This inspection took place on 19 and 20 February 2018. The first day was unannounced. At the last inspection of Beachlands Residential Care Home (Beachlands) in December 2016 and January 2017, the overall rating was requires improvement. At that inspection, we found breaches in Regulations 9, 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care plans were not reflective of people’s individual health and social needs and there were not enough meaningful activities for people to participate in. Mental capacity assessments for people who had limited capacity were not always followed or reflective of individual needs. Systems for monitoring quality were not always effective.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions effective, responsive and well led to at least good. We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan. This inspection showed improvements had not been made and the service remained in breach of Regulations 9, 11 and 17. Additionally this inspection found the service was in breach of Regulation 12. The overall rating for Beachlands has been rated as Inadequate.
Beachlands 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. Beachlands provides accommodation and care for up to 29 people. There were 26 people living at the service when we inspected. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people needed support with their personal care and mobility. Some of the people were also living with dementia.
Accommodation was provided mainly on the ground floor, with a few rooms on the first floor. The service was situated in a quiet residential street in the East Sussex town of Seaford.
The service had 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. The provider for the service is Beachlands Care Limited and Beachlands is their only registered premises.
As at the last inspection, the provider did not to identify a range of areas to ensure safety and quality of care for people. The provider told us that, due to difficulties with the recruitment of permanent staff, the service had been using agency care workers to provide much of the care to people for an extended period of time. Agency care workers were not given the information they needed to enable them to care for people safely. The provider had not identified that agency care workers were not always being supervised in their roles to ensure they provided people with safe and quality care. The provider had not ensured that their audits covered all areas of care delivery or ensured that all other audits were completed to the same standard. This included medicines audits and the accurate and full completion of people’s records.
As at the last inspection, the provider had not ensured all people had assessments and care plans to outline how their needs were to be met. This included assessments and care plans relating to people’s mobility, communication needs, continence care and for people who were living with dementia. Some activities provision had been started since the last inspection but these did not take place every day and they were aimed at people who were able to come to the main lounge. People who were not able to leave their own rooms were not supported by individual assessments of their needs to ensure their social needs were met, and risk of isolation reduced.
Although records showed staff had been trained in the Mental Capacity Act (2005), people who needed support with decision-making continued not to have mental capacity assessments completed to ensure they were appropriately supported.
Where people had individual risks, these were not consistently supported by clear assessments and care plans to reduce their risk. Staff were unclear about actions to take to ensure certain people’s risks were reduced. This included where people were at risk of pressure damage and infection. Relevant professionals were not always contacted to support people to reduce risk, including where they had difficulty in swallowing. The provider had also not developed a training plan so staff were supported in developing skills in relation to people’s more complex needs. For example, supporting people who had catheters or specific nutritional needs.
Although the provider assured us they provided adequate staffing levels and kept this under review, depending on people’s needs, they had not actively reviewed if they had sufficient staff deployed to meet people’s current needs. This related particularly to assessment of staffing levels in relation to people’s dependency and a review of staffing levels at night and. The provider had not been successful in recruiting any staff since the last inspection, where they were found to have safe systems for staff recruitment.
The provider had not identified they were not making sure people’s privacy and dignity was respected. This included ensuring there was no risk of communal use of certain underclothing. Although people had some of their individual preferences documented, staff were not respecting these. For example, staff were not always ensuring people could watch their preferred television channels in their own rooms.
People told us they felt safe at the service. Staff had an understanding of how to safeguard people from risk of abuse and were confident the registered manager would ensure any allegations of abuse were appropriately managed.
Other risks were effectively managed, including fire safety and supporting people with their medicines. Staff were trained in relevant areas, including health and safety and moving and handling. Staff said they were supervised and felt supported in their roles. They said there was a good rapport between them and management.
People made very favourable comments about the meals. They also said they were supported to access external healthcare supports when they needed. People told us they were supported by kindly, caring staff and they could spend their days as they wanted to. Staff showed people a friendly supportive approach. People’s visitors and relatives were welcomed into the home.
The provider had developed action plans in some relevant areas, including a major plan to improve and develop the building and home environment. People said they were confident action would be taken if they raised concerns.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.