Archived: Beech House - Salford

Updated 18 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13,14 and 20 February 2018. The inspection team consisted of two inspectors and a pharmacist inspector from the Care Quality Commission and an expert by experience. An expert by experience is a person that has personal experience of caring for people with needs similar to those at Beech House.

Prior to the inspection we reviewed all of the information we held about the home in the form of enforcement notices, notifications, previous inspection reports, expected/unexpected deaths and safeguarding incidents. We also contacted any relevant stakeholders from Salford city council which included the safeguarding team, healthwatch, infection control and environmental health. This was to establish if there were any particular areas we needed to focus on during the inspection.

During the inspection we spoke with a wide range of people and viewed records in order to help inform our inspection judgements. This included the deputy manager, area manager, temporary home manager, nine people who lived at the home, three visiting relatives, six members of care staff, the chef and three visiting health care professionals.

Records looked at included 10 care plans, five staff personnel files, 35 Medication Administration Records (MARs), training records, building/maintenance checks and any relevant quality assurance documentation. This helped inform our inspection judgements.

We had not requested the home complete a provider information (PIR) prior to the inspection. A PIR is a document the home completes in advance of the inspection, where they are given the opportunity to detail how they will meet the regulations and key lines of enquiry (KLOE).

Updated 18 April 2018

Beech House provides residential care for up to 36 older people. The home is situated in Salford, Greater Manchester and is located near to local transport routes. Car parking is available at the front of the home or in nearby side streets a short distance away. The home is owned by Akari Care Limited.

Beech House is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last comprehensive inspection of Beech House in January 2017, we rated the service as ‘Requires Improvement’ overall and in four of the five key questions we inspected against (Safe, Effective, Responsive and Well-led). The Caring domain was rated as Good. During that inspection, we identified breaches of the regulations with regards to person centred care, safe care and treatment, nutrition/hydration and good governance. We also issued two warning notices regarding nutrition/hydration and good governance following the inspection telling the home they must improve. The provider then sent us an action plan, informing us of the planned improvements they intended to make. We also held meetings with the provider to discuss the concerns, with the local authority also in attendance.

To follow up on these concerns and due to receiving a number of safeguarding alerts about the home, we undertook a further comprehensive inspection on 13, 14 and 20 February 2018. The first day of the inspection was unannounced, however we informed staff at the home we would be returning for a second and third day to complete the inspection. At this inspection, we identified multiple breaches of the regulations regarding person centred care, safe care and treatment, safeguarding people from abuse and improper treatment, nutrition/hydration, good governance and staffing. You can see what action we have asked the provider to take at the back of the full version of this report.

Medication was not being administered to people safely. We identified multiple instances where people did not receive their medication because it was not available in the home to be given to them by staff as prescribed.

People’s skin integrity was not always being well managed and we found guidance from district nursing staff was not being followed. We also observed one person sat in a chair without appropriate pressure relieving equipment in place which could have placed their skin at risk.

We found people were being placed at risk because they were not always receiving food and drink of correct consistency which could place them at risk of choking/aspiration.

We found several environmental risks around the home such as the kitchen area not being secure and people’s thickened drinks left unattended in the lounge area.

People were not always referred through to the falls service for further assessment when necessary. The deputy manager told us people were referred once they suffered two falls or more, however we found this had not been done for one person living at the home in a timely manner. The deputy manager made this referral during the second day of the inspection.

Staff did not always receive the appropriate training, supervision and appraisal to support them in their role.

We identified concerns relating to people’s nutrition and hydration needs with advice and guidance from other health care professionals not being followed. Drinks were not easily accessible for people in communal areas who were at risk of dehydration and one person had run out of their nutritional supplements, despite needing them following weight loss.

The home did not have a system in place to monitor which people were currently subject to deprivation of liberty safeguards (DoLS) authorisations. We found instances where mental capacity assessments had not been undertaken, despite their being concerns about people’s capacity during social work assessments. Applications for DoLS for these people had therefore not been made at the time of the inspection by staff. Staff said these people wouldn’t be able to leave the home freely as it would not be deemed safe for them and would be a restriction.

People living at the home spoke favourably about the staff and the care they received. However we observed several missed opportunities for interaction between staff and people living at the home, such as staff leaning over the barrier near the entrance to the lounge area and watching people who were up early in the morning as opposed to interacting and speaking with them.

People’s dignity was not always preserved and at times we heard staff talking loudly about taking people to the toilet and on one occasion, how one person living at the home had suffered continence issues during the night.

We observed there to be a lack of activities and things for people to do during the inspection. We were informed the activities co-ordinator had recently left the home, which was the reason why none were taking place.

Not all people living at the home had an appropriate care plan in place which meant staff did not have access to information about the care people required.

Confidential information was not being stored securely, with care plans left on the top of cabinets in a room which was not locked and could be accessed by unauthorised personnel.

Quality assurance systems were in place, however were not robust and had not identified the concerns we found during this inspection. There had also been a failure to improve standards despite two warning notices being issued following our last inspection in January 2017.

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, we will be inspecting 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 in 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.