Beechcroft

People’s experience of using this service and what we found

There had been significant improvements to the quality and safety of the service. The provider now had oversight of risks at the service and had taken steps to mitigate them. However, there remained some concerns about the quality and effectiveness of certain records relating to people’s care and treatment.

We made a recommendation about the records of people’s care and treatment.

People had individualised care plans in place, these were used to assess risks present when providing people’s care and treatment. Risk assessments and care plans provided guidance for staff which enabled them to care for people safely. Staff also had information to hand to help them keep people safe in the event of an emergency. This had been updated since our previous inspection.

People’s medication was administrated and managed safely. Staff had guidance available regarding people’s medical conditions and the administration of their medication. This helped ensure people’s medication was administered safely and as prescribed.

There were sufficient staff on duty for the service to be safe and to meet people’s needs in a timely manner. The provider had increased the size of the staff team and now made limited use of agency staff. People’s relatives told us that there was enough staff at the home.

There was a system in place for assessing people’s needs, choices and preferences. Staff were knowledgeable about people’s needs, choices and preferences. People were supported to maintain a balanced diet and had a choice of food available. If people were at risk of malnutrition this was assessed and if needed the advice of a dietician was sought. Staff had guidance available to help people with their nutritional needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff supported people to make as many decisions for themselves as possible. One person told us, “I feel like they respect me.” Another person’s relative told us, “They take their time to listen to them.”

The provider had responded effectivity to the COVID-19 pandemic and had took steps in line with government guidance to help ensure people were safe. The environment of the home was clean and well maintained.

There was a positive culture at the home. People told us that staff were attentive to their needs and showed flexibility in meeting their requests. People’s relatives told us that staff at the home communicate and work in partnership with them and involved them in putting together people’s care plans. Staff members told us that they enjoyed working at Beechcroft; they felt appreciated and looked after by the registered manager and provider.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 29 November 2021).

The provider completed an urgent action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations in relation to; Consent (Regulation 11), Safe Care and Treatment (Regulation 12), Staffing (regulation 18) and Good governance (regulation 17).

At our last inspection we recommended that the provider review staffing arrangements at the home; to ensure it had staff who are enabled to fulfil their roles effectively. At this inspection improvements had been made.

This service has been in Special Measures since 29 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

At our previous inspection of this service in September 2021; breaches of legal requirements were found. We asked the provider to complete an urgent action plan to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan, had taken action that we told the provider to take in a warning notice and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, “Is the service safe?”, “Is the service effective?” and “Is the service well-led?”

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Beechcroft on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We recommended that the provider review how records were kept to ensure they are complete, accurate and fit for purpose.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Beechcroft provides accommodation for up to 43 people who need help with nursing or personal care. At the time of the inspection 31 people lived in the home. The majority of the people living in the home required nursing care and most people lived with dementia.

People's experience of using this service

At this inspection, we identified serious concerns with the management of risk, care planning and delivery, the management of medicines, the implementation of the Mental Capacity Act 2005, dignity and respect and governance.

People’s risks were not always properly assessed or managed. Staff lacked clear and sufficient information on people’s needs and risks. Guidance on the support people needed to keep them safe and well was not always provided for care staff to follow, which placed people at risk of inappropriate or unsafe care.

It was difficult to assess what clinical care (nursing care) people needed as these needs had not always been assessed, care planned or monitored by nursing staff. Nursing notes were often difficult to read as record keeping was so poor. It was not possible therefore to tell if people experienced good outcomes or whether such outcomes were promoted in the delivery of care.

Medication was not always stored or managed safely. Staff lacked sufficient guidance on how to administer high risk medicines such as Warfarin and as and when required medicines such as painkillers or anxiety medicines. Medicines to thicken people’s drinks to a consistency safe from them to drink were not stored, recorded or managed appropriately which placed people at increased risk of choking.

The provider failed to provide people with the support to have maximum choice and control of their lives. This was because managerial and nursing staff failed to ensure the Mental Capacity Act 2005 was always followed to ensure legal consent was obtained from people in relation to decisions about their care. This was found at the last inspection, but little action had been taken to address this.

There was an over reliance on agency staff to fill gaps in the staff rota. This meant there were not always enough staff on duty with sufficient knowledge of the needs and risk of people living in the home. Staff told us the lack of consistent staffing was stressful and impacted on their ability to provide people with the care they needed, as the extra burden of supporting unfamiliar agency staff stretched them to their limits.

People and relatives told us that staff were kind and caring and our observations during the inspection confirmed this. People’s right to be treated with dignity and respect, was however not always promoted in the day to day management of the service. This was a concern at the last inspection but little improvement had been made.

The systems in place to monitor quality and safety were satisfactory but the action taken to improve the service was ineffective and lax. A culture of continuous improvement and learning was not embedded and despite the provider, manager and staff team having knowledge of the improvements that were needed over a period of several months, they had not been made.

