Beaumont Lodge Nursing Home

Beaumont Lodge Nursing Home is a care home providing personal and nursing care to up to 43 people in an adapted building set over two floors. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 32 people using the service.

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

People told us they felt happy and safe living at Beaumont Lodge. Systems were in place to ensure risks were assessed and monitored to keep people safe. Staff understood their responsibility to report any safeguarding concerns and thorough investigations were completed when required. People were supported by sufficient staff who knew people well.

People received their medicines in line with their prescriptions from trained and competent staff. The registered manager forwarded an action plan following the inspection to tell us how they intended to make continued improvements to medicines systems. Referrals were made to health and social care professionals as required and any guidance was followed by 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. People and their relatives were involved in developing their care plans and felt their needs were met in a personalised way. People confirmed they were offered choices and their preferences were respected. People were positive about the food and told us they were always able to request alternatives.

Staff were caring and respectful in their approach and people appeared relaxed in their company. There was a range of activities provided which people enjoyed. Staff spent time with people in their rooms to minimise the risk of social isolation.

Staff received training relevant to their roles and told us they felt valued and supported by the management team. There was a shared ethos of providing person centred care which created a positive and caring culture. People and relatives told us they would feel comfortable in raising concerns and felt these would be responded to promptly. The provider and registered manager were committed to ensuring on-going improvements with 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 good (published 15 October 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

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

We found the following examples of good practice.

The provider had a room specifically built for people to have visits from their relatives. The room had external access so visitors did not need to enter the home and could visit their relative safely. The registered manager had a pre-booking system for visitors and could facilitate up to five visits for different people each day.

The registered manager had considered how social distancing in the home could be improved and had converted a large bedroom into another lounge for people to use.

Staff had thought of ways to communicate with and reassure people who were anxious about them wearing personal protective equipment (PPE). The registered manager had purchased clear face masks for staff to wear when caring for people who were anxious about PPE.

Beaumont Lodge 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. Beaumont Lodge is a nursing home which accommodates up to 43 people in one adapted building. There were 33 people living at Beaumont Lodge at the time of our inspection.

At our previous inspection on 7 December 2017 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of consistent leadership, risks to people’s safety not being effectively monitored, inconsistent staff training and support, the monitoring of accidents and incidents, people not being provided with choices regarding their care and people’s legal right’s not being respected. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good. At this inspection we found improvements had been made in all areas of the service and no breaches of legal requirements were identified.

There were sufficient staff deployed to meet people's needs safely. Staff had time to spend with people and worked flexibly to ensure people were given a choice regarding when they received their care.

Staff received training and supervision to ensure they had the skills required to meet people’s needs. Clinical staff ensured their knowledge and skills were regularly updated. Safe recruitment processes were in place to ensure people received support from suitable staff.

Risks to people's safety and well-being were assessed and control measures were in place to help minimise risks. Risks were reviewed and action taken when people’s needs changed. Staff were aware of their responsibilities in keeping people safe from abuse and any concerns were reported to the appropriate authorities. Accidents and incidents were recorded and monitored by the registered manager and compliance manager. Action was taken in a timely manner to minimise the risk of reoccurrence.

People lived in a clean environment and safe infection control procedures were followed. A contingency plan was in place to ensure people would continue to receive safe care if the building could not be used.

Safe medicines systems were in place to ensure people received their medicines in line with prescriptions. Medicines were stored securely and medicines audits were completed. Appropriate referrals to healthcare professionals were made and advice given was followed by staff. People's legal rights were protected as staff understood their responsibilities regarding the Mental Capacity Act 2005. Staff explained and sought consent from people before providing their care. People’s weight was monitored and a wide choice of nutritious food and drinks were available.

Staff knew people well and ensured their care was provided in a person-centred way. People’s individual preferences were respected and staff considered how people were feeling when providing their care. People were encouraged to maintain and develop their independence and the design of the premises and equipment available supported this. Visitors were made to feel welcome and there were no restrictions on visiting times.

Staff responded to people with kindness and understood their communication styles. Care plans were personalised and contained information regarding people’s life histories. Staff understood the care people required with regards to specific health conditions and the care they wanted at the end of their lives. However, care plans regarding these areas would benefit from more detail. We have made a recommendation regarding this. People had access to a range of activities. Entertainers visited the service and trips to places of interest took place.

The registered manager and provider worked together to assess and develop the quality of the service. A positive culture had developed and staff understood their role in achieving this. The registered manager was accessible and staff felt supported and listened to. People and their relatives were given the opportunity to share their views of the service they received. Complaints were recorded and investigated in line with the providers policy.

This inspection site visit took place on 7 December 2017 and was unannounced.

There was a registered manager in post however they were on leave on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. We were supported by the senior nurse on the day of the inspection.

Staff were not recognising risks and acting upon them. There were bed rails in place for people without proper assessment around the risk of these. Staff were not always knowledgeable on the risks to people including how to support a person appropriately when they had a catheter and how to monitor food and fluid intake and output.

