed feedback about the amount of time staff had to socially engage with people. Staffing levels and allocations was being continually reviewed. People were supported safely with their medicines and minor improvements to medication documents were being made. The service was clean and good infection control measures were followed by staff. Systems were in place to review incidents and accidents so lessons could be learned and shared with staff.

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.

There was a positive culture at the service and people were happy and relaxed being supported by staff. The management team completed audits to monitor the quality of the service and acted where improvements were identified. People, relatives and staff were encouraged to feed back about the service, and this was used to drive improvements. The management and staff team linked and worked with health professionals to help promote good outcomes for people. The management and staff team had worked hard, and improvements were being made and sustained at 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

The last rating for this service was requires improvement (published 25 May 2022).

Why we inspected

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 received concerns in relation to the management of medicines and unsafe staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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 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 Beaumont Park Nursing and Residential Home 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.

Beaumont Park Nursing and Residential Home is a care home providing personal and nursing care to up to 46 people. The building accommodates people across two floors. Some bedrooms have ensuite facilities. There are communal rooms inside and a shared garden. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 32 people living at the service.

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

People’s medicines were not always managed safely. Medicine stocks were not all correct, some medicines were not able to be located and open dates on medicines were not recorded. These errors had not been identified by staff conducting quality monitoring audits.

People’s home was not always clean inside of cupboards and other infection prevention and control (IPC) measures were not always followed such as checks on visitors and storage of COVID-19 testing equipment.

People felt safe and were happy with the support provided. They told us staff were kind, caring and patient and knew them well. People felt staff understood safe ways to support them. Staff had received training on safeguarding people and were confident about how to report any concerns.

People had risks to their health or wellbeing assessed by staff and this information was used to feed into their care plan and give staff the right guidance for supporting them.

People were supported by staff who had been checked to ensure they were safe to work at the service and there were sufficient staffing levels in place. People told us they did not have to wait long for staff support after ringing their call bells.

People were supported by staff who used a personalised approach to care and asked people for their preferences and consent.

People, their relatives and staff thought the registered manager was approachable if they had any concerns and they spoke to them regularly about the quality of their care. Where required, the staff referred people to external professionals for more specialised support and advice.

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

Rating at last inspection and update

The last rating for this service was good (published 23 February 2021).

Why we inspected

We received concerns in relation to safe care, suitable personal care needs being met, safe management of medicines, pressure care and meals. 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. 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 that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements but found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

The registered manager has taken action to address the concerns raised and implemented new tools and systems to reduce the risk of similar concerns in the future.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beaumont Nursing and Residential Home 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.

Beaumont Park Nursing and Residential Home (Beaumont Park) is a residential care home providing personal and nursing care to 25 people at the time of the inspection. Beaumont Park accommodates up to 46 people in one adapted building across two floors.

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

People told us they felt safe and well cared for by the staff team. People’s relatives were also very happy with the care and told us staff were caring and kind and did not rush their family members when providing care.

One relative told us, “The staff I cannot fault. They are lovely, any concerns, I phone up and can speak to the senior carer. It is very reassuring as it was a big step for [My family member] to go into a care home.”

People were supported by staff who understood how to keep them safe. Staff had been given training in safeguarding and the specific conditions people were diagnosed with. This helped to ensure they had the correct knowledge and skills to carry out their roles.

People were given medicines correctly and on time and supported to access various health professionals as required. Relatives told us that staff kept them informed about all changes to their family member’s care and medical needs.

Staff supported people to maintain regular contact with their relatives and friends by using visiting pods in the garden when the government guidance allowed. Relatives spoke very highly of how welcoming, warm and clean the pods were. When face to face visits were not possible, people were supported to use telephone and video calls to stay in touch with their relatives.

People and relatives were very happy with how the service was being managed and felt happy to make contact with the manager or staff team to raise concerns should they have any. People’s views were sought through conversation and phone calls to their relatives. This was used to make any changes or improvements to the care that was needed.

People were supported by staff who had been checked for suitability work in their role by the manager and who were supported to have regular training and checks on their competency.

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 10 December 2019) 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 we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to the management of the care home, staffing levels and training, infection prevention and control and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only to review these concerns and follow up on the previous breaches of regulation.

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 found no evidence during this inspection that people were at risk of harm from the concerns raised. Please see the safe and well-led sections of this full report. The provider had taken action following the last inspection to make improvements where required.

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.

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

Follow up

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

Beaumont Park Nursing and Residential Home is a care home providing personal and nursing care to 27 people on the day of the inspection. The service can support up to 46 people in an adapted building with two floors.

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

With the exception of management staff, everyone we spoke with including staff, people and visitors told us there were not enough staff to meet people's needs. This had an impact on people because they were not supported at the times they needed to be, and staff did not have time to spend with them beyond time used to carry out tasks. As a result, some people felt bored and relatives were concerned about people feeling isolated. There had been a high number of unexplained skin tears at the service which might indicate that staff were rushing to provide care.