After the inspection, CQC asked the provider to submit an urgent and immediate action plan for improvement. The provider and manager responded swiftly, and a programme of improvements was commenced without delay. However, it should not have taken a CQC inspection to identify and act on these risks.

People were referred to and received support from a range of other health and social care professionals in respect of their needs. People’s views on the support provided had been sought via a survey in December 2020.

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 November 2019). At the last comprehensive inspection in October 2019, breaches of regulations 10 (Dignity and Respect), 11 (Consent) and 17 (Good Governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. The provider submitted an action plan to advise of the improvements they intended to make to ensure regulations were met.

You can read the report from our last inspection, by selecting the 'all reports' link for ‘Beechcroft’ on our website at www.cqc.org.uk.

At this inspection, we found that improvements had not been made and the service continued to be in breach of the above regulations. An additional breach of regulation 18 (Staffing) was also found.

Why we inspected

We conducted a focused inspection to follow up the breaches identified at the last inspection. The inspection was in part prompted by a monitoring call completed with the manager which raised concerns that improvements to the service had not been made. As a result, we undertook a focused inspection to review the key questions of safe, effective, caring and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified within the domain of ‘responsive’. We therefore did not inspect this domain. Ratings from previous comprehensive inspections for this key question were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work with the local authority to monitor progress.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service has been placed in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

• Safe procedures were followed for admitting people to the service. Adapted assessment processes were completed, and people were expected to isolate in accordance with best practice when admitted to the home.

• Visitors were able to spend time seeing and speaking with loved ones in a suitable safe space by arranged appointments. The provider had a specified lounge that had a screen to enable appropriate social distancing and it seemed homely and welcoming. Personal protective equipment (PPE) was available for visitors and they entered the building through the nearest entrance to the lounge. Visitors were expected to be tested in accordance with the current guidance

• Visitors had their temperature taken on entering the service. Telephone calls and virtual methods were used to communicate with friends and family keeping them up to date with any changes and informing them of the current IPC visiting guidance.

• There were safe measures in place to facilitate visits for people receiving end of life care and where it had been assessed as being in the persons best interest due to their wellbeing.

• Regular home testing was in place. Stocks of the right standard of personal protective equipment (PPE) were well maintained and staff used and disposed of it correctly.

• Staff had been trained in infection control practices and refresher training had been arranged through the local authorities infection prevention and control team. The provider regularly checked staff practice and knowledge and conducted regular walk rounds of the building.

• The home had a designated cleaning and laundry staff team as well as a COVID-19 Champion.

• The staff changed their clothes on site before and at the end of their shifts to minimise the risk of cross infection.

• People had been supported to access GP’s and other health professionals to receive care and treatment as they required.

Beechcroft is a care home that provides accommodation for up to 43 people who need help with their personal care or nursing care. At the time of the inspection 23 people lived in the home.

People's experience of using this service

At the last inspection, the provider was rated inadequate. At this inspection, the provider’s rating has improved to requires improvement. During our inspection we found that significant improvements had been made across the service but that further improvements were still required.

The implementation of the Mental Capacity Act (2005) at the home was not in accordance with the MCA Code of Practice. We advised the provider of this at our last inspection but no action had been taken to address this.

Some people’s privacy and dignity was not promoted in the delivery of their care and professional advice given in respect of some people’s needs had not always been properly followed.

Although records showed that staff had been complimented by relatives on the care and compassion shown to loved ones at the end of their lives, end of life care planning required further development to ensure that people’s needs and preferences were always met.

The Accessible Information Standard was not embedded in the culture of the home which meant that there was a risk that people were not provided with information about the service and their care in a way they could understand.

Checks on the quality and safety of people’s care had significantly improved but some of these checks were not yet fully effective in driving up improvement. The manager and quality manager were able to tell us about how they planned to improve the service over the next few months to ensure all of the health and social care regulations were met.

People’s needs and risks were identified and staff had sufficient information on the care people needed. Records showed that improvements in the consistency and quality of the care people received had been made, especially in respect of diet and fluid intake, skin integrity, accident and incidents and medication management. The systems in place for identifying and responding to abuse were also working effectively.

Staff recruitment was safe and staff had now completed the training they needed to do their job role effectively. Staff spoken with were positive about the new manager and felt supported in their job role.

At the last inspection, people’s call bells rang for long periods of time without being answered. At this inspection, staffing levels were adequate and hardly any call bells were heard ringing. Those that did were answered promptly by staff.

The premises were adequately maintained and fire safety arrangements were significantly improved.

People told us they felt safe at the home and said staff treated them kindly and patiently. It was clear that staff knew people well and that they were well liked by the people they supported. The atmosphere at the home was relaxed and homely and the culture open and transparent. There were activities on offer to occupy and interest people and visitors were welcomed at any time.

The new manager and new quality manager were clear on their job roles and legal responsibilities with regards to people’s care and it was clear they were committed to continuous improvement.

