Beech Tree Hall

We found the following examples of good practice.

The home looked and smelled clean and was uncluttered. Staff were seen to be wearing appropriate personal protective equipment (PPE) and being careful to maintain social distancing where possible, to help minimise risks. The service worked positively and creatively in supporting people to be comfortable with COVID testing and vaccination.

The deputy manager responsible for managing the day to day running of the service, had knowledge of current guidance. They ensured dissemination of information to staff, liaised with relevant agencies, and maintained communication with people’s families. Staff also helped people to stay in touch with their family and friends by phone and on-line face to face chats.

The provider learned lessons and responded positively to address shortfalls and improve the service. We saw evidence that best practice feedback had recently been provided by a visiting nurse and, as a result, changes had been implemented quickly and effectively.

Beech Tree Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The service was a large home, bigger than most domestic style properties. Beech Tree Hall accommodates up to 17 people in one adapted building that is divided into four flats. The service supports younger people with a learning disability. At the time of our inspection 15 people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. Staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

People were safe and they were supported by staff who were skilled and competent to carry out their roles and responsibilities.

Risks to people's safety had been identified and managed. There were enough staff to support people. The provider carried out checks on new staff to ensure they were suitable to work in the home. Infection control was well managed and the home was clean and free from hazards.

The staff knew people well and were kind and caring. There was a strong focus throughout the service on respecting people’s dignity. Staff planned and provided care to meet people's needs and to take account of their preferences.

People were offered choices around their meals and maintained a well-balanced diet. People received access to health care services when required. Various professionals were involved in providing healthcare to people.

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.

Feedback about the home was positive. The focus of the service was on providing people with a service that placed them at the centre of their care. The provider took action promptly when concerns were shared with them. They had systems to share learning from incidents with the staff team to improve the service further.

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 requires improvement (published 18 January 2019).

The provider breached regulation 17 (governance). They completed an 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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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 we may inspect sooner.

Beech Tree hall accommodates up to 17 people in one adapted building that is divided into four flats. The service supports younger people with a learning disability. At the time of our inspection 15 people were using the service. At the last inspection in March 18, the service was rated requires improvement. You can read the report from our last inspections, by selecting the 'all reports' link for 'Beech Tree Hall' on our website at www.cqc.org.uk

The care service was working towards the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen.

At the time of our inspection there was a registered manager 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.

At the last inspection in March 2018, we asked the provider to take action to make improvements to person centred care, dignity and respect, consent, safe care and treatment, staffing and governance. Action had been taken and we found improvement had been made, however further improvement still need to be made to governance.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse; however safeguarding concerns had not always been reported to the local authority or to CQC, so training in this area had been ineffective.

We found there were enough staff to meet people's needs and the deployment of staff was appropriate to meet people's needs their social and recreational needs.

Risks had been identified and regularly reviewed and evaluated.

Systems were in place for safe management of medicines. Staff received appropriate training and competency assessments. However, we identified some minor issues around storage and medicine returns.

People were not always protected by the prevention and control of infection procedures. We found some areas of the service were not well maintained.

People were supported by staff who had received an induction into the service and appropriate training, professional development and supervision to enable them to meet people's individual needs.

We found the service met the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff had a satisfactory understanding or knowledge of this. People had been assessed to determine if a DoLS application was required. We found people's mental capacity and best interest decisions were considered.

People were offered choices around their meals and maintained a well-balanced diet. People received access to health care services when required. Various professionals were in involved in providing healthcare to people.

We found staff to be kind and caring. Staff respected people’s privacy and dignity.

Care plans identified people's needs and contained sufficient detail for staff to be able to meet their needs.

Relatives we spoke with told us they were listened to by the management team and were confident any concerns would be dealt with by them.

People were involved in meaningful activities, stimulation and community access.

There were opportunities for people who used the service, their families, staff and healthcare professionals to become involved in developing the service and they were encouraged to provide feedback about the service provided. This was both on an informal basis speaking to the managers' and through a quality assurance survey.

There were processes in place to monitor the quality and safety of the service. However, these had not always been effective, had not identified all issues and needed to be more robust.

The registered manager was not fulfilling their duties under the Health and Social Care Act 2008. They had failed to inform CQC of all statutory notifications and had not always informed the local authority of safeguarding incidents.

During our inspection, we found one breach 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 the report.

Beech Tree Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Beech Tree hall accommodates up to 17 people in one adapted building that is divided into four flats. The service supports younger people with a learning disability. At the time of our inspection 15 people were using the service.

At the last inspection in November 2015, the service was rated Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Beech Tree Hall’ on our website at www.cqc.org.uk

The care service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen.

The manager at the service was registered at another location owned by the same registered provider. They were in the process of adding this location to their registration. The registration of the manager at this location was completed on 6 April 2018. 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. The registered manager told us they would eventually only be registered at this location when a new manager had completed the registration process at the other location. Since our last inspection the service has deteriorated, the registered manager acknowledged that the service was not good and there were improvements to be made. They had commenced an action plan to encompass the require improvements and ensure changes were implemented.

Staff we spoke with understood what it meant to safeguard vulnerable people from abuse, and they were confident management would take any concerns they had seriously and take appropriate action. We identified issues at the time of our inspection which when reported to the registered manager they took appropriate action.