Staff had received training in safeguarding people from harm and understood their responsibilities to report concerns. The management team reported concerns appropriately to the required external bodies. Risks were assessed and regularly reviewed and people felt safe. However, some risk assessments would have benefitted from more detail to guide staff on how to care for people safely. People’s medicines were managed safely and they were protected from the risk of infection.

People were supported to have enough to eat and drink and food and fluid intake was monitored and appropriate referrals were made where necessary. People's healthcare needs were met and we saw evidence that referrals and appointments with relevant professionals were made.

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 were up to date with training and people said they knew their jobs well. People reported that care staff were very caring and compassionate but did not have enough time. We observed positive interaction and staff clearly knew people well. However, our observations confirmed that staff were busy and not always visible throughout the service. People confirmed they felt respected and that care was provided in a dignified way by staff. Staff respected their privacy and responded to their preferences where time allowed.

Care Plans were person centred, written in respectful language. The activities that were provided for people were positive but were insufficient to meet the needs of people, many of whom spent the majority of the day in their rooms.

Staff felt listened to by immediate managers but felt more senior managers did not see the pressures they were working under and the impact this had on people using the service.

Complaints had not always been managed well and complainants reported that changes were not made as a result of them raising concerns. Following the inspection, this had been addressed by the acting manager in one instance and the complainant reported they were now satisfied with the response.

Audits of various aspects of care were carried out and this included some analysis to identify root causes. However, issues identified at the inspection were not addressed.

Rating at last inspection

The last rating for this service was Requires Improvement (Published November 2018) and there were breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. This is the second consecutive time this service has been rated requires improvement.

Enforcement

At this inspection enough improvement had not been made and the provider was still in breach of Regulation 17 and 18. This is the second consecutive time this service has been rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the impact this had on the care people were provided with. There were also concerns raised about a lack of stimulation for people, particularly those who were cared for permanently in bed. A lack of responsiveness from the provider was reported in relation to concerns raised about these and other related issues. Due to the number of similar issues being raised from different sources, a decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

Follow up

We will require the provider to send us a specific action plan to show how they will address the continuing breaches and the concerns identified at this inspection. 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 also 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

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

Beaumont Park is a ‘care home with nursing’. 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.

Beaumont Park accommodates up to 46 people in one purpose built building across two floors. The ground floor predominantly accommodates people who have residential care needs and the first floor, people with nursing needs. Some people living on both floors were living with dementia. At the time of the inspection there were 30 people living at the home.

The registered manager left the service in March 2018 and an interim manager who was also an operations manager for the provider, was in post. A new manager had been appointed but had not taken up post yet or registered with the Care Quality Commission. 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.

People were not supported in a timely manner and staff were not always visible in the home. The provider had not taken sufficient steps to analyse and address the reasons for this. The provider had robust recruitment processes in place.

Staff had good understanding of their responsibilities in relation to safeguarding people from potential harm. However, there had been an increased number of safeguarding concerns at the service in the last six months. This indicated that staff may have not always acted to ensure people’s needs were met safely to the degree where neglect by acts of omission had occurred. The interim manager was taking action to improve staff practice and reduce the risk of people receiving poor or unsafe care.

Staff spoke kindly and were respectful to people but were very busy and did not have very much time to chat with them.

Risk assessments were in place that gave guidance to staff on how risks to people could be minimised without compromising people’s independence. Medicines were administered safely and people were supported to access health and social care services when required.

Staff understanding of their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) was sufficient and we saw that they gained people’s consent before they provided any care or support to them as far as possible.

Staff supervision had not been provided regularly over the past two years, although the interim manager had recently taken steps to address this. Training to enable staff to support people well had not been kept up to date over the last year. Again, steps had been taken to make improvements to this and staff had attended more training in recent months.

People were supported to pursue their interests through a wide programme of activities and one to one sessions for people who were at risk of social isolation.

Care plans took account of people’s individual needs, preferences, and choices. However, some areas of need had not been fully considered and lacked detailed information to support staff to understand and meet people`s needs well.

The provider had a formal process for handling complaints and concerns and this was done in line with the provider’s policy. People were aware of how to make complaints and were supported to do so, if assistance was required.

The provider and management team were committed to promoting a person- centred culture within the service and were supporting staff to understand what this meant and how to improve their practice to achieve this. Staff were positive about the changes that were being introduced and showed good understanding of the provider’s values that these improvements were based on.

The provider had quality monitoring processes in place to ensure they were meeting the required standards of care. Some of the issues identified at this inspection had been identified by the provider and the interim manager, and action towards achieving the necessary improvements was ongoing. However, the work required was not yet complete and the improvements needed time in order to be embedded within the service. Some issues identified at the inspection, such as staff deployment and the impact this had on the quality of care, and content missing from care plans had not been picked up and addressed sufficiently.

At the last inspection in June 2016 we found the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing levels and supervision, safe care and treatment, consent to care and good governance. We also had concerns about the impact on people of sharing a bedroom, particularly when the person had not been asked for their consent, or they lacked the capacity to give their informed consent. At this inspection we found the service was meeting the expected standards and was no longer in breach of the Regulations. The provider had reduced the number of shared bedrooms from nine to two, and these were occupied by people who had consented or stated a preference to share.

