Beeston View

Beeston View is a residential care home providing personal and nursing care to 49 people aged 65 and over at the time of the inspection. The service can support up to 54 people across two floors, each of which has separate adapted facilities.

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

Governance systems to monitor the quality and accuracy of care being delivered to people, required improvement. Existing systems had failed to identify shortfalls when care plans needed updating as people’s needs changed or professional guidance was received. This placed people at risk of receiving unsafe care.

Checks were in place to ensure people lived in a safe environment. However, staff practices within the home such as not locking areas of storage and sluice rooms posed a risk to people at risk of falls and to people living with dementia.

We were assured the provider had effective measures in place to reduce the risks of infection and manage the impact of the COVID-19 pandemic.

Staff were recruited safely. Appropriate checks were undertaken for all temporary staff (agency workers). There were adequate staffing levels to meet people’s needs.

Although we found some improvements were needed, we observed positive and caring interactions between staff and people living at Beeston View. People we spoke with were positive about the care provided.

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 16 November 2019).

Why we inspected

We received concerns in relation to poor care, insufficient staffing levels and poor management of the home. As a result, we undertook a focused inspection to review the key questions of safe 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 changed from good to requires improvement. This is based on the findings at this inspection.

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

During the inspection the provider took actions to reduce the risk. Actions were taken to ensure aspects of the environment did not put people at risk and several care plans were updated in response to our concerns.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beeston View 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 unsafe aspects of the environment and care plans not always reflecting people’s changing care needs at this inspection.

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

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.

At the time of the inspection, the service was closed to visitors, but relatives spoke positively about their experience of visiting their loved ones and the communication they had received from the service during the pandemic. Relatives comments included, "Initially we had garden visits outside the main entrance. They have a pod now. It is booked through on line visiting system, staff explained how to use it and what to do when we get there. We sanitise our hands, wear a mask and sign in, it's all explained. We are hoping the visits will be back on soon, but we book Skype calls in as well ." Another relative told us, "We visit in a special room (visiting pod). There is a floor to ceiling screen, and we sit in a completely separate part of the room with a microphone in, it is very impressive. We are really, really pleased.", "They keep us up to date. They are good like that, they made me aware my relative was due to be vaccinated and spoke to me in advance about the tests."

The environment was very clean and hygienic and increased cleaning schedules to reduce the risks of cross infection were in place. We observed staff wearing the correct personal protective equipment (PPE) and they knew how to dispose of it safely.

People and staff were taking part in regular COVID-19 testing. People were being monitored for symptoms of COVID-19 and people who needed to, were supported to isolate in their own rooms. Signage was visible on the bedroom door of any person who had either tested positive for COVID-19 or was isolating. This was helpful in informing staff, prior to entry, what PPE to wear and what enhanced procedures needed to be followed to protect them from risk .

Further information is in the detailed findings below.

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

People benefitted from a range of stimulating and enjoyable activities on offer which were meaningful to them. People were supported to access the community and enjoyed the entertainers that visited the service.

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's dietary needs and preferences were catered for and people enjoyed the homemade food on offer. Mealtimes were relaxed, informal, social occasions where people living with dementia received the support they needed to choose and eat their meal.

People were treated with dignity and respect by kind and caring staff that knew them well.

There were sufficient numbers of safely recruited, suitably qualified and experienced staff on duty to meet people's needs.

The environment was fully adapted to meet people’s needs and was well maintained, clean and hygienic.

People and their relatives were happy with management of the service and the care people received. They had the opportunity to give their views in a number of ways and felt listened to.

The provider had comprehensive systems in place to assess and monitor the quality of the service people received and drive improvement.

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 (report published 21 March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the last inspection in July 2014, the service was rated as Good. At this inspection we found the service remained Good. Our last visit had identified improvement needed in the provision of activities and our question about the service being responsive had reflected this. Despite this, the rating for the service had been assessed as good overall. This visit found that a robust programme of activities were in place of people who used the service.

The registered provider had systems in place to ensure the safety of the people who used the service. This included arrangements for identifying, reporting and taking action on any allegations of abuse. This was reinforced through training for staff, staff knowledge and reporting processes. People’s safety was further enhanced through assessments for individuals identifying risks they faced from the environment or from risks associated with their own health and social needs. The registered provider ensured that a system for the safe management of medication was in place and that the premises were well maintained and hygienic.

The registered provider took the requirement of the Mental Capacity Act 2005 (MCA) and associated safeguards into account. This meant they were working within the law to support and assist people who may lack capacity to make their own decisions. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People who used the service were supported by a staff team who had received the training and had the knowledge to best support them. The nutritional needs of people were met. Consideration was made to the dietary needs of people, their personal preferences and ensuring that those who were at risk of choking could eat safely.

Staff interactions were friendly, caring and supportive. People were supported in a patient manner with people supported in a respectful manner. Staff ensured that people were treated as individuals and had their privacy and dignity take into account through care practice. People were given information about their care and the support they could be provided with.

Care plans provided staff with the information they need to successfully support people in all aspects of their daily lives. Care plans were reviewed and updated when required. A robust activities programme was in place and activity co-ordinators employed to provide carried and regular activities. Records maintained in respect of activities complimented care plans maintained by the service so that a whole picture of people’s progress could be achieved.

Information was in place in respect of how people could make a complaint. Complaints records were maintained and concerns responded to in a timely manner.

The registered manager used a variety of methods to assess and monitor the quality of the Beeston View. These included regular audits of the service and staff and resident meetings to seek the views of people about the quality of care being provided. The registered manager had provided feedback to people about the rating that we had applied at our last visit. The registered manager always notified us of significant incidents within the service as required.

Further information is in the detailed findings below

Comments from people who lived at Beeston View included, 'I was asked whether or not I would be happy to have a male carer - I said not at my age", "They are very friendly and helpful - you can always get what you want if you ask and don't have to wait long", "They are busy but have time talk to you and have a joke - I feel very safe here and have no complaints at all' and 'I've found staff okay and seems enough to me. They have time for you. Can go to any one of the staff if I have a problem and they wll see to it.'

Comments from visitors included, 'Mum was involved in Dad's care plan. Any problems and she speaks to the senior carer or unit manager and they are soon sorted. All the family feel dad is safe and well cared for', 'Staff try so hard - they're patient and caring ' that's at all levels and are so helpful and friendly - nothing is too much trouble."

Comments from staff included 'At the moment there is enough staff to meet resident's needs because we are a few residents down but some days we are rushed if someone phones in sick or if we have residents who are ill. Mealtimes can be rather hectic'

We spoke to two people who used the service who said they were well looked after and happy with the service they received. Some comments made were:-

'It's wonderful here. The staff are lovely and so supportive. I think my care and health needs are very well met.'

'I choose my food and clothes. I go to bed when I like. I'm well cared for. You can always find a member of staff.'

We spoke to three relatives who said that they were overall happy with the care and support provided.

Records showed that people had been assessed before they began to use the service and they had a care plan in place detailing the support they needed.

There were practices in place to ensure that the recruitment of staff appropriately supported the people who used the service.

The home was clean and there were procedures and training in place to promote hygiene and prevent infection.

There were systems in place to obtain the views of the people who used the service and their relatives about how the service operated. The home operated an effective system for the management of complaints.

We asked Cheshire West and Chester Council for information about how the service operated. No information of concern was reported.