Beechdale House Care Home

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

There was a lack of evidence of people being enabled to have choice and control and make decisions about how their support was provided. People were not fully supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People and their relatives gave feedback regarding a lack of meaningful occupation and stimulation for people. which we observed during our visit. People’s families and friends were free to visit Beechdale House and were made welcome. People were encouraged to take part in activities if they wished to do so, although the provision of activities was limited to the times when the activity co-ordinator was at work.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Although people and their relatives did not express concerns around staff, we observed multiple times during our assessment where staff interaction with people fell significantly short of expected standards. For example, our Expert by Experience observed that staff appeared to be 'preoccupied' and failed to interact with people when they required attention. As cited under Safe, we observed numerous occasions during our visit where people were ignored by staff. The significant shortfalls in infection control, medicines, environment and the overall governance of the service left people at risk of not receiving kind and compassionate care from staff.

People were not always treated with dignity and respect. People's independence was not always promoted through good design and the provision of a safe, clean place to live. Staff were not ensuring people were supported in their best interests and in a dignified way. Language used in care records was not always respectful. This was evident in the poor interactions we observed and behaviour charts and daily care notes. For example, people were described as 'aggressive', or 'rude'. This lack of understanding of people's needs left people at risk of harm.

There was a focus on completing tasks at the service rather than person-centred care. People's social needs were not being effectively met. Staff did not have time to spend with people having meaningful conversations. We observed staff being 'task focused' and unable to spend quality time with people. This left people at risk of not receiving person centred care.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

Although people were positive about the activity co-ordinator, there were no structured activities provided for people when this staff member was absent, to engage people to do things they enjoyed. People and their relatives told us staff had supported them to settle into the service when they had newly arrived in an unfamiliar environment. One relative told us, “My relative had to move rooms and the staff had helped to move my family member into their new room and did a good job.”

We discussed the restrictions imposed upon people by the poor environment and building maintenance with the provider. The service had not considered a design to help people who lacked capacity to orientate. The signage for specific areas of the service which the provider was developing was not in place. For example, some signage for people consisted of torn sheets of paper on their bedroom doors with a photograph of themselves. These would not meet guidance for dementia friendly building design, so would not assist a person living with cognitive impairment to orientate themselves within the building.

We saw multiple examples of a lack of encouragement and assistance being offered by some staff for people to enable them to maintain their independence. We saw several examples of people being asked to ‘sit down’ by staff when they attempted to get up from their chairs, rather than attempting to enable people who wished to mobilise. This limited peoples’ choices, preferences, and ultimately, their mobility and was observed to be due to staff being ‘task orientated’ and lacking positive engagement with people. We fed back our concerns to the registered manager and provider about the poor staff culture and lack of positive interaction observed, which they told us they would address.

The registered manager had not ensured that regular care plan audits were identifying the shortfalls found at our assessment visit. This left people at risk of not receiving consistent, safe and high-quality care and support.

Some people and their relatives gave feedback about the lack of interaction and stimulation for people being a concern for them. One relative told us, “My family member has minimum stimulation from staff.” While another relative told us, “They had not seen much stimulation from the staff and their family member liked walking around and sometimes did not use their walker and would walk freely.” This placed the person at risk of harm, as they were not prompted by staff to use their walking aid. People and their relatives described the service as not placing any restrictions on their visits. One person told us, “There are no restrictions, and the staff will let my family member know if we can’t come and keep the communication going.”

The registered manager and clinical lead told us they ensured referrals were made in a timely manner to external teams, to ensure people’s health and social care needs were met. The registered manager described the positive working relationships they had with the regular external health professionals who visited the service to provide support for people. We spoke with an external health team following our site assessment visit, and they confirmed the service made regular, appropriate referrals to the team.

We saw from records the service had identified when people required support and arranged for people to access a range of healthcare professionals; including GPs, dentists, opticians, dietitians and health team specialists when they needed them. We were concerned the guidance from these teams had not always been transferred to the care plans and risk assessments for people, to ensure staff could support people effectively. For example, there was no effective system in place to ensure the regular repositioning of people living with skin management needs or the use of equipment to reduce the risk of falls was taking place. This left people at risk of harm due to their identified health care needs not being met.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.