The service provides accommodation and nursing or personal care for up to 46 adults, some of whom may be living with dementia and/or with life limiting conditions. At the time of the inspection, 38 people were being supported by the service.

The service 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 2008 and associated Regulations about how the service is run.

There were systems in place to safeguard people from harm and staff understood when and how to report any concerns they had to the appropriate authorities. There were risk assessments in place that gave guidance to staff on how risks to people could be minimised.

The numbers of staff on duty were sufficient to maintain people’s safety, although staff reported being rushed at times. The manager was regularly reviewing this so that enough staff were available should the numbers of people using the service increase or their needs changed significantly. The provider had effective recruitment processes in place.

Staff received regular supervision and appraisal. They had been trained to meet people’s individual needs and understood their roles and responsibilities to seek people’s consent prior to care being provided. The requirements of the Mental Capacity Act 2005 were met.

People were supported to have enough to eat and drink, and to maintain a diet that was suited to their needs. The manager was taking appropriate action to deal with comments that some people would have preferred more choice of meals and some told us the quality of the food was not always good. People were also supported to access other health and social care services when required.

Staff were kind and caring and most people were happy living at the service. People’s dignity and privacy were protected and they were supported to make choices and maintain their independence.

People’s needs had been assessed, and care plans took account of people’s individual needs. There was a range of events and activities provided and people were supported to maintain links with the local community. However a few people felt that the activities provided did not satisfy their interests, although they had not been receptive to the manager’s attempts to improve their experience.

The provider had a formal process for handling complaints and concerns.

The service sought feedback from people and acted on the comments received to improve the quality of the service. The provider had systems in place to monitor the quality of the service and the manager had an effective system for auditing each aspect of the service to ensure that management oversight was effective. However, further work was necessary to ensure that people’s experiences were consistently positive about staffing levels, food and opportunities for them to pursue their hobbies and interests.

Staff felt supported by the manager and had a good understanding of their roles and responsibilities.

The service provides accommodation and nursing or personal care for up to 46 adults, some of whom may be living with dementia and/or with life limiting conditions. At the time of the inspection, 46 people were being supported by the service, some of whom were accommodated in shared bedrooms.

The service had a new manager who was in the process of registering with the Care Quality Commission. 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.

There were systems in place to safeguard people from harm and staff understood when and how to report any concerns they had to the appropriate authorities. There were risk assessments in place that gave guidance to staff on how risks to people could be minimised.

The provider had effective recruitment processes in place but staffing numbers were not always sufficient to ensure that people’s needs were met safely.

Staff had not received regular supervision or appraisal. Staff had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided. However, the requirements of the Mental Capacity Act 2005 were not always met.

People were supported to have enough to eat and drink and to maintain a diet that was suited to their needs, although some people would have preferred more choice of meals. They were also supported to access other health and social care services when required.

Staff were kind and caring and most people were happy living at the service. The high number of shared bedrooms did not promote people’s dignity or protect their privacy.

People’s needs had been assessed, and care plans took account of people’s individual needs but were not person centred and contained little information about people’s lives and their preferences. There was a range of events and activities provided which was based on people’s interests and hobbies and people were supported to maintain links with the local community.

The provider had a formal process for handling complaints and concerns, but did not always respond to people’s complaints.

The service sought feedback from people and acted on the comments received to improve the quality of the service although a formal survey had not been recently completed. The provider had systems in place to monitor the quality of the service although some aspects of this system had not been fully utilised in recent months. The lack of input from the provider in relation to quality monitoring had resulted in shortfalls to the service being overlooked.

We found the provider was in breach of a number of regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We also found that records relating to people living in the home were easily accessible to anyone who had access to the building, meaning that people could not be confident that their personal information was secure and confidential.

This was a follow up inspection to check on these specific areas, and as such we did not speak to people using the service on this occasion.

We found significant improvements in relation to cleanliness and infection control. Apart from one room, we found no offensive odours. Odours that we had previously identified in other areas of the home had gone, either through cleaning or total refurbishment. Action was taken immediately after this inspection to address the one remaining odour.

We also found that improvements had taken place in respect of records, which were now being stored in a more secure way.

Staff we spoke with were clear about the needs of the people they were caring for, and accurately reflected the care described in their care plans.

Arrangements were in place to ensure people had adequate food and drink.

We were concerned about the cleanliness of the home because there was an offensive odour in a number of areas in the building. This meant that people living in the home were not living in a clean and pleasant environment.

Our findings also showed that the existing building was not adequately fit for purpose. However, the provider had already started an extensive refurbishment programme to address this.

Overall, there were enough staff on duty with the right knowledge and skills to meet people's needs. There were also plans to provide further training to staff; to ensure they were properly supported to meet everyone's assessed needs.

Suitable arrangements were in place to address people's comments and complaints, and ensure they were listened to.

However, some records relating to people living in the home were not being kept securely. This meant that people could not be confident that their personal information was being kept secure and confidential.