Rating at last inspection and update

The last rating for this service was inadequate (published 03 May 2019) as there were multiple breaches of the regulations. This related to regulations 9 (Person centred care), 10 (Dignity and Respect), 12 (Safe care and treatment), 14 (Nutrition and hydration), 18 (Staffing) and regulation 17 (Good Governance). The service was placed in special measures.

At this inspection, significant improvements had been made but the provider remained in breach of regulations 10 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A breach of regulation 11 (Need for consent) was also identified.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

The service is no longer in special measures. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information prior to this we may inspect sooner.

People’s experience of using this service: The overall rating for this service is ‘inadequate’ so therefore the service is in special measures by CQC.

There were no adequate or effective systems and processes in place to monitor the quality and safety of the service. This resulted in people being exposed to ongoing risks with regards to their care.

The provider’s fire safety arrangements were unsafe. There was no evidence that staff had practiced how to evacuate people from the home in an emergency for a significant period of time. People who lived in the home did not have adequate personal emergency evacuation plans in place and there was a lack of evacuation equipment in place to assist an evacuation.

People’s needs and risks were not properly supported or managed and people’s support was inconsistent and in some instances unsafe. Some people sustained accidental injuries during the delivery of support due to poor moving and handling practice. Some people had fallen due to being left unsupervised or unsecure in a wheelchair or recliner chair. This did not show that people were well treated or looked after.

People who required support at their end of their lives did not have support plans in place to advise staff how to provide appropriate and responsive support to meet their needs.

Some people had unexplained injuries. Some had been reported to the local authority but some had not. A significant number of these unexplained injuries had not been reported to CQC as required. Some people sustained similar injuries for a significant period of time but no consideration had been given to whether this indicated potential abuse.

The number of staff on duty was insufficient to meet people’s needs. People’s call bells rang for significant periods of time before being answered. When call bells rang staff did not always respond with any sense of urgency. Some people told us they waited a long time for help. One person said that they could wait for hours during the night for someone to help them.

Where the manager had concerns about staff conduct they had not always ensured that appropriate action was taken when they left the provider’s employment. This meant they had failed to demonstrate a duty of care.

During our inspection, we observed that staff interacted with people in a kind and caring way. They were respectful towards people and patient.

People had access to a range of activities either group based or one to one in support of their social and recreational needs.

Rating at last inspection: At the last inspection in 2017 the service was rated good. After this inspection, the registered manager in post left the home.

Why we inspected: This was an urgent and responsive inspection planned in response to information of concern reported to CQC via the ‘Share your experience’ link on CQC’s website.

Enforcement : Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: The home has been placed 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

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

As a condition of the provider's registration with the Care Quality Commission, the home is required to have a registered manager. A registered manager is a person who has registered with the CQC 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 home had a registered manager who had worked there for over 20 years.

We looked at care plans and found that they were person centred, detailed and clearly reflected people’s needs. Staff had a good knowledge of the life histories and care needs of the people that they supported. We saw that there were activities available and most people said that they enjoyed them.

The home employed adequate staff in order to meet the needs of the people who lived there. The staff employed were supported by the management team to do their jobs well. They had access to regular training, support and supervision.

The premises were cleaned and well maintained. We saw that the equipment was regularly checked to ensure that it was safe for use. We also saw that the service ensured that the maintenance of the home did not disrupt the care that was being provided.

The manager and staff had a good understanding of the Mental Capacity Act and saw that it was safely applied to ensure that people were cared for lawfully.

The staff were kind and caring and we saw many examples of how they respected the privacy and dignity of the people who lived in the home. People spoke very highly of the staff and the manager and the care that they received.

The home was well led and the manager and deputy manager worked hard to maintain systems and processes to ensure that people received good care in a warm and safe environment.

We saw that risk assessments were in place and were updated regularly to keep people safe. Medicines were managed well for everyone who lived in the home. The deputy manager monitored the systems and processes well and made sure that standards were maintained.

End of Life care was an area where the service particularly focussed and this had been recognised with the service holding the Gold Standard Framework (GSF) Beacon status for End of Life Care. The service had been awarded Beacon status for a second time in March 2015 and this is valid until March 2018. It was clear that this award and the values of the GSF were very important for all of the staff.

We saw records that showed the home supported each person's ability to consent or make decisions. Where a person lacked the capacity to consent we saw evidence of relative involvement in decision making.

We talked with one person who lived at the home and two relatives. They told us they were happy at the home and that the care was good. They said:

'Wonderful [I'm very happy here]'

'Mum is well looked after'

'Very happy with the care'

We observed people were well cared for and treated with dignity and respect. People's needs were assessed and reviewed. We found care records contained relevant information in relation to personal details, individual needs and preferences. Care plans and risk assessments were in place, individualised and up to date.

We reviewed three staff records. We found the provider had undertaken appropriate checks to ensure people had the necessary skills and suitability to work with vulnerable people. Staff demonstrated an awareness and understanding of how to protect people from abuse and report any concerns.

We reviewed the provider's complaints policy and three complaints. We saw evidence that complaints were logged, investigated and responded to appropriately in accordance with the complaints policy.