Beggars Roost Nursing Home

We found the following examples of good practice.

People told us they felt safe with the infection control and prevention measures that were in place. The layout of the service had been changed to support social distancing. For example, in the lounge chairs were spaced apart from each other and additional covered seating areas had been created in the garden.

All visitors and contractors were required to undertake Lateral Flow Devise tests (LFD) on arrival. Visiting was in line with government guidance and had been adapted throughout the pandemic to ensure visiting was compliant with government guidelines. Clear signage around the outside of the premises directed visitors to a sperate entrance.

All people and staff participated in regular whole home testing for Covid 19. Personal protective equipment (PPE) was readily available and there was plenty of it around the service. Staff wore and used PPE appropriately.

The premises were clean and odour free. There was an enhanced cleaning regime in place which included regular sanitisation of high touch areas.

People had been supported to stay in touch with relatives using technology such as video and voice activated devices. People were supported to have visitors to the care home and provision for this was made both in the garden and inside the care home depending on people’s preferences at the time.

A range of activities were available, and people also made use of the fully accessible garden area.

We found the following examples of good practice.

The provider had purchased two outdoor buildings which were being built in the garden at the time of our inspection. These rooms were for visitors to use when seeing their relatives. The buildings had outdoor access, heating and social distancing screens to facilitate safe visiting and follow social distancing guidance. The rooms were being adapted to allow for cleaning and ventilation between each visit to ensure that infection prevention and control measures were met.

Staff were aware of the impact isolation can have on the wellbeing of people and had thought of creative ways to address this. One to one time with people was increased and activities were combined with care. The registered manager told us that to support a person who was anxious the provider purchased a device that uses speech recognition to perform a range of tasks on command and put this in their room. This allowed them to call their relatives at any time, without the need for staff support.

The registered manager told us that while supporting a person in isolation with their meal, an electronic tablet was used to video call the persons relative. This meant that people could see each other and speak to each other whilst having their meal, reducing the impact of loneliness and social isolation.

During an outbreak of COVID-19 the registered manager increased the frequency of testing for staff and people. Staff were tested twice a week and people weekly. In addition, people were assessed twice a day for developing symptoms of COVID-19 or changes in physical health, to ensure that any change was found and acted upon at the earliest opportunity.

Further information is in the detailed findings below.

Beggars Roost Nursing Home 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. The home is registered to provide accommodation and nursing or personal care for up to 28 people and there were 23 people living at the home at the time of the inspection. Beggars Roost Nursing Home is a detached property in a rural location. It is an older residential property which has been extended and adapted to be suitable as a residential care and nursing home. There was a passenger lift so people can access the first floor and corridors had sloping floors rather than steps for those with mobility needs. All bedrooms were single and nine had a en suite bathroom and seven had an en-suite toilet. There is a lounge and separate conservatory area which is used as dining room and for activities. The home had gardens and outdoor space which people used to sit in, to garden in, or, to have their meals during summer.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We made a requirement at the last inspection as people were not fully involved in planning their care and as care did not always reflect people’s preferences. The provider sent us an action plan to say how this was being addressed. At this inspection we found improvements had been made. People were involved in decisions about their care which reflected their preferences and changing needs. The provider had met this regulation.

The provider ensured safe care was provided to people. Risks to people were assessed and measures taken to mitigate these. The premises and equipment were safely maintained. Sufficient numbers of care and nursing staff were deployed to meet people’s needs. Checks were made to ensure staff were suitable to work in a care setting. Medicines were safely managed. The home was clean and hygienic with no offensive odours. Incidents or accidents were reviewed and action taken to reduce the likelihood of any reoccurrence.

The provider and management team ensured current guidance and legislation was followed regarding people’s care and treatment. Staff were well trained and supervised. The staff felt supported and valued.

