The Beeches

People’s experience of using this service:

People were not protected from the risk of infection. Paper containing faecal matter had been left on top of the cistern in one toilet and a bedsheet was stained with faecal matter. Continence pads were not stored safely.

People’s care needs were recorded, as were their preferences, likes and dislikes in most cases. However, activities were not planned based on people’s interests, although there was a programme of activities every day. Information was not presented in an accessible format in line with people’s communication needs. Care plans lacked detail in some cases on how staff should support people’s specific needs.

People did not always feel there were enough staff to support them promptly when they needed help. One person said, “There are not enough staff and it puts me off calling them. I don’t want to overwork them, they do so much”. We have made a recommendation in relation to the deployment of staff.

On the day of inspection it was not clear who had overall management of the home. People had mixed views about the management. One person said, “We have two or three [managers], but they are mostly in their offices. You can go and see them, but they should be out here seeing us”.

People were positive about the care they received and staff were friendly, kind and caring. People were treated with dignity and respect and encouraged to make decisions about their care. A relative said, “We are always made welcome. They know we travel a distance and there’s always a drink and we can eat if we want to. We couldn’t be happier”.

People told us they felt safe living at the home. Their risks had been identified and assessed appropriately with guidance for staff on how to mitigate risk. Medicines were managed safely.

People were happy with the food on offer and said they had a choice of menu. Special diets were catered for. People had access to a range of healthcare professionals and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People and their relatives were asked for their feedback through questionnaires and results were overall positive. Residents’ meetings took place and suggestions were listened to and acted upon. Staff felt supported in their roles and completed a range of training to carry out their responsibilities. They had the skills, knowledge and experience to deliver effective care.

Rating at last inspection: At the last inspection, this service was rated as Good (published in April 2018).

Why we inspected: We were required to inspect this service within 12 months of the last inspection because of a breach of regulation. The provider sent us a plan after the last inspection which outlined the actions they proposed to take to address the issues of concern. This inspection took place to check on the improvements made and in line with CQC scheduling guidelines for adult social care services.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will review the service in line with our methodology for ‘Requires Improvement’ services.

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

This inspection took place on 5 March 2018 and was unannounced.

There was a registered manager however they had been on maternity leave since August 2017 and were not due back at the service until later in 2018. 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 and associated Regulations about how the service is run. The acting manager, who was overseeing the service in the absence of the registered manager, assisted us with our inspection. We have referred to the deputy manager as the acting manager in our report.

Safeguarding concerns had not always been notified to CQC which is a requirement of registration. We also found that records in relation to people were not always up to date. The Beeches was clean and people received the medicines they required, however we found some poor medicines management processes. We have made a recommendation to the registered provider. People told us they felt safe living at The Beeches and staff were able to give us examples of what might constitute signs of abuse.

Although quality assurance audits were carried out to check the quality of the service, we found these did not always identify shortfalls. However, there were other audits undertaken which were robust and we found actions raised were addressed.

People could take part in activities if they wished and staff actively encouraged this. The acting manager had developed new activities within the service to help people feel included. However, people told us they would like to go out of the service more.

People and staff told us there were sufficient staff to care for people and we did not see people having to wait for their care on the day. Recruitment processes were in place to help ensure that there were only suitable staff working at the service. Accidents and incidents relating to people were recorded and action taken to help mitigate reoccurrence and staff discussed events for lessons learnt.

Regular fire checks and fire drills were carried out to help ensure staff would know what to do in the event of an emergency. Individual fire information was available should the emergency services require it.

People who were unable to make their own decisions had the necessary processes carried out to help ensure that any decisions made for them were made in their best interests. Before people moved into the service their needs were assessed to ensure staff could provide the care they required. People were supported to eat a good range of nutritious foods and staff recognised people’s dietary needs.

People were cared for by staff who had access to relevant training and the opportunity to meet with their line manager on a regular basis. People were also cared for by staff who took time to involve health care professionals to help ensure people remained healthy and received effective care.

People were supported to make their own decisions and remain as independent as possible. Staff showed people respect and recognised that people may wish privacy at times. People were supported and enabled to spend time with those close to them and staff showed people empathy and attention when they needed it. There was a close, friendly atmosphere within the home. Relatives were greeted warmly by staff and they only had good feedback for us in relation to the care their family members were receiving. People’s rooms were personalised to their individual tastes.

People’s care records contained information about their needs and guidance for staff to help support them to provide responsive care. In the event that a person required end of life support the acting manager told us they worked closely with the relevant agencies. If people felt the need to make a complaint there was a procedure in place for them to follow.

There was a good working relationship between the acting manager and staff and staff felt supported. People were involved in the running of the service and invited to give their feedback on the care they received.

The acting manager was proactive in relation to any shortfalls we identified and they had a clear vision of how they would like to improve the service. The culture within the staff team was good and staff worked well together and were aware of their responsibilities to demonstrate team work. The service worked in conjunction with other agencies to help provide good care to people.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we found the provider had taken appropriate steps to ensure that people who used the service now had records including medical records in place that were accurate and fit for purpose.

We also looked at the staffing arrangements in the home to ensure that there were sufficient staff employed in the home to meet the assessed needs of the people living there.

People told us that they received good care from staff who knew their needs well. They said that they enjoyed the food provided by the home and that there was a good choice of meals available. We saw evidence that where dietary needs had been identified, they had been communicated to the catering staff and referrals to appropriate professionals had been made.

Since our last inspection, concerns about the management of medication at the home had resulted in a multi-agency safeguarding investigation. At this inspection we found that the provider had taken action to improve the management of medication

At our last inspection we found that staff did not have adequate opportunities to receive feedback about how they were performing or to discuss their training needs or professional development. At this inspection we found that the systems in place to support staff had improved but would benefit from further development.

We checked a sample of care records and found that some contained inaccuracies that could have affected people’s safety or welfare. For example the information recorded on some falls risk assessments was incorrect and, as a result, the assessments did not identify any measures to manage the risks to people.

Relatives confirmed that their family members received good care and support. Relatives said they were consulted about their family member’s care and involved in any important decisions that were made. We found that, whilst staff knew the needs and preferences of the people they cared for, the sharing of information about any changes to the delivery of care needed to improve.

We found that the provider had an effective complaints procedure and that complaints were investigated and responded to appropriately. The staff we spoke with during the inspection were aware of their responsibilities in relation to recognising and reporting abuse. Staff told us that they had received a comprehensive induction when they started work and that they had access to the training they needed. However we found that staff did not have regular opportunities to receive feedback about their performance or to discuss their professional development.