Medicines were not always being managed in a safe way. People did not always have access to the medicines they needed and medicines charts were not always completed accurately. People were not always protected against the risk of infection as staff did not always have appropriate guidance in relation to this. Accidents and incidents were not always monitored to ensure safety of care.

We saw that there were sufficient staff that were attentive to people’s needs. There were elements to the safety of people that were being managed correctly including mobility risk assessments, skin integrity and nutrition. Equipment was available to assist in the evacuation of people and there were personal evacuation plans in place to provide staff with guidance on how to provide support. Robust recruitment took place to ensure that only suitable staff were employed. Staff were aware of how to report abuse and people told us that they felt safe with staff.

Staff had not received effective supervisions and nurse competency had not been assessed. Clinical training had not been provided to nurses and this was reflected in the practices we identified. Staff had not ensured that people had the capacity to make decisions for themselves as appropriate assessments had not taken place.

Although people told us that they enjoyed the food there were not always choices available to people that were on restricted meals. People did not always have the option of a cooked breakfast and a cooked meal in the evenings. We have made a recommendation around this. However people did have access to health care professionals when they became unwell.

The environment did not always meet the individual needs of people living at the service particularly those living with dementia. We have made a recommendation around this.

People were not offered choices of when they wanted to get up, where they had breakfast and when they wanted a bath or a shower. There were times where people were not respected and had routines without choice. Visitors were restricted to where they could spend time with their loved ones at the service. We did see instances of staff being kind and caring towards people. Visitors were able to come to the service when they wanted. People had access to religious services that were important to them.

Care planning was not specific to the person. Care plans lacked guidance to staff on how to deliver the best care that was appropriate to their needs. People had mixed views around the activities on offer and people in their rooms were not always provided with meaningful activities. End of life care plans did not detail the wishes of the person when they were at the end of their life.

There was a lack of leadership at the service. The registered manager had not ensured appropriate management cover whilst absent from the service. People, relatives and staff were not clear on who the manager was. Staff culture at the service was one of managing workload rather than person specific care.

Quality assurance was not robust and did not identify the shortfalls we found on the day. Where people had raised ideas about improvements this was not always followed. We did find instances where improvements were made as a result of feedback from people. Records were not robust and did not always contain accurate information.

Complaints and concerns were taken seriously and used as an opportunity to improve the service. People told us that they knew how to complain and who to.

People and staff thought that the service was well organised. Staff told us that they felt supported and were asked for their feedback through surveys. There was evidence that the provider was working with external organisations in relation to the care provision.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. Staff had informed the CQC of significant events.

The service was last inspected on the 27 and 28 September 2016 where no concerns were identified.

Beaumont Lodge is a nursing home located in Camberley in the county of Surrey. The home is registered to provide accommodation and support for up to 43 people and specialises in providing nursing care for the elderly. At the time of our inspection 43 people were using the service.

There was a registered manager in place. 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 using the service said they felt safe and that staff treated them well. Their privacy and dignity was respected by staff. Safeguarding adult’s procedures were robust and staff understood how to safeguard the people they supported. Staff told us they sought consent from people when offering them support. The registered manager demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

There were enough staff to meet people’s needs and appropriate recruitment checks took place before they started work. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Risks to people using the service were assessed; care plans and risk assessments provided clear information and guidance for staff on how to support people with their needs. People and their relatives [where appropriate] had been involved in planning for their care needs. People were supported to maintain a balanced diet, and had access to a range of healthcare professionals when required. People received appropriate end of life care and support.

Regular residents and relatives meetings were held so that people could talk to the registered manager and provider about the home and things that were important to them. The provider took into account the views of people using the service and their relatives and staff through surveys, and took action to make improvements to the service in response to the feedback. There was a range of appropriate activities available to people using the service to enjoy. People knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

Staff said they enjoyed working at the home; they received appropriate training and good support from the registered manager. Unannounced spot checks, including weekend and night time checks, were carried out by the provider and registered manager to make sure people received good quality care at all times.

We observed support being provided and this was person centred and respectful. We saw staff interacting with people during which they continually spoke with the person offering reassurance and explanations. This meant people were treated in ways that maintained their dignity.

People told us they felt safe at the home because the staff were always available to offer care and support. They told us they had daily contact with the manager and the lead nurses with whom they had good relationships. Staff had training in safeguarding vulnerable adults and they were clear about their responsibilities in ensuring people were protected from abuse.

A family member said, 'I am very happy with the care my relative receive. The staff are very approachable and understanding. My relative is kept very clean and well shaved. This is so important as my relative is not a beard wearer.

Four people told us the service was generally clean and tidy. They said there were enough domestic staff employed to do the cleaning and they had their bedrooms cleaned daily.

We found people expressed their views and were involved in making decisions about their care, treatment and support. They experienced effective, safe and appropriate care and were provided with suitable equipment to maintain their safety. People had their medicines at the times they needed them from staff qualified and skilled to do so. People's comments or complaints were carefully considered and responded to. Suitable precautions were in place to protect people and staff from cross infection of health care associated infections.