Staff told us there were enough staff to meet people’s needs. However, it was not clear if the deployment of staff was appropriate to meet people’s needs in particular their social and recreational needs.

Risks had been identified. However, these lacked detail and were not reviewed or evaluated.

Systems were in place for safe management of medicines. Staff received appropriate training and competency assessments. However, some minor issues were identified.

People were not always protected by the prevention and control of infection procedures. We found some areas of the service were not clean.

We found procedures were followed for the recruitment of staff. Staff supervision did not always take place and staff did not always receive an annual appraisal of their work. Staff received training. However we identified this was not always effective.

We found the service did not always meet the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Not all staff had a satisfactory understanding or knowledge of this. People had been assessed to determine if a DoLS application was required. However, we found people’s mental capacity and best interest decisions were not always considered and there was not a consistent approach to ensure all decisions were made in people’s best interests.

People were offered a well-balanced diet. However, through our observations we saw people were not always supported to maintain a balanced diet.

People accessed health care services when required.

People and relatives spoken with all said the staff were kind and caring. People also said staff respected them and maintained their dignity. However, from our observations we found this was not always the case.

Care plans did not always identify people’s needs and lacked detail for staff to be able to meet their needs.

Relatives and people we spoke with told us they were listened to by the management team and were confident any concerns would be dealt with by them.

There was lack of meaningful activities, stimulation and community access for people who used the service.

There were processes in place to monitor the quality and safety of the service. However, these had not been regularly completed and were not effective. This had been recognised by the registered manager and the provider, who were taking action to address the shortfalls. They were recruiting staff and using a consultant to provide oversight.

During our inspection, we found six 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 the report.

Beech Tree Hall is a care home for up to 17 adults with learning disabilities. Accommodation is provided in four flats; Oak House, Holly House and Birch House are located on the ground floor. Elm House is located on the first floor. The home is owned and by run by Mr Donald Smith, who also has a small number of other homes for people with learning disabilities, in the Yorkshire area. At the time of the inspection there were 15 people using the service.

The service has a registered manager. 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 and associated Regulations about how the service is run.

People said they felt safe and the staff we spoke with had a clear understanding of safeguarding people from abuse, and of what action they would take if they suspected abuse.

Care and support was planned and delivered in a way that ensured people were safe. The individual plans we looked at included risk assessments which identified any risk associated with people’s care. We saw risk assessments had been devised to help minimise and monitor the risk, while encouraging people to be independent.

People’s medicines were well managed generally, although the temperature that the medicines were stored at was not monitored and recorded consistently in all of the flats.

We found there were enough staff with the right skills, knowledge and experience to meet people’s needs. There had been a period where there had been shortages of staff, and this had led to the use of agency staff, while new staff were recruited. However, this had improved, as new staff had been recruited and when the management team used agency staff, they tried to use the same workers to help maintain consistency for people.

We saw the staff training record for the service. This showed that staff were provided with appropriate training to help them meet people’s needs. An improved system was also being introduced to make it easier for the registered manager to keep track of when staff needed training and updates. However, there was a need to ensure that all staff, including the registered manager, received regular formal, documented supervision with their line managers.

We found the service to be meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and the staff we spoke with were aware of the Act. However, there was a need to further develop some of the assessments, records, and the practice in some areas, and the registered manager was taking action to address this.

People were supported to maintain a balanced diet. The people we spoke with told us they liked the food and were involved in choosing and planning their menus, shopping and cooking their meals.

People were supported to maintain good health, have access to healthcare services and received on-going healthcare support. We looked at people’s records and found they had received support from other professionals and healthcare services when required.

People’s needs were assessed and care and support was planned and delivered in line with their individual support plan. We saw staff were aware of people’s needs and the best ways to support them, and there was an emphasis on maintaining and increasing people’s independence.

The registered manager and all of the staff we spoke with and saw supporting people, had a caring approach and treated people with respect and dignity.

The service was for people with challenging needs and behaviour and staff successfully provided a very positive and calm atmosphere, and were very person centred and responsive in their approach.

People’s individual plans included information about their family and others who were important to them and they were supported to maintain contact with them. We saw that people took part in lots of activities and events in the home and in the local community and that this depended on the choices and individual interests of each person.

The service had a complaints procedure and people knew how to raise concerns. The procedure was also available in an ‘easy read’ version.

The registered manager was very open and committed to continuous improvement of the service. They knew people’s backgrounds, needs and preferences in detail, and was very concerned for their welfare.

There were audit systems to make sure people received a good quality and safe service, and in general these were reasonably effective. However, there was room to improve the management overview in some areas, such as people’s financial support and medicines, while including more consideration of the MCA code of practice.

The registered manager told us the company sent out satisfaction surveys to stakeholders for them to comment on their experience of the service provided. They said that most people’s relatives were very involved, and preferred to discuss their views on a day to day basis, when they phoned or visited.

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. One person said, 'Staff ask me what I want. I decide.'

People experienced care, treatment and support that met their needs and protected their rights. During the inspection we spent time observing how staff members interacted with people who used the service. The staff were good at communicating with and engaging people. They were respectful of people's wishes and feelings. One person said, 'The staff are very nice here.'

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

There was an effective complaints system available.