Beech House Care Home

Updated 8 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 comprehensive inspection took place on 23 and 25 October 2018; the first day of inspection was unannounced. The inspection was completed by one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

As part of the inspection process we also used information the provider sent us in the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

Before the inspection visit we looked at all the key information we held about the service, this included whether any statutory notifications had been submitted. Notifications are changes, events or incidents that providers must tell us about.

We checked whether Healthwatch Nottinghamshire had received feedback on the service; they had not. Healthwatch Nottinghamshire is an independent organisation that represents people using health and social care services. We spoke with one visiting healthcare professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

In addition, we spoke with four people who used the service and two relatives. We also spoke with the registered manager, the deputy manager, a senior carer, a carer, the housekeeper, the cook and the activities coordinator. We also spoke with both directors.

We looked at the relevant parts of four people’s care plans and reviewed other records relating to the care people received and how the service was managed. This included risk assessments, quality assurance checks, staff training and policies and procedures.

Updated 8 January 2019

This comprehensive inspection took place on 23 and 25 October 2018; the first day of inspection was unannounced.

The service had previously been inspected in February 2016 and was rated ‘Good’.

Beech House Care Home 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. The home provides accommodation and personal and nursing care for up to 32 older people, some of whom are living with dementia. The service has a range of communal areas and a garden. There were 27 people using the service at the time of our inspection.

Beech House Care Home took a thorough and carefully planned approach to ensure people received a personalised and responsive service. Staff enjoyed going the extra mile to ensure people enjoyed how they spent their time and understood how this benefitted their well-being. Links between people and the local community were valued and actively promoted and supported, again with staff understanding the value this had on people's well-being.

Activities were carefully planned to be relevant to people, were meaningful to people and matched to people’s levels of ability, if for example they were living with dementia or were restricted in how they could participate.

People were supported to maintain their relationships with their relatives who were welcomed to become as involved with the home as they liked, including becoming volunteers if they so wished.

The provider had a clear vision for providing care that was inclusive and centred on people’s individual needs. The provider and the registered manager's leadership style was inclusive and inspired and valued their staff team. As such, the staff team were highly motivated, dedicated and passionate about the quality of care they provided to people.

A registered manager was in post. 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. Robust systems were in place to check standards of care met with people’s expectations and identify where improvements could be made.

People felt safe living at the service and people were supported by staff whose suitability for the role had been checked.

Risks to people were identified and actions taken to manage and reduce known risks. This included risks associated with people’s health conditions as well as risk in the environment and risk from foreseeable emergencies, such as fire.

Medicines were administered as prescribed and well managed. Medicines were stored and disposed of safely.

The premises were clean and hygienic and staff followed infection prevention and control guidelines.

There were sufficient numbers of staff deployed to meet people's needs.

Staff working at the service had been subject to pre-employment checks. Pre-employment checks help the provider decide whether staff are suitable to work at the service.

Systems were in place to identify and review when things went wrong so as to be able to make improvements.

People's needs were assessed, regularly reviewed and robustly monitored; this helped staff provide care to meet their needs and proactively promote good health outcomes for people. This was reinforced as staff had received training in areas relevant to people's needs; for new staff this included a robust period of introductory training and assessment to ensure their competence. Staff had the skills and knowledge to help ensure people were treated equally, were free from discrimination and were supported with any needs relating to their faith.

The provider ensured people received sufficient nutrition and hydration. People received assistance from staff with their nutrition or hydration if this was required and aids were used to promote people’s independence wherever possible. People at risk of weight loss were monitored and actions taken to help prevent reduce any risks.

People received support with their healthcare from a variety of other healthcare professionals and referral systems were used to access this support when needed, for example from the falls team.

The premises had been adapted to meet the needs of people living at Beech House Care Home, including for people living with dementia. This included signage and visual prompts to help people orientate as well as different communal areas decorated to aid people’s reminiscence. The outside garden area had also been made accessible to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff checked people consented to their care and the principles of the MCA were followed. People and relatives contributed to their care plans and as such care plans were personalised and reflected people’s choices and preferences.

People and relatives told us they felt staff were caring and considerate. Staff had formed warm relationships with people and regularly engaged people in conversation and activity. Staff responded if people became anxious or uncomfortable and provided reassurance and comfort. People’s privacy and dignity was respected and their independence promoted.

People and relatives were involved in their care planning and staff respected people's known views and preferences. People’s views were regularly gathered and responded to so as to improve their experience of care and of living at Beech House Care Home.

Care was planned and provided to people when they approached the end of their lives. Staff understood how to promote people’s comfort during end of life care and had taken steps to ensure this was prepared for.

Processes were in place to manage and respond to complaints in a way that involved the complainant to ensure issues were resolved to their satisfaction.

People, relatives and staff were actively encouraged to give feedback and any feedback given was fully considered and improvements made. People’s views were valued and respected.