People’s nutritional needs were assessed and people were supported to eat and drink. There was a choice of food. Health care needs were monitored and referrals made to other services to ensure there was a coordinated approach to people’s care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion. Care was individualised and reflected people’s preferences and changing needs. People’s privacy and dignity were promoted.

People received personalised care which was responsive to their needs. The provider identified and met people’s communication needs. A range of activities were provided which were based on people’s choices and their needs. The provider had an effective complaints procedure and people and their relatives confirmed they were listened to and changes made when requested. The provider had links with hospice services regarding the provision of end of life care.

The service was well led and provided person centred care based on its values of treating people with dignity, promoting independence and rights to privacy and dignity. People and their relatives had opportunities to express their views about the service and were consulted about their care. A number of audits were carried out regarding the quality of the service.

Further information is in the detailed findings below.

Beggars Roosts Nursing Home provides accommodation and nursing care for up to 28 older people. At the time of our visit, there were 27 people in residence. The home is set in a rural area and had a variety of communal areas and a well-tended garden.

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 2008 and associated Regulations about how the service is run.

Feedback regarding the service was mixed. Most people and relatives were extremely positive, but others raised concerns about a lack of flexibility. They told us that there was a set routine and staff appeared ‘put out’ if this needed to change. We found that people were not fully involved in planning their care and that there was limited information about people’s life history and interests to promote personalised care.

People and relatives spoke highly of the nursing care at the service. Staff understood people’s medical needs, monitored their health and took prompt action to address any concerns. Where appropriate, referrals were made to healthcare professionals, such as the GP or Speech and Language Therapist (SALT).

There were enough staff to meet people’s needs. Although nursing and care staff were focused on delivering personal care, activity staff provided stimulation and social contact for people, including those cared for in their rooms. People told us that the staff were kind. One relative had written to the provider saying, ‘We couldn’t have chosen a more kind or caring group of people to look after him’.

Staff had received training and were supported by management through supervision and appraisal. People and relatives had confidence in the staff and their abilities.

People felt safe at the home. Risks to people’s safety were assessed and reviewed. Staff understood local safeguarding procedures. They explained the action they would take if they were concerned that someone was at risk of abuse. People received their medicines safely.

People told us that staff treated them with respect. Staff understood how people’s mental capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

People enjoyed the food and were offered a choice of meals. The chef had involved people in planning the menu. People told us they enjoyed the home’s peaceful setting and we observed people enjoying their meals in the garden.

There was a system in place to monitor the quality of the service and to make improvements. This had been effective in many areas but had not picked up that qualifications for some staff to train others were out of date.

People, their relatives and staff told us that they felt confident to raise issues or concerns with the registered manager. Where concerns had been identified, actions were recorded and addressed.

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

Everyone that we spoke with told us that their care was personalised to their needs and that they were happy with the service they received. People also told us that staff respected their wishes with regard to the care they wanted. For example, one person said, "They have my care plan upstairs in the office. Any additional needs are identified as we go along. They arrange for the optician and such like to come in. They are nice and caring". Another person told us, "The staff are wonderful and gentle. I have a sore neck and they very careful when they move me around".

Everyone that we spoke with said that they felt confident that issues would be resolved if raised with management of the service. For example, one person said, "We have a book (pointed to a folder in their room). It tells us our rights. I would go to Matron".

People also told us that they were happy with the environment in which they lived and with the equipment provided. For example, one person said, "They have two cleaners come in my room every day. They are very good. They empty bins, clean the sink and hoover if needed". Another person told us, "I have a lovey view of the birds in the garden from my room. I think I have the best room in the place".

Our evidence gained during the inspection supported the comments made by people.

One person said, "I am really well cared for."

Another person told us that they were happy with how their personal care needs were met. They told us that they felt very reassured with how the care staff provided support.

We also spent time observing the interactions between staff and people who use the service. We found this to be positive, friendly and caring.

We spoke with staff who told us that they were very happy working in the home. They felt supported in their work, had good training and felt the management was open and supportive.