Archived: Beech House Nursing Home (Partington)

Updated 21 February 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 20, 21 and 22 March 2017 and the first day was unannounced which meant no one at the service knew beforehand that we would be attending. The inspection team consisted of one adult social care 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. The expert by experience had experience working in nursing settings.

Before the inspection we reviewed the information we held about the service. This included asking the Local Authority and Healthwatch Trafford for information. The Local Authority did not raise any concerns.

Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Part of the local Healthwatch programme is to carry out Enter and view visits to health and social care services to find out how they are being run and make recommendations where there are areas for improvement. Healthwatch had undertaken an Enter and View visit to Beech House Nursing Home in December 2016. The outcome of the visit was positive and the authorised representatives leading the visit felt that the standard of care at Beech House Nursing Home was good.

We also reviewed information from the local NHS Trust’s infection control lead; an infection control inspection had been carried out in February 2017. The infection control lead had drawn up an action plan for the service after issues had been identified.

During our inspection we spoke with 10 people living at the home, eight of their relatives and two visiting health professionals to obtain their views of the support provided. We spoke with 12 members of staff, which included the registered manager, area manager, the administrator, two qualified nurses, activities coordinator, senior care staff, three care staff, catering and domestic staff.

We spent time observing care in the communal lounges and dining rooms and used the Short Observational Framework for Inspections (SOFI), which is a way of observing care to help us understand the experience of people using the service who could not express their views to us.

We looked around the building including bedrooms, bathrooms, the kitchen, the laundry room, clinic rooms and in communal areas. We also spent time looking at records, which included four people’s care records, three staff recruitment files, training records and records relating to the management of the service.

Updated 21 February 2018

We inspected Beech House Nursing Home on 20, 21 and 22 March 2017. The first day of the inspection was unannounced, which meant we did not notify anyone at the service that we would be attending.

Beech House Nursing Home provides nursing and residential care for up to 28 older people. At the time of our inspection there were 25 people living in the home.

People are supported in two buildings. The house provides accommodation for people requiring nursing care. The bungalow next door provides residential care.

The house has a communal lounge area and large conservatory used as a dining room. The bungalow has a small dining area and separate small lounge area. The kitchen where meals are made is in the main house and there is a smaller kitchen for snacks and drinks in the bungalow. The laundry room is situated in the bungalow. The house has two floors; the upper floor is accessed by stairs and a lift.

At the comprehensive inspection of Beech House Nursing Home on 1and 3 December 2015 we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). We issued the provider with six requirements stating they must take action to address these breaches.

Following that inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to these breaches. This inspection was undertaken to check that they had followed their plan, and to confirm that they now met all of the legal requirements.

During this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations.

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."

The service had a new manager who had worked at Beech House Nursing Home for ten weeks prior to our inspection. They were in the process of being registered with the Care Quality Commission. 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.

At the last inspection we found there were not sufficient levels of staff of staff on duty. At this inspection we found staffing levels had not improved and we noted people did not receive their care in a timely manner.

We observed some positive interactions between people and staff when direct care was being provided. However, we saw staff rushing around and not always acknowledging people as they passed them or entered their rooms. Consideration was not always given to people's privacy and dignity as people's personal information was not always protected.

Robust recruitment processes had not been followed because one some staff member did not have references from their previous employment.

Care plans were based on the needs identified within the assessment, however we found care plans were not always person centred, and didn’t provide enough information on people’s past histories.

We found systems were in place to make sure people received their medicines safely. When we did raise an issue with medicines this was explored and resolved straight away.

Potential safety hazards were identified by the inspection team as we walked around the building. We brought these concerns to the management team’s attention and found these had been resolved on the second day of our inspection.

All areas of the home looked clean. Procedures were in place to prevent and control the spread of infection. An infection control audit in February 2017 had identified areas for improvement and these were being implemented.

Policies were in place to ensure people's rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Although policies and procedures were in place it was clear that they were not always put into practice.

People had access to activities, however we received mixed feedback with regards to the activities provided. People were not always protected from social isolation. The range of activities available were not always appropriate or stimulating for people.

People had enough to eat and drink throughout the day. Where people needed support with eating, they were supported by a member of staff. However, we found people who needed their fluid intake recorded had not always been completed correctly by staff.

Audits on the home's quality were not accurate which meant systems to improve the quality of provision at the home were not always effective. We found the home in breach of the regulation in relation to good governance as there were not effective systems in place to monitor the quality of the service. Surveys were completed but the information was not collated and used to improve the provision of care at the home.

The home environment was not dementia-friendly, in that adjustments had not been made to help people living with the condition to navigate around the home. We recommended that the home investigates and implements good practice in modern dementia care to improve people’s quality of life.

Healthcare services were available to people who required them. People had access to health care services when their health needs changed. Staff made referrals to health care professionals for further advice and guidance to manage their health conditions. Staff followed health professional's guidance and recommendations for people.

People told us they knew how to complain if they were unhappy and records showed the service responded appropriately to complaints they had received.

We found 11 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We served an Notice of Proposal to cancel the providers registration. The provider submitted representations that were not upheld, therefore a Notice of Decision was adopted the cancel the providers registration.