Archived: Beaumont Court

This inspection took place on the 26 and 27 January 2017 and was unannounced.

The last inspection we carried out at this service was in October 2015 at which the provider was found to be in breach of three of the regulations namely safeguarding people from abuse and improper treatment, staffing and good governance. At this inspection we found improvements had been made and the provider had complied with the legal requirements of all three of the aforementioned regulations.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since August 2016. 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.

People who were able to talk with us told us they felt safe living at the service. Relatives confirmed they had no concerns about their family member's care or how they were treated by staff. Safeguarding policies and procedures were in place for staff to follow and records showed that historic safeguarding cases had been dealt with appropriately.

Staffing levels had improved since our last inspection and permanent members of staff had been recruited. Staff and relatives told us this had led to more consistent care being delivered. Staff support had improved also in that staff were appropriately inducted, supervised and appraised. The training that staff needed to fulfil their roles had been reviewed and staff training had been brought up to date in key areas. Training In other topics relevant to the needs of the individual people whom the staff team supported, was planned to be completed in the near future.

Recruitment procedures remained robust, as they had been at our last inspection visit. Medicines continued to be managed safely and any medicines related issues were picked up promptly and addressed through the provider's quality assurance systems.

Risks that people were exposed to in their daily lives were assessed and regularly reviewed to protect people's safety. Environmental risks were well managed and emergency planning had been considered. Accidents and incidents were responded to appropriately. Analysis of accidents and incidents took place so that measures could be put in place to prevent repeat events.

People's needs were met and staff displayed a good overarching knowledge of how to support people, their behaviours, likes and dislikes. People and staff enjoyed good relationships and there was a calm happy atmosphere within the home. Medical attention from external healthcare professionals was sought in a timely manner whenever necessary.

Staff maintained people's privacy and dignity and encouraged them to be as independent as possible. People had choices about how they lived their lives and they were all active within the local community, for example, by attending day centres and going horse riding regularly.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and the provider had submitted applications to the local authority to deprive people of their liberty lawfully, to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken and related records were available for us to view.

Care records were well maintained and regularly reviewed to ensure they remained up to date. Monitoring tools were used to ensure continuity of care. Handovers between shifts took place and a diary system was used to pass messages between changing staff teams.

The registered manager was organised and focused. Staff spoke highly of the input she had had into the service and the way in which she had driven improvements. The provider's oversight of the service had improved and quality assurance systems were effectively applied. The provider's compliance team monitored the service well and this meant that any shortfalls which were identified were promptly addressed. Staff and the registered manager were accountable for their actions.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, staff supporting them and from looking at records.

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people, for example by assisting them with personal care. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. People told us that they were happy with the care and support they received from the service. One person said, "I like it, I am enjoying it" and "It's a grand place to live it is".

People's diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Staff were fully aware of people's care and support needs.

People told us and staff confirmed they pursued activities within the community and this was evident during our inspection when people told us they had returned from gardening sessions and day centres. The provider promoted people's well-being.

Is the service responsive?

People's care needs and any potential risks that they may be exposed to were assessed before they received care and support from the provider. The provider had arrangements in place to review people's care records regularly and we saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as dieticians or doctors, or where, for example, their weight or behaviours needed to be monitored, they received this care.

There was an effective complaints system in place and we found that people felt confident in raising concerns with staff or the manager.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager confirmed that no people who lived at the home at the time of our inspection were subject to a DoLS. We discussed with the manager the recent Supreme Court judgement handed down on March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The manager confirmed their understanding of DoLS and mental capacity. The manager told us that they were currently in discussions with their local safeguarding team in light of this judgement, for further advice on their responsibilities and the arrangements they now need to put in place, for people in their care.

People's care needs had been assessed and their care records showed that risk assessments were in place to reduce the chances of them coming to any harm, whilst living their lives as independently and fully as possible. Where necessary, the provider had drafted a personal emergency evacuation plan (PEEP) for people who lived at the home, to ensure that staff had instruction on how to evacuate them from the building, for example, in the event of a fire or a flood.

We reviewed the safeguarding policy and procedures in place to address and manage incidences of a safeguarding nature. We found that these arrangements were both appropriate and safe. Staff and management were able to give us examples of different types of harm and abuse, and they confirmed how they would report and progress any safeguarding matters brought to their attention.

We reviewed the arrangements in place for the management of medicines including how medicines were stored, administered and disposed of when no longer required. We found that these arrangements were both appropriate and safe. Staff were trained in the safe handling and administration of medication.

We found that entry into the building was secure. People were cared for in a safe, clean and hygienic environment. There were enough staff on duty to meet the needs of the people who lived at the home and a member of the management team was available on call for support and in the event of an emergency. Health and safety checks, maintenance and checks on the utility supplies within the home were carried regularly.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "The staff are nice." Another person told us, "I am enjoying it, they are good the staff." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

People's needs were taken into account with pictorial information available to them and adaptations made to the environment to enable them to move around the home safely and independently.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Our observations on the day of our inspection highlighted and records showed, that the provider worked in conjunction with, for example, social workers and doctors to get people's care right.

An effective quality assurance system was in place which helped to ensure that people received a good quality service at all times, by monitoring care and addressing shortfalls promptly. The provider monitored care delivery by staff and gathered the views of people and their relatives about the service they received.

Staff told us they were clear about their roles and responsibilities. The provider had a range of policies and procedures in place which gave direction and instruction to staff. Staff meetings were held monthly and a number of health and safety checks were carried out regularly. In addition, accidents, incidents and safeguarding matters were monitored regularly, to ensure care delivery was appropriate.

People told us their consent was obtained before care was delivered and staff acted in accordance with their wishes. Where people did not have the capacity to consent we found the provider acted in accordance with legal requirements.

We found that people's care needs were assessed and their care and treatment was planned. People received care which reduced the risk of poor nutrition and dehydration. Where necessary external healthcare professionals had been consulted about people's dietary concerns.

We saw that people had enough equipment available to enable them to maintain their independence as much as possible and this equipment was suitably maintained.

We found the provider had a structured staff selection and recruitment policy in place which aimed to ensure staff were suitably skilled, experienced and qualified to deliver care safely.

At this inspection we also checked whether previous shortfalls in the management of cleanliness and infection, and the maintenance of records had been addressed. These issues had been identified during our last inspection at the service on 29 October 2012. We found improvements had been made and the risks associated with infection and the maintenance of records had been reduced.

We found that staff were appropriately trained and the service had systems in place to monitor the quality of the service that it provided. However, although people who received care and support told us they were happy and we saw they were well supported, we found that failures to maintain records appropriately may put people at risk of receiving inappropriate care and treatment. In addition, failures to manage cleanliness and infection control may put people and others, such as staff and visitors, at risk of catching a healthcare associated infection.